Pernicious Anaemia Society
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Diabetes ?2, Pernicious Anaemia and Hashimotos

My partner was diagnosed with Hashimoto's disease (autoimmune hypothyroidism) two years ago and three months or so ago was diagnosed with Pernicious Anaemia, for which he is receiving IM hydroxycobalamin weekly (doesn't seem to be able to go longer than that without the injection). However he has also been just avoiding a diabetes 2 diagnosis for years and now he can no longer escape this. We are about to limit fats and portions, having reduced to almost zero simple carbohydrates and starches. So we mainly eat meat, some fish, non starchy vegetables, and limited fruit. I have three main questions:

1. Does anyone have an opinion or literature references about diabetes and Hashimotos (and PA and other illnesses in this complex syndrome) distinguishing it as a third type of diabetes perhaps, or describing it as something other than a coincidental late onset diet-related type 2 diabetes?

2. How have other people with at least one of the related illnesses (PA, Hashimotos, Lupus...) dealt with this with regard to diet, exercise, or other approaches? (For instance, I notice that quite a few people use gluten free approach but I didn't notice this being related to any diabetes).

3. Has anyone noticed an improvement in the diabetes (glucose levels in blood or symptoms) after using B12 in the longer term?

I'm just trying to do my best to understand this and help my partner - not wishing to deny the illness or anything.


24 Replies

I keep a log of my food and drink and symptoms. I use this to find other intolerances. About 8 years ago I developed B12d and became allergic to gluten and all dairy.

I've since also stopped adding sugar to everything but still have a fairly starchy diet . My father has type 2 diabetes. I don't think B12 improved issues with sugar. There is some connection to improved cholesterol however.

the log is another way to monitor progress. B12 is used in cell replication and so promotes healing but the progress is slow. Especially from any nerve damage. I supplement with folic acid and B6.

There is a link between autoimmune issues. Once you get one others may follow.

The logbook also is a way the gather evidence for further discussions with your GP. Once he/she is certain that you are monitoring the progress closely, I've found they are will to work with you. My concern is that the weekly injections will not continue and they will want to revert to 3 month (for hydroxo-b12) or monthly for cyano-b12.

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Thank you. He is fortunate with regard to frequency of injections since we can get hydroxycobalamin injections over the counter and he can have them as often as I or he are prepared to inject. Same goes for my parents who live with us (91 yrs each); I am treating mum for B12 deficient dementia (overlooked diagnosis despite obvious blood results) and same for Dad, although he only has peripheral neuritis; memory much better. I will be trying out methyB injections eventually, although my next immediate step will be methylB sublingual 5000s for everyone. (Including me because although I had 450 picograms/millilitre I had symptoms which have vastly improved with the MethylB 5000 daily sub lingual in just 1 and a half months.

I get your point about the log book. Thank you. I will keep reminding him to fill out the diabetes one he has been given.



Also look at supplementing folic acid as B12 needs folate as part of the methylation cycle. OTC is typically 400 mcg and the max prescription is 5 mg. I can tolerate only about 3 mg daily as I get a thumping in my ears when it is more.


Hi pvanderaa,

Is there any problem with oral folate absorption where there is malabsorption of B12? Also, wouldn't the addition of folate to just about all cereals mean low folate would be difficult to achieve? Although we avoid all those starchy things so I have been thinking about it. I was told by his endocrinologist that his folate is good, however I have noticed recently that there is a sublingual product available of Superior Source, Methylcobalamin B12 5000 mcg, B-6 & Folic Acid 800 mcg MicroLingual, 60 Tablets from iherb on line.


B12 needs intrinsic factor to absorb at specific receptors in the illium (last portion of small intestine). Folate is absorbed like all other nutrients in the lining of the gut. These are two different mechanisms.

The folic acid additives in the diets may in fact mask B12D and lead to neurological damage detected later.

However, once you start B12 injections, the metabolism in the cell takes off and you need additional folate and minerals.

I take 2x 800 mcg twice a day along with a multivitamin 50+ for men.

One of my symptoms following a B12 jab, occurs about 6 to 12 hours after the jab, the severity depends on how low I got on B12 before the jab. I get anywhere between a soft poo up to diarrhea. This is most likely caused by the metabolism working overtime and detoxifying my body. The byproducts are filter out in the liver and pancreas and dumped into the gut. hence the delayed symptom.


