Pernicious Anaemia and Metformin

Status
Not open for further replies.
P

Pinky&TheBrain

Member
Relationship to Diabetes
Type 2
For some time I have been trying to find out from medical professionals whether or not my B12 deficiency - caused by having pernicious anaemia, affecting my autoimmune system to not produce enough Vitamin B12, and for which I am obliged to receive an injection every 12 weeks [the same as everyone else with these symptoms - irrespectively - which is not regularly checked by blood tests] - will be affected further, i.e. reduced even more, by now having to take both Metformin & Gliclazide to control my recently diagnosed Type 2 diabetes. Unsuccessfully I might add.
Is there anybody out there that could provide some clarification. Note: I have to literally force my GP practice to provide blood test forms to monitor my Type 2, with it being even more difficult to have my B12 monitored at the same time [preferably BEFORE I have the next injection].
I am in no hurry to find out, nor am I concerned - health wise - as at no time have I exhibited any symptoms for these conditions, nor do I suffer from tiredness/lack of energy etc [as part of the B12 deficiency]. In fact, without having been obliged to have blood tests taken almost 4-years ago - due to sudden loss of intestinal blood [a dose of food poisoning being the cause] I would never have known about the pernicious anaemia, and nor would I have known about the Type 2 if it was not because of a significant weight loss over a few months less than 2-years ago [over the last 20-years, visits to my GP can be counted on less than all the fingers on one hand].
Regards
 
If you’re already on B12 injections for the pernicious anaemia, I’d think they’d also cover any deficiency caused by the Metformin. I’ve never heard of Gliclazide affecting B12 levels.

I see on your previous threads that you had two bleeds and rapid weight loss. I hope you got to the bottom of what caused that. Rapid weight loss can be associated with intestinal problems but it’s also a symptom of Type 1 diabetes, which comes on more slowly in adults. How is your blood sugar? Have you had a recent HbA1C test?
 
Metformin is known to reduce b12 levels and utilisation but the treatment for that is supplemental b12, which you are already getting.

The guidance is not to test for serum b12 once diagnosed with PA and receiving injections. My understanding is there is no point getting tested for serum b12 once on injections as all that will tell you is that the injections are being done and you have high serum levels (or should have anyway). It will not tell you why you need them be that PA or something like metformin.

MMA testing and homocysteine can help indicate if your cells are receiving enough active b12, regardless of serum levels.

Potentially you may not be getting frequent enough b12. 12 weeks might be enough for some but others find they need more frequent injections to avoid symptoms. And it is symptoms that should guide frequency not levels at this point. If you have any neurological symptoms guidance https://cks.nice.org.uk/topics/anaemia-b12-folate-deficiency/management/management/ says every other day til symptoms relived and then 2 monthly. Otherwise every 2-3 months. PA is unlikely to respond to oral b12 so it could be a battle getting injections more frequently on the nhs. New guidelines are coming in the new year but keep getting pushed back. https://www.nice.org.uk/guidance/indevelopment/gid-ng10176
 
Any haemoglobinopathies including anaemia can make the HbA1C test unreliable as it assesses the glucose attached to red blood cells and there is another test the fructosamine test which would be more reliable.
Usually when people need B12 injections is because they haven't got the ability to absorb vit B12 from food, which can be caused by some medication if used long term eg esomeprazole, metformin, damaging the area of the gut which produces something called intrinsic factor which is requires for absorption
 
Inka said:
If you’re already on B12 injections for the pernicious anaemia, I’d think they’d also cover any deficiency caused by the Metformin. I’ve never heard of Gliclazide affecting B12 levels.

I see on your previous threads that you had two bleeds and rapid weight loss. I hope you got to the bottom of what caused that. Rapid weight loss can be associated with intestinal problems but it’s also a symptom of Type 1 diabetes, which comes on more slowly in adults. How is your blood sugar? Have you had a recent HbA1C test?
Click to expand...
The first loss of around a litre of blood a bit of food poisoning from mushrooms, coupled with a dash of diarrhoea with blood [one session], followed by blood in Number 2's for about 4 days - Jan '19 - was put down to a possible burst ulcer - but not confirmed as an internal examination was not carried out until May '19 where possible scar tissue was noted after the gastroscopy. Note, I was perfectly fine after this bout of bowel movements up to the examination at hospital when I returned to the UK from the Middle East. This was when I went on to Hydroxocobalamin injections for the PA [6 injections in just over a week before returning to the Middle East]. After the second blood loss - again around a litre - early Dec '21 - the gastroscopy indicated a burst duodenal ulcer + a couple of others still evident + scarring from an earlier duodenal ulcer [possibly related to Jan '19].
Never having experienced the referenced symptoms of a B12 deficiency, notably tiredness etc, I rely on calendar dates to remind me when the 12 week interval is near. I have had blood tests prior to the next B12 injection, which have indicated that my B12 is near the top of the scale. I have also 'missed' - deliberately - an injection, with a blood test prior to the next injection indicating that my B12 is still near the top of the scale. I would actually like some sort of investigation carried out to determine the exact frequency of B12 injections I need - not necessarily at the same frequency everyone has them at. It would also appear that the Metformin is not impacting my B12 levels.
In January '23, my HbA1c was around 98. The last blood test, July '23, indicated this was down to 58 - with no change to diet or lifestyle.
 
B12 test levels when on injections are pointless though. It will (or should) always show high levels in the serum. The only tests that are of any use at this stage are mma and homocysteine. These will show if your cells are actually getting enough b12 from that well loaded serum, or not. Do you have a problem with getting them at the 12 week intervals?

Out of interest how were you diagnosed with PA? Intrinsic factors antibodies?
 
When you actually do definitely have anaemia the HbA1c blood test can be unreliable apparently. Instead, a fructosamine blood test can be used. That's what I remember from years ago anyway so whether it's still true or not, I have no idea.
 
HSSS said:
B12 test levels when on injections are pointless though. It will (or should) always show high levels in the serum. The only tests that are of any use at this stage are mma and homocysteine. These will show if your cells are actually getting enough b12 from that well loaded serum, or not. Do you have a problem with getting them at the 12 week intervals?

Out of interest how were you diagnosed with PA? Intrinsic factors antibodies?
Click to expand...
Noted. I must admit to not having any issues with getting the injections every 12 weeks - currently I have left it almost 24 weeks, still with no side effects or symptoms. Due for a blood test next week.
I was diagnosed with PA, apparently, because of the abnormal size of my red blood cells, and the lack of them. It obviously did not affect me in any way during the time of initial blood loss and the blood test some 3/4 months later
 
Status
Not open for further replies.
Back
Top