Low Ferritin and raised Hba1c

[gillivy]

Hi all, I'm 67 and my Hba1c has been increasing year on year. It is now 43. I am not overweight, I am busy with grandkids so get plenty of exercise. However, I donate blood annually which lowers my Ferritin (currently 26 ug/L). I have been reading that low ferritin can affect Hba1c. Has anyone else come across this?

 

[42istheanswer]

I haven't come across it previously, but your post did make me wonder - are your routine blood tests being done just after your routine annual blood donation? Has your GP ever suggested iron supplementation when your ferritin is only measuring 26?

If (as does seem likely since HbA1c is based on the red blood cells) low ferritin and/or recent blood donation can affect HbA1c, and your ferritin is usually OK when you haven't just given blood, then maybe asking if you can have the tests repeated in 3-6 months might give a more accurate answer regarding your risk of diabetes. If your ferritin is not recovering then you may need to talk to GP about how you can increase your ferritin (and possibly whether it is wise for you to continue to donate blood if your ferritin does not recover quickly from the donation?)

 

[JITR]

Hi all, I'm 67 and my Hba1c has been increasing year on year. It is now 43. I am not overweight, I am busy with grandkids so get plenty of exercise. However, I donate blood annually which lowers my Ferritin (currently 26 ug/L). I have been reading that low ferritin can affect Hba1c. Has anyone else come across this?

I had the opposite condition, HbA1c 104 and Ferritin over 1,200 at diagnosis of T2 and hemochromatosis. I was told the only way to get Ferritin was by venesection (blood 'doning' each month). However the venesections did not start until 4 months later. By then my Newcastle diet had brought the numbers down to HbA1c 35 and Ferritin just above 600 (about half). The Hepatologist took full credit for the Ferritin reduction, even after I pointed out the reduction.

My impression was that little is generally known about the all factors contributing to Ferritin levels. That was confirmed when I read some researchers now think Ferritin plays a role in the immune system. I'd be interested to know where you read that low Ferritin can affect Hba1c.

If I were you I'd take your HbA1c and Ferritin levels as independent of each other until a clear relationship is established and measured. What has become clear is that HbA1c in the prediabetic range indicates accumulation of fat in the liver, and dysregulation of glucose, lipids (fats) and probably other things such as iron as well (i.e. Ferritin high or low).

The only way to treat fatty liver is by diet to lose up to 15 kg or more, maybe less at 43. AFAIK no one seems to have researched the numbers for pre-diabetics and pre-pre-diabetics, despite estimates of 25%-33% of the population having a fatty liver. Anyway to avoid all the nasty consequences, dieting to get HbA1c down to the mid 30s makes sense.

 

[trophywench]

I was always told (back in the day) that the risk of you having an accident/having some other health problem within the months after donating blood was far too great to continue them taking it. That is still the case now. T2's can sometimes still donate serum depending on dunno what - but not every 'centre' does that thing.

 

[trophywench]

Oh and PS I seem to have suddenly decided 2+ years ago to have far too many white blood corpuscles since when my HbA1c level has shot up to over 65 from being constantly in the low 50s for at least several decades and all the diabetes clinic do is nag me about improving my TIR. I did get an appt to see Haematology the day after we'd planned to go away in our Moho and were both looking forward to but as OH was awaiting new date for his awaited operation then, I cancelled it, new date in September. I simply haven't eaten that much the last week as more than a bit worried about husband and still like that - trouble is lack of any inspiration and energy. Grumble, sorry chaps.

 

[gillivy]

I had the opposite condition, HbA1c 104 and Ferritin over 1,200 at diagnosis of T2 and hemochromatosis. I was told the only way to get Ferritin was by venesection (blood 'doning' each month). However the venesections did not start until 4 months later. By then my Newcastle diet had brought the numbers down to HbA1c 35 and Ferritin just above 600 (about half). The Hepatologist took full credit for the Ferritin reduction, even after I pointed out the reduction.

My impression was that little is generally known about the all factors contributing to Ferritin levels. That was confirmed when I read some researchers now think Ferritin plays a role in the immune system. I'd be interested to know where you read that low Ferritin can affect Hba1c.

If I were you I'd take your HbA1c and Ferritin levels as independent of each other until a clear relationship is established and measured. What has become clear is that HbA1c in the prediabetic range indicates accumulation of fat in the liver, and dysregulation of glucose, lipids (fats) and probably other things such as iron as well (i.e. Ferritin high or low).

The only way to treat fatty liver is by diet to lose up to 15 kg or more, maybe less at 43. AFAIK no one seems to have researched the numbers, despite estimates of 25%-33% of the population having a fatty liver. Anyway to avoid all the nasty consequences, dieting to get HbA1c down to the mid 30s makes sense.

Many thanks for replying. This is the link to the research I've mentioned. Presumably the opposite applies to??

Ferritin is the storage form of iron, and it reflects the iron status accurately [1]. An earlier study showed that reduced iron stores have a link with increased glycation of hemoglobin A1C (HbA1c), leading to false-high values of HbA1c in non-diabetic individuals [2].

https://www.ncbi.nlm.nih.gov › pmc

Influence of Iron Deficiency Anemia on Hemoglobin A1C Levels in Diabetic ...​

 

[gillivy]

I haven't come across it previously, but your post did make me wonder - are your routine blood tests being done just after your routine annual blood donation? Has your GP ever suggested iron supplementation when your ferritin is only measuring 26?

