Type 2 Diabetes, exercise and B12 depletion

[clivealive]

I was diagnosed with Type 2 diabetes in May 2015 am on Metformin and was told I needed to exercise in addition to watching my diet and weight.

In June I purchased a "mini" exercise bike which I sit on and proramme to use for 20-25 minutes a day.

I have had Pernicious Anaemia for 45 years following gastric surgery for a perforated peptic ulcer and had prior to the diabetes led a very sedentary life. The P.A. is "controlled" by monthly injections of B12 (cyanocobamalin).

After five months doing the exercises my tiredness and exhaustion have increased dramatically and I am wondering if the combination of exercise and Metformin is having an adverse effect on my B12 levels as the symptoms are worse in the run up to the next injection.

I am male, 74 years old, stand 6 feet 4 inches tall and weigh 12 and a half stones.

Any words of advice would be welcome.

 

[grovesy]

I believe that Metformin can affect B12.

 

[clivealive]

I believe that Metformin can affect B12.

Hi Grovesy

Thanks for your reply,

As you will guess I'm very new to diabetes and as some of the "side effects" are similar to P.A. I'm finding it hard to "pin down" what is causing my exhaustion.

I read on the Metformin leaflet under Very rare side effects "... low levels of B12" but it doesn't go on to say what's to be done. That's not really very helpful is it?

If it's to do with absorption of B12 through the "stomach" it might not be relevent to me as the only way I can get B12 is through injection - unless it means that Metformin somehow lowers in the blood stream the level of B12 available to me. That would be worrying!!

Athletes use B vitamins to boost and maintain performance via their diets and energy drinks, but of course a) I'm not "allowed" those and b) there's my absorption problem due to the gastric surgery.

I wish you well

 

[Lurch]

If, if I have calculated your BMI correctly (kilos / height squared in metres), it is under 22. The claimed healthy BMI is 25. Is it at all possible you are not having enough calories per day for exercising?

If you go to the excellent Jenny Ruhl nutrion intake calculator you can input you own data and most usefully also your carb intake, and check what your calorie intake should be to maintain a healthy weight:-

http://www.phlaunt.com/diabetes/DietMakeupCalc.php

Worth a check. Good luck.

 

[Matt Cycle]

If, if I have calculated your BMI correctly (kilos / height squared in metres), it is under 22. The claimed healthy BMI is 25. Is it at all possible you are not having enough calories per day for exercising?

If you go to the excellent Jenny Ruhl nutrion intake calculator you can input you own data and most usefully also your carb intake, and check what your calorie intake should be to maintain a healthy weight:-

http://www.phlaunt.com/diabetes/DietMakeupCalc.php

Worth a check. Good luck.

BMI is fine in Clive's case. The normal (healthy weight) BMI range is 18.5 to 25.
Underweight is 16 to 18.5.
Overweight is 25 to 30.
Obese is 30 to 35 and so on.

 

[HOBIE]

I would straight away think high blood sugar. You feel very tired when this is the case with me. Good for you on your bike & keep at it. Do you get thirsty ? & welcome CA

 

[trophywench]

The B12 deficiency with Metformin isn't very rare at all - it's quite well known in fact! (must be if I know about it LOL) I know one or two people who suffer from it and also have to have monthly jabs - cos it does actually cause PA exactly the same as having PA from some other cause. So I would make an intelligent guess that yes it WOULD make existing PA worse.

However the comments made about high BGs do stand - but if your BGs are well in the proper range notwithstanding the tiredness - then it HAS to be 'worse' PA doesn't it?

Unless, of course you've also now gained an underactive Thyroid into the bargain - another auto-immune condition that diabetics are just prone to get, and tiredness and feeling more cold than normal under whatever weather circs apply, are the two main symptoms of that.

I'd go back to the docs, tell them everything relevant - and get them to check everything if I were you!

 

[Mark T]

From what I read, Metformin blocks the absorption of B12 from Diet. So wouldn't do anything for injections.

What are you BG levels like when you feel tired? Do you self test?