Thank you. Is there a proportional relationship i.e. b12 : folate that you think is optimal?


Try going to and asking in their forums. They are to diabetes what this forum is to PAS. Ask about LADA, or slow-onset type 1 diabetes.

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Hi Hose 1975,

Thanks for that advice. I'm having a look at the site now. By the way, I have another message from you that begins, "If you've been limiting carbs and his blood glucose is still rising, and he already has several autoimmune conditions then you may want to consider the pops" in my inbox but when I go to read the rest, I cannot find it on line. Mysterious.


I was typing my reply on my phone and the browser crashed, meaning that I jabbed the screen in exactly the place to submit the reply. When I composed, painstakingly, a much longer and more detailed response the site basically said that my response was bang out of order (although for what reason I can't fathom). So I deleted the half-baked reply as it was useless on its own.

Basically, I said that if you've not done so already you should start logging absolutely everything (and weigh / measure everything) that your husband eats to get an idea of exactly how much carbohydrate he's eating per day; don't forget the milk and other dairy. Please don't restrict fat as that's going to be his main source of energy but make sure he's not overeating at the same time (to get a rough idea of how many calories he should be eating per day you should hunt out a basal metabolic rate (bmr) calculator online and multiply the result by 1.2 to give an idea of the minimum he should be eating; my fitness pal can also do this for you). Also be aware that roughly 60 % of protein, via glucogenesis, turns into glucose so if he's eating lots of protein it might be contributing to the problem. If you can, buy a blood glucose monitor and start testing before, and 1 and 2 hours after, every meal to see what impact different foods are having on his levels. His bloods should be below 7.8 mmol/l at the two-hour mark and should ideally not have risen more than 2 mmol/l at any point during the meal. The folks on think highly of the SD Code Free meter, which you can get at a reasonable price on Amazon I think (other tax-avoiding entities are available).

Having one or more autoimmune conditions puts you at a much higher risk of developing another. Your poor husband sounds like he's almost in a position to call 'House!' :-/

I cannot recommend the crew highly enough. They are very lovely and almost all of them are either going or have gone through the same thing themselves, or a they have a loved one who is. I lurked there throughout two rounds of insulin-dependent gestational diabetes and was basically told by the hospital after the second one that it was now a case of when, and not if, I permanently developed diabetes. My blood sugars have been rising slowly despite weight loss and exercise; a low-carb diet is my last roll of the dice before I have to start on yet another sodding medication but I knew what to do because of all the reading I'd done via the forums. And so far, it's working (roughly 80g carb per day, same for protein: diet is 25% carb, 25% protein and 50% fat). My fitness pal has been an invaluable tool.

One last word of advice: ignore standard-issue NHS advice about how you need to eat starchy carbohydrates with every meal. That advice is one of the reasons that GPs tell the newly diagnosed type 2s that diabetes will inevitably lead to complications and having to inject insulin. Well, yes, if diabetes is an inability to handle carbs and you're telling your patients to eat lots of carbs then of course it's going to end in tears! I've always felt that it was like telling an alcoholic to have a couple of shots of vodka with every meal but that cirrhosis was almost inevitable...

Good luck and feel free to PM me if you want.

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Dear Hose1975,

Thank you for your comprehensive replay. My partner is logging his blood sugars and I am cutting back on his protein and fat. We already consume nearly zero simple carbohydrates or starchy vegs and very limited fruit. We are, indeed, aware of the problem with the old fashioned dietary advice still permeating every mainstream health outlet. However I have not got into weighing his stuff yet, more just operating by view. I will attempt to do so and I will look up the other technical measures you mentioned. I have been lurking on the site and have looked up LAVA diabetes and various things.

One last question, what does "PM" -ing someone mean? (Although we have a news website, I have always avoided doing much on facebook etc, so not up on the lingo.)

Thanks again


PM means personal message.

Please don't cut his fat or protein: your husband has to get his calories from somewhere. I'd really consider cutting the fruit first, especially if you're eating anything tropical (pineapples, mangoes, etc.), bananas, oranges and so on. Most people find that apples - only one per day - is okay, as are berries and cherries.

