Managing Anemia and Diabetes: Connections, Complications, and Care

Understand the relationship between anemia and diabetes, including risks, causes, and effective management strategies.

By Medha deb

Created on Sep 26, 2025

Understand the relationship between anemia and diabetes, including risks, causes, and effective management strategies.

Both anemia and diabetes are common yet distinct conditions. While neither directly causes the other, they frequently coexist, and their overlap can make management of each more complex. Understanding the connections, risks, and practical treatment options is essential for people living with either or both conditions, as well as their healthcare providers.

How Are Anemia and Diabetes Related?

Diabetes and anemia are not direct causes of each other, but their relationship is significant due to several shared risk factors and overlapping complications. Research shows that:

Up to 25% of Americans with type 2 diabetes are also affected by anemia.
Diabetes-related complications, particularly those affecting the kidneys and blood vessels, can increase the likelihood of developing anemia.
Having one condition does not guarantee the development of the other, but the risk is higher, especially with unmanaged disease or complications.

Anemia is often underrecognized in people with diabetes, even though its presence can worsen disease outcomes and overall quality of life.

What Is Anemia?

Anemia occurs when your blood has fewer healthy red blood cells than needed, or when your red blood cells are not functioning sufficiently. This leads to reduced oxygen transport to tissues and organs.

Common signs of anemia include:

Persistent fatigue
Paleness (especially noticeable in the skin or inside the eyelids)
Shortness of breath
Dizziness or lightheadedness
Fast or irregular heartbeat

For people with diabetes, these symptoms can easily be mistaken for those of poor blood sugar control, making it important to investigate new or worsening fatigue or weakness.

Diabetes-Related Complications Contributing to Anemia

Several complications associated with diabetes can increase the risk of anemia, especially over the long term.

1. Chronic Kidney Disease (CKD)

One of the most common causes of anemia in people with diabetes is kidney damage (diabetic nephropathy):

Healthy kidneys produce erythropoietin (EPO), a hormone that signals the bone marrow to make more red blood cells.
When kidney function declines, less EPO is produced, leading to fewer red blood cells and, ultimately, anemia.
Early CKD may show few symptoms, meaning anemia can be an early warning sign that kidney function is compromised.

2. Inflamed Blood Vessels and Reduced Signal Transmission

People with diabetes are more likely to experience inflammation in their blood vessels:

This inflammation can block or reduce the transmission of EPO from the kidneys to the bone marrow.
As a result, bone marrow production of red blood cells drops, resulting in anemia.

3. Increased Risk of Blood Loss and Nutritional Deficiencies

Other diabetes-related complications that can lead to anemia include:

Poor gut absorption of nutrients (due to nerve damage or diabetes medication side effects), causing iron, B12, or folate deficiencies.
Prolonged use of some diabetes medications (like metformin) connected to B12 deficiency and subsequent anemia.
Increased bleeding risk (for example, from gastrointestinal problems), which can lower red blood cell counts.

4. Complications Compounded by Anemia

Anemia not only arises from diabetes complications but can also make existing ones worse:

Worsened kidney, heart, and vascular problems, increasing the risk for heart failure and other cardiovascular diseases.
Higher likelihood of developing secondary complications like retinopathy (eye disease) and neuropathy (nerve damage).

How Does Anemia Affect Blood Sugar Levels?

The relationship between anemia and blood sugar is complex. Anemia can both affect measurement of blood sugar levels and change how the body responds to glucose.

Some studies found that anemia can cause false high blood sugar readings on glucose meters. This may lead to the risk of dangerous low blood sugar (hypoglycemia) if people overtreat based on these erroneous readings.
Iron-deficiency anemia has been linked with higher measured fasting and postprandial (after eating) blood sugar levels in people with diabetes. After iron supplementation, these levels — specifically A1C — were observed to normalize.

This occurs because, in iron-deficiency anemia, glucose molecules attach to fewer available red blood cells, making A1C levels appear higher than they actually are.

