A 35-year-old woman with Type 1 Diabetes reports that she has been feeling tired all the time. She also mentions frequent episodes of low blood sugar. Laboratory tests show low hemoglobin and iron levels. What could be the potential issue, and what are the next steps?
The combination of tiredness, frequent hypoglycemia, and low hemoglobin and iron levels suggest that this patient may be experiencing iron-deficiency anemia, which could be contributing to her fatigue and poor glycemic control. Potential causes of iron deficiency in a woman of her age include heavy menstrual periods and less commonly, gastrointestinal bleeding. The next steps would be to further investigate the cause of her iron deficiency with additional tests, such as a stool test for occult blood, and to start her on iron supplementation. Her insulin regimen may also need to be adjusted to prevent further episodes of hypoglycemia.