Vitamin B12 and Metformin

[24yearsandcounting]

As a diabetic, I have been prescribed Metformin which I tolerated well. Recently I have been feeling really tired and am now being tested for B12 deficiency, at my request. No guidance has ever been given on this at my diabetic clinic and the leaflet that comes in the box suggests that this is an extremely rare side effect. Now I find that this is not true. Has anyone else had symptoms? It has made me extremely incontinent, tired and weak.

[Activity2004 Administrator]

Have you talked to your doctor about the tiredness and medication? Has your doctor suggested a lower dose or change to a new medication?

[24yearsandcounting in reply to Activity2004]

Yes I spoke to him on the phone (he rang me in response to a letter i sent him): he has given me an appointment to go and discuss the matter, and also a date to go for a blood test. the leaflet in the pack says 'rare side effect; one in 10,000'. Doc said, 'more like one in 20'.

[Activity2004 Administrator in reply to 24yearsandcounting]

Please let us know what you find out soon when you get back from the upcoming appointment.

[Gambit62]

a) 1 in 20 is the likelihood of someone over the age of 52 having a B12 absorption problem.. This is mainly because stomach acidity tends to lower as you get older and the absorption of B12 requires a certain level of acidity The likelihood rises as you get older and is probably nearer 1 in 5 when you reach the age of 70+

b) metformin is known to interfere with the absorption of B12 it also seems to make cells more efficient at using B12. It is also only one of a very large number of absorption problems - most common of which are age (lowering stomach acidity) and Pernicious Anaemia (actually a specific autoimmune gastritis which has anaemia as a symptom but that was how it was discovered and the name has stuck).

c) Most GPs know next to nothing about B12 and B12 deficiency. Well done on your GP for at least being aware that deficiency isn't rare.

d) I don't know where the figures for the incidence of metformin in the leaflet came from as I don't know how they could possibly distinguish metformin as a specific cause, especially given that age is a factor

e) the most common drug causes of B12 deficiency are probably the use of PPIs to treat heart burn. Heart burn can be caused by high stomach acidity but it can also be used by low stomach acidity. Using PPIs to treat low stomach acidity will lower acidity further (though it may resolve the heartbur) increasing the risk of B12 deficiency. PPIs should not be used for extended periods of time, but they frequently are.

f) unfortunately the symptoms of B12 deficiency are easy to mistake for the symptoms of diabetes. Peripheral neuropathy is a factor in both and so B12 deficiency is often mistaken for damage done by diabetes.

If you have an absorption problem that can't be reversed then the normal treatment would be regular vitamin B!2 injections - generall

i) UK: hydroxy-B12 2-3 months frequency or

ii) UK cyano-B12 monthly

though there are a significant numbers of patients who find that this regime just isn't enough for them.

[Saoirse2016]

I was on metformin (Glucophage) for my type 2 diabetes, I suffered with all the side effects listed on the leaflet!

Back in those days, the "very rare" symptom was noted as being a general feeling of being unwell, which I kept complaining about, but the GP ignored me. One time when the nurse was taking bloods I mentioned feeling like death warmed up so she put one vial for testing for B12 levels.

I was given B12 injections several times over the years, I'm not on Glucophage any more, but still getting the symptoms of low B12 levels.

The GPs just don't give a stuff

[24yearsandcounting in reply to Saoirse2016]

Hi there

thanks for the reply; it's comforting to know that i am not alone. Credit to the nurse who sent your blood for B12 checking; our diabetic 'nurses' nod in sympathy when I say I keep falling asleep all the time - two to three hours at a stretch - and don't offer anything more constructive. while I wait for my doctor's appointment I may try using apple cider vinegar as (evidently) old folks lack the stomach acid necessary to utilise the b12 found in food: I don't suppose it can do me any harm although I don't like it very much. I think my hair has stopped falling out quite so much since starting the B12, and the woeful incontinence has improved (thankfully!!). It's very difficult to know what are symptoms and what is just the normal aging process. Incidentally my user name is nothing to do with the diabetes, but is a comment on how long it took to get my atrial fibrillation diagnosed, and treated.

su

[Saoirse2016 in reply to 24yearsandcounting]

I remember a doctor telling me off for talking to the nurse instead of coming in to see her. I [rather stupidly] bit my tongue and didn't say "well she's the only one around here trying to help me".

I'm saving up to see a private practice doctor to see if they won't give me better than a blank stare...

I've been drinking apple cider vinegar (in water!) on and off for a few months, I noticed a huge difference with my acid reflux, and was feeling better in general. I think I need to keep drinking it on a regular basis!