Summary Table: Anemia’s Effects on Blood Sugar

Condition	Impact on Blood Sugar Readings	Notes
Iron-deficiency anemia	False high glucose and HbA1C readings	Corrected with iron supplementation
Anemia of chronic disease (CKD-related)	Less reliable A1C measurement	Alternative monitoring may be needed
Hemolytic or blood-loss anemia	Poor correlation with glucose values	Red blood cell turnover affects readings

Treating Anemia in People with Diabetes

Treatment depends on the cause and severity of anemia. For people with both diabetes and anemia, a combined approach tailored to individual needs is critical.

Dietary and Medication-Based Treatments

Iron-deficiency anemia:
- Increase dietary intake of iron-rich foods (beans, lentils, red meat, leafy greens, fish, tofu, dried fruits).
- Use of iron supplements as recommended by your doctor.
- If taking metformin (commonly prescribed for diabetes) and diagnosed with low iron or B12, consult your healthcare provider. Adjustments in medication or dose may be required.
Kidney disease-related anemia:
- If undergoing kidney dialysis, intravenous iron may be needed to raise hemoglobin counts; however, this may increase risks for heart attack and stroke, so must be carefully monitored.
- If kidneys do not produce enough EPO, a synthetic erythropoietin (rhEPO) may be prescribed to stimulate red blood cell production.
- 5–10% of patients may develop rhEPO resistance, requiring close medical oversight.
For severe anemia, a blood transfusion may be necessary, especially if blood loss is the underlying cause.
Vitamin B12 or folate supplementation is recommended if deficiencies are confirmed.

Regular Monitoring and Individualized Therapy

Routine screening for anemia, especially for those with diabetes complications, long disease duration, or advanced age, may help with early detection and intervention.
Addressing lifestyle factors, optimizing blood sugar control, and managing blood pressure reduce the risk for both anemia and diabetes complications.

Preventing and Managing Anemia with Diabetes

Prevention and careful management of anemia in people with diabetes can help improve outcomes, slow the progression of complications, and enhance overall wellbeing.

Schedule regular blood tests for hemoglobin levels and kidney function.
Maintain a balanced diet with consideration for iron, folate, and vitamin B12 intake.
Monitor for symptoms of fatigue, pallor, or rapid heart rate, and report new symptoms promptly to your healthcare provider.
Optimize diabetes management by achieving stable blood glucose levels and addressing hypertension.
Early and regular intervention for kidney health can delay or prevent anemia onset.

Frequently Asked Questions (FAQs)

Q: Can treating anemia help my diabetes control?

A: Yes, correcting anemia — especially iron deficiency — can improve accuracy of glucose and HbA1c readings, and reduce symptoms that make diabetes management harder, like fatigue.

Q: Does having diabetes mean I will get anemia?

A: Not all people with diabetes develop anemia. The risk increases with certain complications, especially kidney disease, chronic inflammation, and nutritional deficiencies. Regular monitoring is important.

Q: Is it safe to take iron supplements if I have diabetes?

A: Generally, yes, if iron deficiency anemia is diagnosed. However, never start supplements without consulting your healthcare provider, as too much iron can be harmful, particularly in people with kidney problems.

Q: What are the signs I might have anemia if I have diabetes?

A: Common signs include unexplained or worsened fatigue, weakness, pallor, faster heartbeat, and shortness of breath. If you notice these, especially if your diabetes is otherwise well-managed, ask your doctor for a blood test.

Q: Can anemia complicate other diabetes-related health issues?

A: Yes. Anemia can worsen the effects of diabetes on your kidneys, heart, and blood vessels, as well as raise the risk for eye and nerve damage.

Key Takeaways

Anemia and diabetes commonly coexist, particularly when diabetes complications are present.
Kidney disease, chronic inflammation, and nutritional deficiencies are leading contributors to anemia in diabetes.
Anemia can distort blood sugar measurements, complicating diabetes management.
Diagnosis, treatment, and prevention strategies should be individualized and rigorous, incorporating dietary, pharmacologic, and lifestyle measures.
People living with diabetes should be proactive in monitoring for anemia to safeguard long-term health.

References available on request. Please consult your healthcare provider for recommendations tailored to your individual health needs.

References

Author

medha deb

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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