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Anemia and Glucose: Is There a Connection?

Christie Borders, MS, CNS

Published in Glucose

9 min read

November 1, 2022
Doctor pricking patient's finger for blood
Doctor pricking patient's finger for blood

Did you know that people with diabetes have a higher chance of developing anemia? As both of these conditions affect the blood, it makes sense that the two might be connected.

But what other factors cause blood sugar and anemia to be closely tied together? Do abnormal glucose levels impact iron levels, or the other way around? 

Read on to learn more about the causes and symptoms of anemia, and how this condition may affect your blood sugar levels.

What is Anemia?

Woman sitting up in bed and holding her head

Anemia is a common condition that affects about one third of the global population. It occurs when your blood produces a lower amount of red blood cells than usual. 

Hemoglobin, a protein in your red blood cells, carries oxygen to your body’s organs and tissues. It also transports carbon dioxide from your organs and tissues back to your lungs.

When you have anemia, your blood does not have enough hemoglobin and your organs and tissues do not get enough oxygen. This lack of oxygen can cause fatigue, weakness, and other serious symptoms. 

Symptoms of Anemia 

Early on, anemia symptoms can be so mild that they are hard to notice. But according to the Mayo Clinic, symptoms may become more apparent as your anemia worsens. If you experience any of the below symptoms, you may want to consult your doctor or healthcare provider. Here are some common signs and symptoms of anemia:

Common symptoms of anemia

Causes of Anemia 

According to researchers, anemia is not a diagnosis in itself, but rather a sign of another underlying condition. It has multiple causes that can be grouped into three categories:

  1. Conditions that cause a decrease in productions of red blood cells
  2. Conditions that cause increased destruction of red blood cells
  3. Conditions that cause a loss of blood, particularly when you lose blood quicker than your body can produce new red blood cells 

Within these umbrella categories, there are many potential conditions that can be a cause of anemia. Some examples of conditions that can cause anemia include:

Types of Anemia

Woman clutching her hand

Anemia can have multiple causes and types. Here a few common types of anemia:

Aplastic Anemia

Aplastic anemia occurs when the body stops producing enough new blood cells. This type of anemia is rare, but very serious. It can cause fatigue and leave you more prone to infections and uncontrolled bleeding. Treatment for aplastic anemia may include medication, blood transfusions, or a bone marrow transplant.

Iron Deficiency Anemia

Iron deficiency anemia is a common type of anemia caused by insufficient iron. When your blood does not have enough iron, your body cannot produce enough hemoglobin. This type of anemia can cause fatigue and shortness of breath. It is often treated with iron supplements.

Sickle Cell Anemia

Sickle cell anemia, also called sickle cell disease, is an inherited disorder that affects the shape of red blood cells. Red blood cells are usually round and flexible, allowing them to move easily through the body. 

If you have sickle cell anemia, your blood cells are sickle or crescent shaped, making them rigid and sticky and leading to slowed or blocked blood flow. There is no cure for sickle cell anemia, but there are treatments to prevent complications


Doctor preparing to draw blood from patient

Thalassemia is an inherited disorder that causes your body to have less hemoglobin than normal, which can lead to anemia. Thalassemia can be mild and call for no treatment, but severe forms of Thalassemia may require blood transfusions. 

Vitamin Deficiency Anemia

 Vitamin deficiency anemia is caused by lower than usual levels of vitamin B12 and folate. Without these nutrients, your body produces red blood cells that are too large and do not work properly, which can reduce their ability to carry oxygen. It can be treated with foods rich in B12 and folate as well as with vitamin supplements.

How is Anemia Diagnosed?

Because there are so many potential causes of anemia, this condition should be diagnosed by a medical professional. If you think you may be experiencing symptoms of anemia, visit your doctor or a qualified medical professional. They can help you determine whether or not you have anemia.

Common Tests Used to Diagnose Anemia 

Petri dish with blood in it

Your doctor may diagnose anemia based on your medical and family history, a physical exam, or results from lab tests. These tests include blood tests, bone marrow tests, or other diagnostic tests

Blood Tests

A complete blood count (CBC) tests for anemia may determine your:

  • Red blood cell and hemoglobin count. If your levels are lower than normal, this may be a sign of anemia.
  • Hematocrit levels, which are a measure of how much space red blood cells take up in your blood. Hematocrit levels that are too low may be a sign of anemia. 
  • Mean corpuscular volume (MCV) levels, which are a measure of the average size of your red blood cells. In iron-deficiency anemia, red blood cells are usually smaller than normal. In macrocytic anemia, which can be caused by vitamin B12 or folate deficiency, red blood cells are usually larger than normal.