[24yearsandcounting in reply to Saoirse2016]

Hi;

I have just bought some Apple Cider vinegar; I unscrewed the top and took a swig … JEES!! … then I read the instructions, and now I use one tablespoon full in a big mug of water, over two or three hours. I am now waiting to see my doctor to get some guidance, and a blood test. I don't think I have ever been tested for B vitamins before. I have searched through my patient record, but I don't think they really want you to; they make it so difficult. i will post again when i have more news.

su

[Kash27]

Hey, so many similar related issues I am reading here! My GP questioned me by asking me, why do I think I am deficient in B12!! I had read about metformin and B12 deficiency in my blood results notes, so I told him, and he thanked me for educating him!! He had no clue about metformin and B12 relationship. No other contact from him, and have been given daily b12 supplements daily instead of injections. I still feel tired and occasional dizziness, but no point going to GP again. I am 2000mg metformin daily

[24yearsandcounting in reply to Kash27]

Wow, I thought my metformin dose of 1,500 was high; shows what I know. I do hope when it's all sorted out that they wont prescribe me with B12 injections; it's not the injections themselves but the 16 mile round trip and the long wait I don't like. How much B12 do you have to take daily? I bought some B complex which contain 15ug (micrograms) and I take two of them per day; I have no idea what is too much. i stopped taking any Metformin at all as I was so angry that my health and vitality had been compromised like this. Not to mention the humiliation of incontinence causing me to have to squat and pee in the street. that's much improved now, thank goodness!!

[Sid_Arthur]

. . . I'm relatively NEW to the B12 depleting effects of metformin, . . . & restoring healthy bodily stores which have been used up ( - than some on HU !!❗) . . . but still found I now understand MORE than most GPs !!❗ 😱❓

You'll find plenty of g🍒d quality(-seeming!) info on the site b12-vitamin.com - . . . worth visiting soon I'd suggest! 😊

MOST importantly: think the B complex you're taking, with 15ug B12/tab, . . . are likely to be FAR TOO little initially ( - even at TEN/day!).

See b12-vitamin.com/injections/ page. As the 'Alt treatment w' ORAL Supplements' says, . . . it may be possible to restore the depleted levels of B12 . . . with DAILY doses of 5 mg ( = 5000ug) . . . for 4-6 weeks !

Plenty of easy to digest info on this site - including doses & frequencies, discussed on a recent thread on HU's PA forum t🍒❗ This info . . . may be the (?)BEST ( - late, ... or early?) '❌Mas 🎁' ... EVER ??! Pleased to be able to 'pass it forward' !!❗ 😊

NOTE: there are 3 natural B12 forms: hydroxo- (inactive) ... & methyl- & adenosyl- ( both active). Many products are available with one or more of these forms . . . - so, worth being aware. The higher quality products are keen to display this info, . . . in part, as a marketing matter ! Worth going for the more quality products, I feel on this (nontrivial!) matter of restoring health . . . !!❗ 😊 Range of products come as tabs, capsules, drops & sprays.

Had N⛔ noticeable effect with the B12 ( - 'transdermal') patches . . . as seems a common experience of many on HU ( - ... but, others report them to provide ➕ve effects, in reviews ??!). 🔍 for posts abt them on HU t🍒❗❓❗

And, worth seeing the site B12d.org . . . - & thereon, . . . use the 'B12d calculator'! The whole bk "Vit B12 deficiency in .... " is available on that site for FREE ( downloadable, chptr, by chptr !) . . . & INexpensive to buy as a hard copy, as made available on a 'non-profit' basis . . . - on this sociologically important PUBLIC HEALTH matter ! 😊 Bless THEM . . . ! ! ❗ 😊

Further site, ... for interest ( - tho' of less immediate help !): CluB-12.org

AtB,

Sid 😑

Sunday 4 June 2023, . . . into the dark of a summer's night . . .

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[Sid_Arthur]

. . . this may ALSO be of interest: healthunlocked.com/pasoc/po... . . . . . . & also worth 🔍ing 'NICE active B12 assay 2015" ! 😊

- knowledge/information 'is' p💥wer, . . . it cld be said ! 😊

AtB,

Sid 😑

Tuesday 6 June 2023, ... into the dark of a cooler summer's night . . .

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[Sid_Arthur]

Hope you've made some important progress since your post !