 

[KookyCat]

High blood sugar can cause B12 leeching because it's water soluble (even when entering the blood directly), you have probably noticed that high blood sugar makes you thirsty, so you drink more and in turn flush more vitamin B12 out of your system. Prior to diagnosis I had a B12 level of 41 that refused to increase, turns out it was the combination of excess water consumption and a weird problem I knew about with intrinsic factor. Insulin treatment is also known to cause B12 problems but I don't know why, I just rock up for jabs and do as I'm told. Probably worth mentioning to the doc though because when I was in B12 hell I could tell my B12 levels were dropping about a week before the injection because I just wasn't building up any reserves. Hope you feel better soon 🙂

 

[robert@fm]

BMI is fine in Clive's case. The normal (healthy weight) BMI range is 18.5 to 25.

Actually, it isn't quite that simple. The BMI calculation is based on the square of the patient's height, rather than the cube as it should have been, and thus carries the hidden assumption that the patient is of about average height (5'8" or 1.75m). A very tall person whose BMI is "healthy" could in fact be underweight.

 

[clivealive]

If, if I have calculated your BMI correctly (kilos / height squared in metres), it is under 22. The claimed healthy BMI is 25. Is it at all possible you are not having enough calories per day for exercising?

If you go to the excellent Jenny Ruhl nutrion intake calculator you can input you own data and most usefully also your carb intake, and check what your calorie intake should be to maintain a healthy weight:-

http://www.phlaunt.com/diabetes/DietMakeupCalc.php

Worth a check. Good luck.

Thank you Lurch,

I visited the site you mentioned which seemed to me to be more about losing weight.

I said I wanted 0% weight loss (as you say my BMI is fine) and from the data I entered got this rather confusing result which goes on to talk about calories and high quality protein - about which I know nothing:-
TO MAINTAIN YOUR CURRENT WEIGHT:

To maintain your body weight eat 1,970 calories.

You have decided to eat 180 grams of carbohydrate a day. This is 36.6% of your total caloric intake.

Required Protein Intake: 64 grams of high quality protein.

This would be supplied by: 10.7 ounces or 299 grams of a high quality protein food like meat, fish, eggs, or cheese, which typically contain 6 grams of protein.

Recommended Protein Intake: 148 grams.

This would be supplied by: 25.0 ounces or 700 grams of a high-quality protein food like meat, fish, eggs, or cheese, which typically contain 6 grams of protein.

Your ideal protein intake level is roughly 30% of your total caloric intake.

Ideal Fat Intake: 73 grams.

Since carbs make up 36.6% of your diet, fat should only provide 33.4% of your total calories.

Note: Calculated calories for nutrients will not match total calorie recommendation due to rounding during calculations.

In my daily diet sheets I measure and record every mouthfull of food and liquid extrapolating only the carbohydrate and sugar content which is where I got my (average) figure of 180 grams from and giving a sugar content between 30 and 40 grams per day.
I have no idea how to eat 1,970 calories a day....

Thanks for you help and I wish you well

 

[clivealive]

I would straight away think high blood sugar. You feel very tired when this is the case with me. Good for you on your bike & keep at it. Do you get thirsty ? & welcome CA

Thanks for your reply Hobie,

I'm sorry, but I'm very new to all this.

I don't think it is "high sugar" as my carbohydrate intake is quite low and I don't suffer from thirst. I think I'm "leaning" more toward the P.A. being the culprit and as my weight is pretty stable (and was never the issue really) I will probably scale down the exercises a bit
This is the exercise bike - but that's not me on it 🙂

 

[clivealive]

BMI is fine in Clive's case. The normal (healthy weight) BMI range is 18.5 to 25.
Underweight is 16 to 18.5.
Overweight is 25 to 30.
Obese is 30 to 35 and so on.

Thanks Matt Cycle - agreed my weight is OK

 

[Northerner]

I don't think it is "high sugar" as my carbohydrate intake is quite low and I don't suffer from thirst. I think I'm "leaning" more toward the P.A. being the culprit and as my weight is pretty stable (and was never the issue really) I will probably scale down the exercises a bit

Hi Clive, are you able to monitor your blood sugar levels at home i.e. do you have a meter and testing strips prescribed? I ask because you suggest your carb intake is quite low, but I think most of us would think that 180g per day is actually moderate to high carb intake. Using a meter you can directly associate your blood sugar levels to the food/drink you have consumed and determine whether it is causing your levels to climb high and in turn contributing to your tiredness. 'Low carb' is generally considered to be well below 100g per day. I consider my consumption to be 'moderate', varying between 100-140g per day.

 

[clivealive]

The B12 deficiency with Metformin isn't very rare at all - it's quite well known in fact! (must be if I know about it LOL) I know one or two people who suffer from it and also have to have monthly jabs - cos it does actually cause PA exactly the same as having PA from some other cause. So I would make an intelligent guess that yes it WOULD make existing PA worse.

