What is Anemia?
Anemia is a medical condition characterized by decreased red blood cell production and low hemoglobin levels in the blood [1, 2]. Hemoglobin is a protein in red blood cells that carries oxygen from the lungs to the body's organs and tissues [3]. It can lead to various symptoms such as fatigue, weakness, and dizziness due to the reduced oxygen flow to the body's organs [4, 5].
There are five main types of anemia:
- Iron deficiency anemia
- Aplastic anemia
- Sickle cell anemia
- Thalassemia
- Vitamin deficiency anemia: this is most commonly due to low vitamin B12 levels or low folic acid levels.
Treatment of anemia will depend on the type of anemia you have. For example, for iron deficiency or vitamin deficiency anemia, iron supplements such as increasing B-12 and folate intake are likely to reduce your anemia. Women are generally at higher risk of anemia, due to blood loss during menstruation.
The duration of anemia also depends on the anemia subtype. The condition can be temporary or long-term, ranging from mild to severe hypoglycemia [5]. It's important to note that anemia can indicate an underlying health issue, and early detection can be a valuable indicator of these conditions [2]. Luckily, it can easily be measured by a standard blood test administered by your healthcare provider.
What Is Hypoglycemia?
Hypoglycemia is a medical condition characterised by an abnormally low blood glucose levels, commonly known as low blood sugar. This can result in dizziness, fatigue, sweating, nervousness, or irritability. There are multiple levels of hypoglycemia. Mild hypoglycemia can be experienced by most if they have not eaten in a while or done an intense/long exercise session [6]. More severe forms of hypoglycemia are caused by physiological changes, such as hyperinsulinemia (producing too much insulin), taking exogenous insulin for diabetes, or hormone deficiencies.
Good to know
Alcohol can also cause hypoglycemia. This was recently attributed to increased insulin release from pancreatic beta cells and would explain why food cravings increase after drinking.
Does Anemia Cause Hypoglycemia?
Yes, anemia increases difficulties in regulating blood sugar, which could lead to hypoglycemia. Let us unpack the science linking iron deficiency anemia and blood glucose regulation.
Animal studies of anemia and hypoglycemia
Studies on animals with iron deficiency found that the livers of iron deficient mice released more glucose from their stores and more insulin from their pancreas. This led to more utilisation of glucose by the peripheral tissue [8]. Therefore animals studies indicate low iron levels can actually cause hyperglycemia, rather than hypoglycemia [9].
Genetic studies of anemia and hypoglycemia
Looking at gene expression in iron deficient people can help focus on how blood glucose is regulated. These studies support iron deficiency anemia increasing glucose levels by increasing expression of glyconeogenic enzymes - enzymes that help produce glucose from glucose stores in the body [10].
Human studies of anemia and hypoglycemia
An excellent marker to study blood glucose is the glycation of hemoglobin A1C (HbA1c). This is a marker of long-tern blood glucose in a patient over the past three months. It is commonly used as a marker in diabetic care by the American Diabetes Association [11]. Levels of HbA1c above 6,5% were established as a cut-off for diabetes, as they indicate high blood sugar levels. A series of human studies support iron deficiency increasing HbA1c levels, meaning that iron deficiency increases blood glucose over time. This elevation of long-term blood glucse could be medicated by iron supplements.
Summary: Does Anemia Cause Hypoglycemia?
No, anemia is unlikely to cause hypoglycemia, although it does have a significant impact on blood sugar level. To the contrary, anemia can increase blood glucose and insulin levels, as demonstrated by animal, genetic and human studies. Iron supplements could restore blood glucose levels, supporting the role of iron deficiency anemia in hyperglycemia.