. . . worth a read ( - ... as soon as convenient !!?):

pulsetoday.co.uk/news/clini... . . . found via Tracy Witty's VERY informative site, . . . - B12deficiency.info by 🔍ing for metformin . . . thereon, . . . 🙂

I'd better 'BUY' the diligent Ms Witty . . . 'a coffee' s🙂🙂n, . . . 🙂 🙏 🙂

. . . ONE calm breath at a ⏳, . . . in this precious N😐W, . . .

Sid 😐

Monday 28 August 2023 . . . on this ☁️dy enough Bank Holiday !!! ☁️☁️☁️

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[24yearsandcounting in reply to Sid_Arthur]

Hello Sid,

because of failing memory and weak cognitive skills, i can barely remember what i said before - or when i said it. Well, i am 75!

so i wrote to my GP to ask for a B12 test, and he eventually agreed to doing it.

the result was 448 ng/l on a scale of 187 to 883. i found this out on my online portal, the GP has never contacted me to tell me. My folate level is 8.6 (range 3.1 to 20.5) so I started taking a vit B complex one a day pill. i very soon noticed a difference in that i wasn't so tired / exhausted / sleepy, and the incontinence started to improve. I have watched a lot of videos on you tube, mainly Dr Berg who explains it all so clearly and concisely. i then bought some methylcobalamin , B12 1,000ug and have been taking them (sublingually) intermittently, alternating with the b-complex which i now take four a day of.. i have no guidance on this, but i am booked in to see the diabetic nurse at the surgery next week; so i may get better instructions - or not! i have stopped taking metformin completely, so my blood sugar has gone up quite a lot. on the subject of hair loss which was extremely evident on my comb every morning; what i hadn't noticed was that the little hairs on my arms had completely disappeared, and my eyebrows were much reduced; i have no hair under my arms and my pubic hair has also suffered. everything but my facial hair growth!! typical! as time goes on, the sleepiness is reducing, and the incontinence is beginning to wane. Did i tell you that i had to squat and pee in the street when i found the public conveniences locked? the brain fog has lifted but i still managed to pay my credit card bill TWICE, and i made the same mistake on two occasions.

I hope that my visit to the diabetic clinic goes well and they understand what i am going through. i am heartily sick of being told there is 'nothing wrong with you'. That started when my verruca (at age 15) was deemed to be hard skin. the ME took a long time to be diagnosed properly, the Atrial Fib took 24 years. Doctors hey?

[Sid_Arthur]

. . . pleased to hear there's been some improvements in the months since your post.

I suspect there's room for more too - you're likely to find the ytube vid 'The Bittersweet Truth' by Dr P Jamnadas of interest, . . . & great benefit, I suspect:

m.youtube.com/watch?v=6zZBi...(Not working as expected?)

. . . An ( - 'early' ) VERY MERRY XMAS, . . . & HAPPY B'DAY to You, with the above - you'll be explaining the KNOWN fundamentals glucose biochemistry to the confused 'diabetologists' after watching the above, . . . 🙏 🙂 🙏

. . . ONE calm breath at a ⏳, . . . in this precious N😐W, . . .

Sid 😐

Monday 28 August 2023 . . . on this still ☁️dy enough Bank Holiday !!!

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[24yearsandcounting in reply to Sid_Arthur]

Hi

i tried to look at the report in the times, but they want me to subscribe or it's smartphone only. Jees! just one more hurdle. i give up.

what did it say?

[Sid_Arthur]

The Times - Mon 17 July 2023, by M Porter, MD: thetimes.co.uk/article/vita... - for a snippet of the whole, . . . 😟❓

Sid 😑

Tuesday 29 Aug 2023, . . . into the dark of an autumnal night . . .

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[24yearsandcounting in reply to Sid_Arthur]

Hi Sid,

I am sitting here getting my file of papers ready for an appointment with the diabetic nurse tomorrow morning and pulling out copies of documents and print-outs to show them.

Yes I am getting your messages and finding it a little frustrating that so much if them are written in emoji code with which I am not familiar, but thanks for taking the time and trouble to write.

I am sick to death of this latest turn of events; in addition to dealing with atrial fibrillation, clinical depression, diabetes, low thyroid, INR blood tests, and endless pills, I have a grumpy demanding cat to contend with. And no chocolate to soothe my nerves.

And I know that the nursie tomorrow will pooh-poo me and my evidence. I guess they think I am imagining things – you get that a lot when you are female, and overweight!

I shall go to Morrison’s and buy some chocolate to console myself.

I feel so unsupported by medics and clinics lately; I shall go to bed now, and do half a dozen Sudoku puzzles.

Thanks for supporting me; I will report back tomro (my software is supposed to auto correct that!)

su