Diabetes Involves Errors In Iron Metabolism
The definition of diabetes is strictly in terms of blood sugar levels. If your blood sugar levels test above 126 mg/dl when you are fasting or above 200 mg/dl two hours after you eat, you have diabetes . Any successful treatment of diabetes involves lowering your blood sugar levels. The driving force of diabetes, however, is inflammation. And one of the driving forces of inflammation is iron.
One of the ways a diabetics body deals with inflammation is to create a protein called ferritin . This protein serves as a kind of jail for iron. When iron is bound to ferritin, it cant generate free radicals that damage cells all over the body, but especially the insulin-making cells of the pancreas and the appetite-regulating cells in your fat mass.
Gestational Diabetes And Anemia
Anemia is common during pregnancy. As a matter of fact, approximately 19% of women have iron deficiency anemia during their pregnancy. Iron deficiency can lead to problems with the baby such as a low birth weight and possibly needing a blood transfusion at birth. It can also cause post-partum depression for the mother.
Having a folate deficit can lead to a low-birth weight or spine and brain defects.
Almost all pregnant women are advised to eat foods high in iron and folate, and prescribed prenatal vitamins high in both.
The Role Of Iron In Diabetes And Its Complications
In this review, we discuss the role tissue iron and elevated body iron stores play in causing type 2 diabetes and the pathogenesis of its important complications, particularly diabetic nephropathy and cardiovascular disease . In addition, we emphasize that iron overload is not a prerequisite for iron to mediate either diabetes or its complications. Important in its pathophysiology is the availability of so-called catalytic iron or iron that is available to participate in free radical reactions.
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Race And Ethnicity Can Affect A1c
The A1C test works best on hemoglobin A, the most common type of hemoglobin that people have. But depending on where in the world you come from, your blood might have a different type of hemoglobin. These are called hemoglobin variants, and they are more common if you or your family come from Africa, South and Southeast Asia, or the Mediterranean.
Having a hemoglobin variant such as hemoglobin S, C, D, or E, can affect the accuracy of an A1C result. Luckily, many labs now run A1C tests that are not affected by hemoglobin variants. There is a full list here. If you have a hemoglobin variant, you and your provider can work together to find a lab that will give you accurate A1C results.
How Intestinal Bacteria Can Affect Your Blood Sugar And Lipid Levels
- Date:
- Kumamoto University
- Summary:
- Intestinal bacteria have attracted recent attention since they were discovered to influence various physiological functions and diseases in humans. Researchers analyzing the influence of changes in intestinal bacteria on sugar and lipid metabolism have found that secondary bile acids produced by intestinal bacteria can influence blood glucose and lipid concentrations as well as parts of their molecular mechanisms.
Intestinal bacteria have attracted recent attention since they were discovered to influence various physiological functions and diseases in humans. Researchers from Kumamoto University in Japan analyzing the influence of changes in intestinal bacteria on sugar and lipid metabolism have found that secondary bile acids produced by the bacteria can influence blood glucose and lipid concentrations as well as parts of their molecular mechanisms. This result is expected to lead to the treatment of metabolic diseases such as diabetes and dyslipidemia by targeting intestinal bacteria that produce secondary bile acid.
Previous research has shown that dysbiosis due to antibiotic administration influences protein expression levels in the liver, an organ responsible for sugar and lipid metabolism. Thus, researchers at Kumamoto University decided to clarify the influence of antibiotic-caused dysbiosis on sugar and lipid metabolism and the mechanism thereof.
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Does Anemia Due To Iron Deficiency Happen Quickly Or Does It Take A Long Time
Iron deficiency anemia comes on gradually. When your rate of iron loss exceeds the amount of iron you absorb from the foods you eat or supplements, iron stores are slowly used up. At this stage, ferritin will be low, but serum iron and TIBC are usually normal and there is no anemia. As the iron deficiency worsens, serum iron levels fall, TIBC and transferrin rise, and anemia starts to develop. With prolonged or severe iron deficiency, the red cells become small and pale due to decreased hemoglobin levels. Reticulocyte count also decreases.
Anemia Management In Persons With Diabetes
The good news is that managing anemia isnt too much different from managing the diabetes itself. You need a good diet, a disciplined approach, and qualified medical help:
Ways to take care of yourself include:
- Keep your BMI and waist circumference in healthy ranges by exercising and eating healthy
- Eat foods rich in iron, folic acid, B-12 and vitamin C
- Manage your high blood pressure
- Commit to good glycemic control
- Keep your doctor appointments
- If you have Celiac disease, follow a Gluten-free diet
- Meet with a dietician if you are unsure about the food choices to make
Does diabetes cause anemia?
Indirectly, yes: the complications that diabetes cause make anemia more likely. Taking care of yourself and controlling your diabetes is the most important thing to do to decrease your risk.