I assume that your husband has stopped eating pasta, bread, potatoes and rice? All starchy carbs, all will cause a wicked spike in blood glucose levels in someone with abnormal blood glucose control. Replace pasta and rice with courgettes and cauliflower.

Fat isn't going to affect your husband's blood glucose levels. Protein will have some effect but should be okay unless he's chowing down on 200 g of chicken at a sitting. IF you've cut the carbs and kept an accurate log of everything, then I think it's time for a serious chat with a doctor. In my village we're lucky enough to have a large enough practice that one of the GPs (not my regular one) specialises in diabetes. Maybe it's the same where you live?


Dear Hose 1975,

We are lucky to have a really good endocrinologist, whilst the many gps in the practise we frequent and in the whole large town are pretty hopeless, I'm afraid. So one relies on this kind of forum to make decisions. The diabetes educator we saw was still hooked on high carb low fat and so was the dietician. We do know a dietician we see in another state who makes more sense so we will consult her when we go there in about a month.


In the meantime do introduce yourself to the community over at They will be able to provide so much advice and help, as they're actually living it.


Okay, will do when I have a moment.


I forgot to say that tropical fruits may be a significant factor, since he has formed the habit of cutting up strawberries and cantelope and eating a large bowl with yoghurt and artificial sweetener. I will definitely print out what you have said here for him to read. Thanks


There is also MODY - but don't think there is really anyone on the forum that is aware of that or has much to say about it having recently posed a question on there and got no response.


Thanks Gambit62. I will look this one up on the forum. I guess that even if it were the almost unnoticeable form the higher blood sugars would do harm.


I typed Diabetes into the Search Box on the Green Bar at the top of the page and the above posts appeared....

Do hope you find something helpful amongst them :-)

I recently read about the involvement with the adrenals and diabetes - but did not bookmark it. When you have Hashimotos it is possible that the adrenals have been a little stressed - even if your hubby hasn't been. Perhaps try to support them with lots of VitC.

Is he being optimally treated for his Hashimotos ? I am a sufferer and was diagnosed late in life in 2005. I have learnt lots from others who know more than me and have improved my health enormously. Happy to help where possible :-)

You may also wish to research Folic Acid v Methylfolate. The first is synthetic and the latter natural....



I have pa and hashis diet and exercise very important, also check iron vitamin d and folic acid. Although I don't always feel like it I make sure I walk usually 30 -60 mins a day and keep active. Stick to lean meat veggies pulses fish and cut out gluten if it doesn't agree. I have a very strict regime if i stick to it i can feel quite good but i do get times when i crash though. Its wprth mentioning it took me about 4yrs to get the balance of meds right.

Good luck



Agree with everyone's suggestion- important to keep folate about 15 and ferritin up too.

I think I've come across a different type of diabetes mentioned which is in middle and not treated with insulin? Type 1A?


Probably MODY - Mature on set diabetes of the young - has about 11 different genetic variations. The genes are dominant so if you inherit them from a parent you will develop diabetes - though one genetic form is very low grade and often totally unnoticeable - think it is MODY3. Its caused by the pancreas not functioning properly rather than an autoimmune response to levels of sugar related hormones in the blood so not sure if it really counts as an autoimmune problem.

2% of diabetics are actually MODY and because the cause is slightly different really need a different treatment regime but this is often missed.


"Is there any problem with oral folate absorption where there is malabsorption of B12? "

I wondered if you had looked at MTHFR gene mutations? These are mutations in a gene that affects folate metabolism which in turm could affect B12 uptake.

I don't know much about it but am planning to have a private blood test for the most common MTHFR gene mutation before end of the year.


Like pvandera think it is unlikely that B12 would affect blood sugar levels as don't think it is used as part of the sugar regulation cycle.

However, did come across an article week or so ago about using a mixture of methyl and adenosyl B12 to treat diabetic neuropathy.

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Have been out all day and want to thank people for their helpful responses. My partner is on Vit D supplements and they are doing well; his folic acid is good (but I will try to learn more about these levels). And we are contemplating methyl B injections for neuropathy.

Thanks all.


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