My husband takes Metformin. He has just been for his review and I badgered him to ask if his B12 had been tested and if so, what the level was. I didn't think he'd ask. He's very resistant to doing things like that. But he did.
He's been on Metformin since lockdown.
His level of B12 today is "fine" according to the GP. In fact it's 300. And as far as I'm concerned that's worryingly low.
How should we best treat this? I am thinking B12 drops perhaps but not sure of the frequency I should advise.
I'm about to start SI B12 myself, so I could inject him too if he'd let me. But that might be over-kill for this level and probable reason?
Any advice would be appreciated. Don't tell me to get him to get anything else tested because he won't. We only found out he's diabetic because during the lockdown the surgery rang and said that they hadn't seen him for 15 years and would be mind popping in for his BP to be tested!
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FancyPants54
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Why not have a daily b12 oral supplement.My husband has type 1 diabetes and had his b12 tested added to his routine bloods after I got ill on my request.
His was 180! ( 200-900)
Deemed normal no advice.
He had no symptoms of b12 deficiency.
He however agreed to take one 10mcg b12 supplement a day.
If there are no noticeable symptoms I wouldn't go to injections right away. A low dose supplement of around 25 to 100mcg should be ok if there are no absorption issues. If low stomach acid, and/or absorption issues are suspected then 500 to 1000mcg would be more appropriate.
ref:
"What is an adequate dose of oral vitamin B12 in older people with poor vitamin B12 status? "
3000 may be perfectly fine for your husband - if he'd had an early serum B12 measure that was more than 20% higher that would indicate an absorption problem. Unfortunately you can't really tell much from a single test result.
If he is symptomatic then try following the advice given by Technoid.
Unfortunately though the symptoms of B12 deficiency overlap with a number of other conditions including conditions for which metformin is prescribed such as diabetes. You could try speaking to a pharmacist about alternatives to metformin if it doesn't seem to be resolving issues that caused it to be prescribed in the first place.
However, most western countries have a much lower threshold, with the cut-off forwhat is considered too low often being around 160-210 pg/ml.
However, these cut-offs are cut-offs applied to a result (serum B12) which cannot really be relied on to exclude deficiency so IMO they are of limited usefulness.
A b12 supplement is a good idea. No reason to wait until deficient, better to prevent. Both diabetes and b12 deficiency can cause neuropathy, which is best to avoid.
Decreased vitamin B12 levels are a known consequence of long-term treatment with metformin. The mechanism is currently thought to be multifactorial, comprising altered intestinal motility, bacterial overgrowth, and reduced uptake of vitamin B12 within the small intestine (or a combination of these factors).20 Jun 2022
Whilst I would agree that 300 may be normal for your husband and that not everyone will have identifiable B12 deficiency symptoms at that level (or even lower), some can have symptoms at much higher levels. But as your husband has diabetes, it may be that he does have B12 deficiency symptoms, because that could be a symptom - see
'A very recent study confirmed that vitamin B12 supplementation regulates several diabetes-associated genes such as TCF7L2, FTO, and CREBP/CBP through methylation of MiR21 and could thus epigenetically influence the risk of obesity, insulin resistance, and type 2 diabetes mellitus [12].'
More research is needed, but the possibility that lack of B12 ( indeed any problem with one-carbon cycle function) increases risk of expressing epigenetic vulnerabilities, in this case for diabetes, is being considered. Dr Chandy has long considered that to be the case for autoimmunity.
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