Bone Marrow Tests

A bone marrow test for anemia may be used to determine whether your bone marrow is making normal amounts of blood cells. A bone marrow test will include:

  • Aspiration, which involves a small amount of bone marrow fluid being collected through a needle
  • Biopsy, which involves a small amount of bone marrow tissue being collected through a larger needle. The bone marrow samples will be studied in a laboratory.

Other Tests for Anemia

Other diagnostic tests for anemia include:

Can Anemia Affect Blood Sugar?

Doctor talking to patient in office

The connection between glucose and anemia is complex and not yet fully understood. Though diabetes may not directly cause anemia, it can contribute to the development of anemia in a few ways. 

Iron-deficiency anemia is common in people who have type 2 diabetes, especially those with diabetic nephropathy (a complication of diabetes that damages the kidneys). Still, the effect of iron deficiency on glucose metabolism isn’t clear. 

Studies indicate that high blood sugar levels can cause the body to absorb less iron, resulting in iron deficiency anemia. Gastrointestinal bleeding and kidney damage are other common diabetes complications that can lead to anemia.

Pernicious anemia is a condition where the body doesn't produce enough intrinsic factor needed to absorb B12. This leads to anemia and is common in people with type 1 diabetes.

So, it seems that there is a connection between blood sugar levels and various types of anemia. Non-diabetic glucose monitoring can come in handy here to help you keep an eye on your blood sugar levels so that you can make healthier choices for your well-being.

But what if you have low iron levels or anemia and no history of blood sugar problems? Can this type of anemia affect your blood sugar?

Does Low Iron Cause High Blood Sugar?

Some research suggests that iron deficiency anemia may indeed impact blood sugar. Animal studies have found that iron deficiency can cause changes in glucose metabolism, fat metabolism, and insulin signaling in rats. Even a slight iron deficiency led to significant changes in glucose and insulin regulation.

Other animal studies have shown possible links between severe iron deficiency and glycemic response. Elevated serum glucose and lipid levels were more likely in severely iron-deficient rodents. The reduction in hemoglobin appears to be highly correlated with the severity of hyperglycemia and hyperlipidemia, though some studies show conflicting results. 

One human trial evaluated the effects of correction of iron deficiency anemia on insulin resistance in 54 non-diabetic premenopausal women. Significant decreases were found in fasting insulin levels after correction of anemia in women under the age of 40 with normal body mass index. Following treatment, fasting insulin levels were positively correlated with hemoglobin levels.

Hemoglobin A1C and Anemia

A 2014 study of 120 people with diabetes and iron deficient anemia found a positive correlation between iron deficiency and high HbA1c levels. HbA1c levels are a measure of how much glucose has attached itself to the hemoglobin in your blood. Elevated HbA1c levels can indicate a high amount of sugar in the blood. 

Because iron-deficiency anemia has been shown to raise HbA1c levels, it may lead to a false diagnosis of diabetes. More research is needed to determine why anemia can raise HbA1c levels, and what kinds of anemia can impact the reliability of HbA1c tests. 

While more studies are being conducted, the authors of one study recommend that doctors recognize that different results in glucose and HbA1c levels could be a sign of anemia or iron deficiency. If anemia is identified, it may be a good idea to work with your doctor to address any potential deficiency before using the HbA1c test for a diagnosis of diabetes. 

Nutrition Support for Anemia

Table with salmon, eggs, sardines, and wheat crackers

Nutrition interventions might help in the treatment of anemia, but your nutrition needs may depend on the cause of your anemia. Taking steps such as increasing your iron intake or vitamin B12 intake may be recommended by your doctor.

Not all anemia should be considered the same or necessarily require the same approach to treatment or nutrition support. As we mentioned earlier, some people may have anemia due to vitamin B12 deficiencies or iron deficiencies, while others may have anemia caused by genetic factors or other underlying conditions. 

If you have been diagnosed with anemia by your doctor, it may be a good idea to work one-on-one with a qualified medical provider. Your doctor or dietitian can help ensure that any nutrition interventions you pursue are in line with the cause for your anemia. 

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Heather Davis, MS, RDN, LDN

Reviewed by: Heather Davis, MS, RDN, LDN

Heather is a Registered and Licensed Dietitian Nutritionist (RDN, LDN), subject matter expert, and technical writer, with a master's degree in nutrition science from Bastyr University. She has a specialty in neuroendocrinology and has been working in the field of nutrition—including nutrition research, education, medical writing, and clinical integrative and functional nutrition—for over 15 years.

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