Vitamin B12 Deficiency

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Tim Aylesbury

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Type 2
Hi,

I am a 50 year old with Type 2, diagnosed in 2015 and on Metformin.

I had a face to face appointment with my Diabetes Specialist Nurse on Tuesday and as part of the latest Blood Test results, it is has been identified that I have low levels of Vitamin B12, probably due to several years of taking metformin.

I am having difficulty standing for any amount of time and cannot walk very far, even with crutch, before I start shaking and nearly collapse. I have had three falls this year, where my legs have collapsed either underneath me or one occasion, I went forward, broke my fall with my Knees and went face down into the Pavement.

Referrals and action by the Doctor's is very slow and researching on the internet is scary, particularly around the neurological conditions, associated with Vitamin B12.

I am wondering if anyone has any experience of Vitamin B12 and Diabetes, that may be able to advise what to do next, as the falls, difficulty walking and standing are starting to effect my quality of life.

Regards.

Tim.
 
Hi, I take a vitamin B12 supplement, am diabetic and have issues with vitamin and mineral absorption.

The following is not a recommendation and professional medical advice should always be sought

The daily vitamin B12 dietary requirement is 2.4 mcg and the upper tolerable safe limit is undefined so I set it at the generally recommended UL of1000mcg for my own App limit. It is water soluble and so presumably excess is excreted in the urine.

However I aim for my daily food and supplements to provide 40 mcg B12.

Serum B12 should be between 180 and 2000 (pg/ml) and my last blood test revealed it to be 1288.

Vitamin B12 is easily obtained from Holland and Barrett and I take half a tablet daily.

Seems to work for me.

I Wonder if ringing 111 for advice might help.
 
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What has your nurse suggested to remedy the deficiency?
If you are continuing to take Metformin, then oral supplements will not work and you need B12 injections and the nurse should have offered this. The Metformin blocks the absorption of Vitamin B12. It is possible that the deficiency is causing the issues with falls. Have they checked your feet with the tickle stick to assess the nerve health in your feet? Hopefully with an injected supplement you will see some improvement, but don't settle for oral supplements being suggested or prescribed, push for the injections, because if the Metformin has stopped your body from absorbing the B12 from food it will do the same to oral supplements.
 
Do you need the Metformin anyway?
I took it for such a short time but it had dreadful effects, particularly alongside the Atorvastatin and so I have no problem sticking to a low carb diet which sorted out the type 2 in a very short time.
It seems as though the treatment could be putting your life and well being at risk every day - and you are a generation younger than me. I really do feel that HCPs will get people taking tablets which do them no good at all - have you ever tried diet control only or was it straight to tablets?
It seems wrong to question such a universal treatment - but it can seriously ruin lives when it is applied mindlessly.
I'd be sitting in a nursing home staring at the garden through the windows of the lounge if I was still taking the tablets. Instead I went out on Mayday morning and danced up the sun.
Some old Greek probably said 'whilst we are alive let us live' and after the last few years, I am definitely in agreement.
 
@rebrascora thanks. I didn't know that. Please ignore my previous post
 
Hello there. I have T1 and VitB deficiency. It initially manifested itself as a tendency to drag my feet, trip over anything and fall. It's not nice, I have had several broken ribs and all manner of hand injuries before they did tests, discovered I have pernicious anaemia and B12 deficiency. I have injection of hydrocoxobalamin (Vit B) every 8 weeks. In addition you need to get your iron and folate levels checked out and possibly take supplements for those as well as the injections.

I would most definitely request the injections and further tests if your nurse does not offer you them. May I suggest you check out the NICE guidelines here https://bnf.nice.org.uk/drugs/hydroxocobalamin/
 
My other half has Vit B12 deficiency which he blames on the GP putting him on esomeprazole for a gastric issue which has been shown to damage the area of the gut which produces intrinsic factor which is required for Vit B12 absorption, so he has 3 monthly injections.
 
Sorry to hear about your issues with VitB12 @Tim Aylesbury

Hope you are able to get it sorted.

Have you discussed your mobility challenges with your Dr?
 
Hi, Thanks for all the responses, very helpful.

Following some chasing after my last post, I have been to see a NHS Podiatrist who has confirmed that the pulses in my feet, etc are all ok and I have been discharged from Podiatry.

I should be starting a course of Folic Acid tablets and Vitamin B Injections very soon.

If anyone has any dietary suggestions regarding Vitamin B12 that would be appreciated.

Once again, thanks for your continued support.

Regards.

Tim.
 
Have you had your vitamin d checked as well mine was very low and put on tablets , folic acid and b12 are affected by metformin , im not sure what percentage it is but i think some doctors think does the benefits of it overide the disadvantage , most medications the major ones anyway have some dreadful side effects
 
Good food sources for vitamin B12...but not necassarily low carb

All bran
Cornflakes
frosties
Egg
Kidney
Liver
Salmon
Sardines

Most meats are a medium source of B12

You can also get B12 supplements. The acceptable range of B12 according to many sources is 2.4 to 1000 mcg however there is no defined upper limit.
 
but yes Anemia can be a consequence of all this , i guess we all need to be out own doctor some time , list to your body and gut
 
There are side effects as you say of most medications just as there can be with the air you happen to breathe in, depending on what it has in it. However, by no means every single person either taking that drug or breathing that particular air in, will get that particular side effect.

With drugs needed for whatever the Dr prescribing it along with the patient, needs to weigh up the pros and cons. eg. You have a bike accident and break some ribs, one or more of which causes a pneumothorax (collapsed lung) so you can't actually breathe in and out properly. Do you bother causing more short-term pain and trauma by inserting tube through the person's side to enable the lung to re-inflate properly? Or avoid doing that very thing cos you can't give them a general anaesthetic to do it ? Well - I should blooming well hope you do cause them the pain etc! The pros here are that by breathing properly they have much more chance of surviving what was never otherwise likely to be potentially fatal. The con is that it blooming well hurts like hell because despite the nerve blocking injections they give you before doing it, it's not 100% usually guaranteed to work like magic cos of all the adrenalin cortisol and other helpful things the body does automatically caused by the original accident let alone this additional medical/surgical assault.

Is the metformin - if indeed that truly is what has caused the B12 deficiency, because that shortage can occur without metformin, helping you more than it's likely to hinder you?
 
If your Metformin is causing a B12 deficiency you'll need an injection. Metformin stops it from being absorbed in the gut, although I believe this is mainly when the dose of Metformin is 1500mg or more.
 
Some medications prevent the production of something called intrinsic factor produced in the gut which is required for the absorption of vitamin B12 from foods and also if taken as oral meds hence the need for injected B12. Metformin is implicated but also Esomeprazole.
 
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