If (as does seem likely since HbA1c is based on the red blood cells) low ferritin and/or recent blood donation can affect HbA1c, and your ferritin is usually OK when you haven't just given blood, then maybe asking if you can have the tests repeated in 3-6 months might give a more accurate answer regarding your risk of diabetes. If your ferritin is not recovering then you may need to talk to GP about how you can increase your ferritin (and possibly whether it is wise for you to continue to donate blood if your ferritin does not recover quickly from the donation?)

Thankyou. I did have my Ferritin/Hba1c taken 3 days after donating blood so you could be right. I'll see what my doctor says. I always take iron supplements for a few weeks after donating so be interesting to see if it does go back up which may dovetail with a lower Hba1c! The body is so finely tuned isn't it!?

 

[JITR]

Thankyou. I did have my Ferritin/Hba1c taken 3 days after donating blood so you could be right. I'll see what my doctor says. I always take iron supplements for a few weeks after donating so be interesting to see if it does go back up which may dovetail with a lower Hba1c! The body is so finely tuned isn't it!?

'Finely tuned' is a good way of putting it. I'd say pre-diabetes and T2 put it out of tune.

Looking at one of the more recent studies related to the links I saw this:

Results: The mean HbA1c level was significantly lower in the group with IDA (5.4%) than in the healthy control group (5.9%; p < 0.05). When the patients were divided into three groups according to the severity of anemia through Hb levels, HbA1c levels were observed to decrease as the severity of the anemia increased (5.5%, 5.4%, and 5%, respectively; p > 0.05). The HbA1c levels of the patients with IDA were higher after iron therapy (from 5.4 ± 0.5 to 5.5 ± 0.3; p = 0.057). The mean hemoglobin (Hb), hematocrit (Hct), mean cell volume (MCV), mean corpusculer hemoglobin (MCH), and ferritin values also increased after iron therapy (p < 0.05).

Conclusion: The study results showed that IDA was associated with low HbA1c levels, and increased after iron therapy. Based on the study findings, it is necessary to consider the possible effects of IDA on HbA1c levels.

Not sure if all the other studies came to the same conclusion.

Anyway, looks like your HbA1c results are likely to go up if your GP thinks they are on the low side and prescribes medication and/or dietary changes.

 

[Martin.A]

Hi all, I'm 67 and my Hba1c has been increasing year on year. It is now 43. I am not overweight, I am busy with grandkids so get plenty of exercise. However, I donate blood annually which lowers my Ferritin (currently 26 ug/L). I have been reading that low ferritin can affect Hba1c. Has anyone else come across this?

You're donating blood at age 67? I thought the cut-off was 65?

To donate blood you will need to:

• be generally fit and well
• be aged between 17 and 65
• weigh between 7 stone 12 lbs (50kg) and 25 stone (158kg)
• have suitable veins (we will check these before you donate)
• meet all donor eligibility criteria (we will check this with you before you donate)

I used to donate blood but at my last two appointments they wouldn't let me. The drop of my blood that they popped into that container of liquid, to see if it floated or sank, didn't pass the test. When I reached 65 I stopped going.

 

[everydayupsanddowns]

I think where anaemia / red blood cell issues are thought to be negatively affecting the reliability of HbA1c values, an alternative long-term glucose check called Fructosamine can be used instead?

 

[Lucyr]

Oh and PS I seem to have suddenly decided 2+ years ago to have far too many white blood corpuscles since when my HbA1c level has shot up to over 65 from being constantly in the low 50s for at least several decades and all the diabetes clinic do is nag me about improving my TIR.

I have permanently high white blood cells too, had them tested recently which showed they’re still high. Haematology just said to do some extra tests to look at the white blood cells and make sure they looked alright, nothing concerning in the shape so it’s just my normal is abnormal

 

[Lucyr]

However, I donate blood annually which lowers my Ferritin (currently 26 ug/L). I have been reading that low ferritin can affect Hba1c. Has anyone else come across this?

A low ferritin level can affect hba1c if it’s causing anaemia but 26 isn’t low by my GPs range which is 13-300 as normal.

My ferritin is low normal at similar to yours, but unreliable due to my high white blood cell count so I have seperate iron tests done. Last time I had it checked I had got my iron level up to a high for me of 7 after a couple years of supplementing iron, with a normal range on that test of 11-25, and all of the other additional iron tests showed low iron. My diabetes is still just measured by a1c though.

 

[peggy]

I'm pre diabetic at 42, at my last blood test in March my ferritin was only 5.
Just waiting on results of blood test taken yesterday.

 

[trophywench]

Nobody has offered or suggested testing my ferritin level. Like I said - only concerned with getting my TIR up higher - and honestly that for me means spending FAR more time on ME every single hour of my life and it's 'daft' things eg because OH been in hospital, younger daughter (age 50, 4 daughters, 3 at work by now, 2 not living with her, 7 yo granddaughter herself) asked if we needed any shopping? Yes please - 2 x 2L bottles of full fat milk, a 50/50 loaf and some nice green beans - she'd previously got me a loaf - thick sliced white. OMG 22g CHO per slice. Haven't bought anything thicker than medium sliced for a million years - and very rarely white. So she duly brought us the shopping and it was a 50/50 loaf, good-oh - BUT when I opened it yesterday it was thick sliced again ..... 'only' 20g - but you see when its medium as per my normal, the packet says 17.5g but I know to jab for c.16g (ish) but don't know exactly what to allow for the thick! Daft because I know it takes ages to gradually get the dose exactly right for what you're eating but don't want to because I have no desire to keep eating it once Pete's mobile again and we can do our own shopping! Sensible slightly older daughter due on Friday afternoon - she still works more or less full time and they live further away than younger one and have all sorts of probs of their own to deal with, without us needing her.

Just nuisances really, nothing that's going to make me drop dead suddenly in my view, but simply don't need any more hassle right now.