Gene mutations can occur when there is a change in the DNA code, such as a substitution, insertion, or deletion of nucleotide bases. Substitution mutations, where one base is swapped for another, typically have the smallest effect since only one amino acid may change. Insertion and deletion mutations, which add or remove bases, can have larger effects by disrupting the reading frame of the entire DNA sequence. An example is sickle cell anemia, a substitution mutation that causes red blood cells to take on a sickle shape.