However the comments made about high BGs do stand - but if your BGs are well in the proper range notwithstanding the tiredness - then it HAS to be 'worse' PA doesn't it?

Unless, of course you've also now gained an underactive Thyroid into the bargain - another auto-immune condition that diabetics are just prone to get, and tiredness and feeling more cold than normal under whatever weather circs apply, are the two main symptoms of that.

I'd go back to the docs, tell them everything relevant - and get them to check everything if I were you!

Thanks trophywench,

WOW! there's a lot of info there.

I'm very new to diabetes and don't know what "BGs" are and the last thing I need is for an underactive thyroid.

Sadly my doctor is not very understanding with regard to P.A. He's a strong believer in "one size fits all" regardless of height, weight, matabolism or age. He prescribes my injections to be evey four weeks because that's what it says in his drug book. When I report my P.A. neuropathy symptoms he simply shrugs and tries to "blame something else" as if after 43 years I don't know what they are like. I had to fight him like mad a couple of years ago to win the concession to have the occasional three week injection when I feel the need and I forsee another battle looming which is why I'm seeking answers to my increased exhaustion levels.

Thanks again for your comments and I wish you well for the future.

I think my diabetes is "under control" with the Metformin (now down to 2 a day) diet and exercise. My original HbA1c in April read 51mmol/mol and my second in August was down to 40mmol/mol and he hasn't scheduled another test until next February so I guess he thinks so too. He's probably more concerned about his budget than anything else as the practice was marked down as underperfoming by the CQC

 

[clivealive]

Hi Clive, are you able to monitor your blood sugar levels at home i.e. do you have a meter and testing strips prescribed? I ask because you suggest your carb intake is quite low, but I think most of us would think that 180g per day is actually moderate to high carb intake. Using a meter you can directly associate your blood sugar levels to the food/drink you have consumed and determine whether it is causing your levels to climb high and in turn contributing to your tiredness. 'Low carb' is generally considered to be well below 100g per day. I consider my consumption to be 'moderate', varying between 100-140g per day.

Hi Northerner, no I was not given any facility to test my blood. I guess with my HbA1c reading in August being 40 my doctor didn't consider it necessary.
I thought RDA was for "Sugar: This is about 70g for men and 50g for women, but it varies depending on: your size, your age, how active you are. 160g – 195g carbohydrates"

Thanks for your comments and I wish you well.

 

[clivealive]

From what I read, Metformin blocks the absorption of B12 from Diet. So wouldn't do anything for injections.

What are you BG levels like when you feel tired? Do you self test?

Agreed Mark T I've read that too - its the info leaflet that's so vague.
No, I have been given no equipment to self test and don't even know what "BG levels" means as I'm new to all this.

Thanks for your comments and I wish you well.

 

[Northerner]

Hi Northerner, no I was not given any facility to test my blood. I guess with my HbA1c reading in August being 40 my doctor didn't consider it necessary.
I thought RDA was for "Sugar: This is about 70g for men and 50g for women, but it varies depending on: your size, your age, how active you are. 160g – 195g carbohydrates"

Thanks for your comments and I wish you well.

Hi Clive, for information BG = Blood Glucose, also called Blood Sugar 🙂 The RDA values are appropriate for people without diabetes, but do tend to be on the high side for most people with diabetes as diabetes gives us a much reduced ability to process and control the effects of carboydrates, and particularly sugar

 

[trophywench]

.... sugar is just another carbohydrate - not a food group on its own - and it is (IM not very HO) utter madness specifying it separately as if it was.

Thyroid test is one of the annual blood tests you will now automatically have because you are diabetic - I'm very surprised it hasn't been done already. Why don't you change your doctor if he's unhelpful generally?

 

[Matt Cycle]

Actually, it isn't quite that simple. The BMI calculation is based on the square of the patient's height, rather than the cube as it should have been, and thus carries the hidden assumption that the patient is of about average height (5'8" or 1.75m). A very tall person whose BMI is "healthy" could in fact be underweight.

Growing up in Sheffield, with no knowledge of the concept of BMI and in pre-PC days amongst my school mates it would have been based visually as follows, along with strangulated vowels and associated terms of endearment:

Lanky streak o' p***
All reight
Ovverweight
A reight fat b*****d