Low Iron and Diabetes Type 2

Low iron is a common problem, especially in women and people who are on multiple medications such as those with diabetes type 2.

Because iron absorption is impaired when it is taken with medicines or supplements, it is not uncommon that you are deficient in iron. When iron levels are low, you develop anemia.

Anemia and low iron in individuals with diabetes type 2 can worsen some of the symptoms of diabetes such as fatigue, getting tired easily, visual problems, tingling and numbness, and gastrointestinal problems.

You should get frequent blood tests to monitor for low iron levels (anemia) if you have diabetes especially type 2 diabetes.

It is typical for persons with diabetes to get this blood issue as well. You can better control the problems underlying anemia if you identify them early.

What can cause low iron levels in diabetics?

Low iron is common. It is particularly more common in women because of the monthly blood loss in their periods. It is also common in people who are on weight loss medicines that impair the absorption of nutrients.

Commonly used weight loss medicines that may result in low iron levels and other nutrient deficiencies are:

• Semaglutide (Ozempic, Ryeblsus, Wegovy)
• Liraglutide (Saxenda and Victoza)
• Orlistat

Semagltutide and Liraglutide are used to treat obesity as well as diabetes. Hence, most people using these medications are prone to develop nutrient deficiencies.

Orlistat is a weight loss medicine that may impair the absorption of nutrients. Similarly, Acarbose or Glucobay can also impair the absorption of nutrients.

How low iron affects you if you have diabetes?

Low iron results in anemia. Anemia in diabetics can impair their quality of life. It is associated with exercise intolerance. Diabetics with anemia are less likely to work out with full energy than normal people.

The result is impaired blood glucose. Low iron levels may also worsen the symptoms and increase the risks of developing some diabetic problems, such as damage to your eyes and nerves.

Additionally, it can exacerbate diseases like kidney, heart, and artery disease, which are more prevalent among diabetics.

Low iron levels can be brought on by failing kidneys, which are frequently damaged by diabetes. Your body’s red blood cell requirements are signaled by healthy kidneys.

Erythropoietin (EPO), a hormone they release, tells your bone marrow to produce more blood and in diabetics, the EPO production from damaged kidneys is insufficient to meet your demands. Low iron and erythropoietin deficiency multiply the problems of anemia.

Many times, kidney disease is not discovered until it has progressed significantly. However, if your anemia test comes back positive, it may be a precursor to a kidney issue.

In another case, blood vessel inflammation is more prevalent in people with diabetes which means that the signal that the bone marrow needs to produce additional red blood cells may not reach it as a result.

The hemoglobin protein, which is necessary for carrying oxygen through your blood, can also be decreased by some diabetic drugs.

These medications consist of metformin, thiazolidinediones, fibrates, ACE inhibitors, and more. Please discuss your risk for anemia with your doctor if you take one of them.

Low iron levels can also be brought on by blood loss, which is possible if you get renal dialysis or you are taking pain medications like NSAIDs that can cause ulcers in your stomach.

Symptoms of low iron levels in diabetics

You might encounter any of the following signs:

• Low body temperature
• Cold hands and feet
• Shortness of breath
• Lightheadedness
• Dizziness
• Extreme fatigue
• Pale skin
• Rapid heart rate
• Headache

It’s crucial to keep in mind that several anemia symptoms, such as headache, lightheadedness, dizziness, and excessive exhaustion, are also signs of high blood sugar.

To ensure that you are not mistaking high blood sugar with possible anemia, check your blood sugar frequently.

Call a medical practitioner to get your anemia examined if your symptoms last for several days or weeks without accompanying ketones or high blood sugar levels.

Which diabetes drugs can cause low iron levels?

Your levels of hemoglobin, a protein required to transport oxygen through the blood, may drop as a result of several diabetic medicines.

Your chance of developing anemia may be increased by taking certain diabetic medications:

• Fibrates:

For diabetics at risk for cardiovascular issues, this kind of medicine is used to modestly decrease triglycerides as well as LDL.

Clofibrate (Atromid-S), gemfibrozil (Lopid), and fenofibrate are a few examples of fibrates (Antara, Lofibra, and Triglide).

• Metformin:

This is one of the drugs for type 2 diabetes that is most frequently administered to help control blood sugar levels.

Metformin can cause GI upset. People on metformin do not feel like eating and restrict their diets. They ultimately become iron deficient. However, vitamin B12 deficiency is more likely associated with metformin than iron deficiency.

According to a study, metformin can promote vitamin B12 malabsorption, and long-term (more than 10 years) usage of the medication can result in a vitamin B12 shortage in up to one-third of users.

A lack of vitamin B12 can result in anemia. If you have diabetes and have been on metformin for a while, it is advised that you undergo a yearly blood panel.

• Angiotensin-converting enzymes (ACE) inhibitors:

ACE inhibitors encourage blood vessel relaxation and opening, which enhances blood flow and lowers blood pressure.

For those with diabetes and chronic renal disease, these medications are frequently recommended.

ACE inhibitors come in a variety of forms, such as lisinopril, enalapril, and benazepril. It is confirmed by a study that ACE inhibitors are associated with low iron levels. [ref]

• Thiazolidinediones:

These drugs, sometimes referred to as TZDs or glitazones, reduce insulin resistance in type 2 diabetics. This can also cause low iron levels in diabetics. [ref]

Effects of low iron levels on diabetes type 2

Blood sugar levels can be impacted by anemia in a number of ways. People with anemia may have a falsely high A1C. Increasing diabetes medications in such patients can result in hypoglycemia.

One study from 2010 discovered that anemia caused falsely high blood sugar readings on glucose meters, which in turn caused hazardous hypoglycemia episodes when patients overtreated the falsely high blood sugar.

Anaemia brought on by iron deficiency is associated with increased blood glucose levels, as evidenced by a 2014 research.

In both patients with and without diabetes, iron deficiency anemia was linked to higher A1C readings, according to a 2017 analysis of numerous research.

Due to more glucose molecules adhering to fewer red blood cells, this happened. Participants’ HbA1c levels dropped after receiving iron replacement treatment.

Treating low iron levels with diabetes type 2

Through dietary sources, you can better control your iron levels. Adult women are required to take 18 mg per day of iron and adult men require only 8 mg.

• Green leafy vegetables, especially spinach
• Tofu
• Red meat
• Iron-fortified bread and cereals
• Beans and lentils
• Oysters
• Dried fruit, like prunes, raisins, and apricots
• Liver
• Fish

If you consume iron combined with foods high in vitamin C, such as fruits and vegetables, your body will absorb iron more effectively. You can absorb less calcium if you drink coffee, tea, or both.

Iron supplements may be required if the hemoglobin drops despite a normal or adequate diet.

Iron supplements may aggravate the stomach issues that affect most diabetic people. In patients intolerant to oral iron supplements, intravenous iron replacement may be required.