Will anemia make my diabetes worse?
Anemia can make your complications from diabetes worse. It can worsen eye disease, kidney problems, heart disease, and make diabetic ulcers harder to heal. It also decreases the quality of life because of the lack of energy. Leave your comments down below!
TheDiabetesCouncil team would like to thank Dr. Mitch Winkler for his feedback. You can learn more about him on this page
TheDiabetesCouncil Article | Reviewed by Dr. Christine Traxler MD on May 28, 2020
References
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What About The Glycemic Index
Your daily carb total, spread steadily across the day, is one key to good blood sugar control. Some people also use the glycemic index , a rating of how individual foods raise blood sugar levels. Beans and whole-grain breads and cereals have a lower GI than white bread and regular pasta. Juice has a higher GI than whole fruit. Craving a high-GI food? Eat it along with a lower-GI choice to help control your levels.
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The Role Of Iron In Diabetes Without Overt Iron Overload
A relationship between high iron intake and high body iron stores outside the setting of genetic iron overload and type 2 diabetes is well recognized . Loma Linda University’s Adventist Health Study was the first to report the association between meat intake and type 2 diabetes risk that has since been consistently observed by several other studies . Numerous studies have confirmed that this association is related to the high heme content of meat and increased dietary heme intake . Similarly, high body iron stores have been linked to insulin resistance , metabolic syndrome , and gestational diabetes . Recently, Jiang et al. carried out a nested case-control study within the Nurses Health Study cohort. Among cases of incident diabetes, the mean concentration of serum ferritin was significantly higher compared with control subjects, and the mean ratio of transferrin receptors to ferritin was significantly lower. This relationship with markers of body iron stores persisted after correction for various other risk factors for diabetes, including markers of obesity and inflammation.
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Study Design And Participants
The China Health and Nutrition Survey is a longitudinal study across 228 communities within nine provinces of China. Surveys began in 1989, with subsequent surveys every 24 years, for a total of nine rounds between 1989 and 2011. The China Health and Nutrition Survey was designed to provide representation of rural, urban and suburban areas varying substantially in geography, economic development, public resources and health indicators, and it is the only large-scale, longitudinal study of its kind in China. The original survey in 1989 used a multistage, random cluster design in eight provinces to select a stratified probability sample a ninth province, Heilongjiang, was added in 1997 using a similar sampling strategy. Essentially, two cities and four counties were selected in each province. Within cities, two urban and two suburban communities were selected within counties, one community in the capital city and three rural villages were chosen. Twenty households per community were then selected for participation. The study met the standards for the ethical treatment of participants and was approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill and the Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention. More detailed survey procedures can be found elsewhere.
Who Needs Iron Supplements
The people who typically need iron supplements are pregnant women and those with documented iron deficiency. People should not take iron supplements before talking to their healthcare practitioner as excess iron can cause chronic iron overload. An overdose of iron pills can be toxic, especially to children.
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Iron & Diabetes: Your A1c
So why am I babbling on about iron? Because there are two different iron-level conditions that are relevant to diabetes. The first is hemochromatosis, a genetic disease found most commonly among people with Celtic ancestry.
Hemochromatosis makes you absorb too much iron, and the high iron levels attack many organs in the body, including the beta cells. So people with the hemochromatosis gene are at very high risk of getting diabetes. Some people absorb enough iron that their skin turns slightly brown, and if they develop diabetes, its sometimes called bronze diabetes because of the bronzed color of the skin.
The other condition is the exact opposite, a form of anemia, or too little hemoglobin in your blood. It occurs when you dont absorb enough iron or when you lose iron because youve lost a lot of blood. Without iron, you cant make hemoglobin, and without hemoglobin, you cant make enough red blood cells.
This condition is called, not surprisingly, iron-deficiency anemia.
A test for both these conditions is the ferritin test. Ferritin is the protein that the body uses to store iron, and its a good indicator of overall iron levels in the body. Low ferritin could mean iron-deficiency anemia. High ferritin could mean hemochromatosis.
Conversely, if you find you have iron-deficiency anemia and you treat it with iron supplements, your A1c will go down.
So many things can affect our health, and so many things can affect the lab tests we use to monitor our health.
Three Things Diabetics Can Do About High Iron And High Hemoglobin Levels
Iron issues and high hemoglobin levels are far more important to diabetics than most diabetics and their doctors know. Anyone can lecture diabetics about all the foods they eat that they shouldnt. Helping diabetics find the keys to managing their appetites takes a little more compassion, and a lot more science.
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Consequences Of Anemia In Patients With Diabetes
So why it is so important for people with diabetes and anemia to seek treatment? There are several reasons!
First of all, anemia can worsen many typical diabetic problems: kidney disease, heart disease, and eye and nerve damage, for example.
Since anemia can impair oxygen delivery to body tissues, it can make it even harder for a diabetic person to heal ulcers and surgical wounds.
The heart of patients with diabetes are already under strain. The added stress of anemia can drive already-overworked heart muscle into hypertrophy, failure, and death.
Besides the physical problems, anemia can worsen fatigue, depression, and quality of life for the person with diabetes.
So what does this all mean? It means that anemia can complicate life for people with diabetes tremendously. The importance of identifying and treating anemia cannot be overestimated.
Blood Donation And Diabetes
As discussed, iron overload is common in patients outside the setting of known iron overload syndromes. Insulin resistance has been described in such patients , and iron-chelating agents and blood donations have been shown to decrease the development of diabetes in such patients . Interestingly, even in apparently healthy individuals, blood donation resulting in decreased iron stores has been associated with a low incidence of diabetes . Recent randomized studies have demonstrated that iron stores influence insulin action, and following bloodletting over a 4-month period, insulin sensitivity improved. Finally, a low-iron diet improves cardiovascular risk profiles . Fernandez et al. investigated the relationship between iron stores and insulin sensitivity in 181 men. Men who donated blood more than two times over a 5-year period were matched with nondonors. Blood donation was associated with increased insulin sensitivity and decreased iron stores. Additional and intriguing support to this association also comes from a study on patients with iron deficiency who exhibit a decreased incidence of diabetes.
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What Treatment Options Are Available For Iron Overload
Within the scientific community, the role of iron as a risk factor for diabetes and cardiovascular disease has drawn significant attention because it may be easily modifiable through dietary modification and other iron reduction strategies. Historically, phlebotomy and iron-chelating pharmaceuticals have been the frontline treatment for iron overload in people with hereditary hemochromatosis. However, recent research indicates that iron reduction may also be beneficial for people with mild to moderate iron overload. Iron chelation and phlebotomy produce improvements in insulin secretion and sensitivity, decrease glycated hemoglobin, and improve endothelial function in patients with and without hemochromatosis. 90070-8/pdf” rel=”nofollow”> 26, 27) For patients with severe iron overload, a prescription for therapeutic phlebotomy from a hematologist may be required for those with milder cases, regular blood donations may be sufficient for lowering iron levels.
Specific dietary guidelines have been created for patients with hemochromatosis, and some of the recommendations may also be useful for people with mild to moderate iron overload. The guidelines, developed by the Iron Disorders Institute, include the following:
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What Is Haemochromatosis
Haemochromatosis is an inherited condition. It leads to the build-up of iron levels in the body. This is iron overload and causes you to become very tired and lose weight. Both of these are also symptoms of diabetes, but that doesn’t mean you already have diabetes. You should speak with your doctor if you notice or feel these changes.
Other symptoms of haemochromatosis include weight loss, joint pain and weakness.
The build-up of iron in your body is a slow process. But if you don’t get it treated the condition can damage parts of your body like the pancreas. The damage to the pancreas is how this illness causes diabetes.
Prevent And Treat Anemia
If you have an issue with glucose such as diabetes, your key to preventing anemia lies in controlling your blood sugar and blood pressure, says the Society for the Advancement of Blood Management. Good glucose control lowers your risk of developing kidney damage which in turn cuts your risk for anemia. Otherwise, treating anemia is based on the cause and severity of the condition. If an illness causes anemia, then treatment of the underlying illness usually resolves anemia. In addition, you may be able prevent and treat anemia by eating a diet rich in iron and vitamin B-12. In other cases, your doctor may recommend taking supplements or receiving injections to treat anemia. Talk to your doctor about your anemia concerns in general. Don’t attempt to self-medicate as too much iron, whether from diet or from pills, can cause adverse health effects.
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Id And Ida Andglycemic Control In Patients With Type 2 Dm
Christy et al. found a positive correlation between IDA and increased A1C levels, especially in the controlled diabetic women and individuals having FPG between 100-126 mg/dl.
In addition, investigations performed on diabetic chronic kidney disease patients, and diabetic pregnant women showed increased HbA1c levels in iron deficiency anemia , which was reduced following iron therapy and improvement of Hb level .
Anemia in diabetic patient appears to have a remarkable unfavorable effect on quality of life and is associated with disease progression and the development of co-morbidities. Reduced hemoglobin levels, even to a limited degree, can identify patients at increased risk of progressive renal disease. Although anemia is clearly associated with both micro- and macrovascular complications in patients with type 1 diabetes, it remains to be established what role anemia may have in the development or progression of these complications . There is a direct relationship between anemia and diabetic kidney disease, A number of studies, including the reduction on endpoints in non-insulin-dependent diabetes mellitus with angiotensin II antagonist losartan trial, have suggested that reduced Hb levels, even within the normal range, identify patients with NID-DM at increased risk for progressive renal disease .