Suitable medication for diabetes

[Cetus]

In February my HbA1c reading was 41. Last week in hospital A&E it was 53.

I understand that below 41 is okay; 42 to 47 is pre-diabetes; 48 and above is diabetic.

I'm extremely exhausted to the point of being largely housebound. When I see my GP I suspect I will be asked to take medication for diabetes.

Am I right in thinking certain diabetes medications can cause trouble with B12 deficiency? Is there a particular diabetes medication which is best for people with B12 deficiency?

My GP is sceptical that I have B12 deficiency and is likely to take no precaution about this when prescribing, if he knows of B12 interactions at all.

[Nackapan]

I think you will see a specialist nurse fitsy before any medication. I hope so.

[fbirder]

Anything but metformin should be OK. They are certain to suggest metformin. Ask for something else. They have a wide variety, most of which work.

Better still, if you think it possible, suggest that you will try lifestyle changes - lose weight, eat better, exercise more. Note that doesn't mean - become Twiggy, eat like a rabbit, run a marathon. I managed to get my HbA1c stabilised at a level satisfactory to my nurse specialist by making some fairly small changes to my lifestyle. I'm still too fat, eat too much rubbish and don't exercise apart from walking, but I've done enough.

[Cetus in reply to fbirder]

fbirder I came across an article which saids there was no theoretical case against metformin and B12 but then I thought there were studies which looked only at correlation (without any theorising) which did find a connection.

So I accepted the metoformin which I now have my doubts about.

[fbirder in reply to Cetus]

There is definitely a correlation between metformin use and low B12. But, as Gambit62 says it will be irrelevant for you because you have injections.

Metformin is excellent for most people. Not for me, as the side-effects were horrendous (as I said to my diabetic nurse - who cares if I lige an extra five years if I spend ten years on the toilet).

[Gambit62 Administrator]

Cetus, if you are on B12 injections then the metformin will be irrelevant as you are no longer getting your B12 from your food and this is the bit of the process that metformin interferes with. I have seen one study that suggested that metformin could actually make cellular processes using B12 more efficient.

HbA1c is a good measure of how well glucose levels are being controlled over time so it does suggest that you are now diabetic but they should do a fasting blood sugar test to confirm.

If you need more support with diabetes then I suggest you look at one of the diabetes forums

healthunlocked.com/diabetes...

healthunlocked.com/drwfdiab...

[Cetus in reply to Gambit62]

Gambit62 Following your comment I dug out an article called "Metformin Causing Vitamin B12 Deficiency - A Guilty Verdict Without Sufficient Evidence" which was so persuasive that I accepted my GP's suggestion of metformin.

I am beginning to wonder if I was too hasty because the article doesn't actually say there is proof metformin is okay with B12.

Do you know exactly where in the pathways metformin was in the past reckoned to interfere with B12?

I am hoping to interpret the theory as it applies to my own symptoms, which seem to include folate problems as well as poorly functioning methionine synthase.

[Gambit62 Administrator in reply to Cetus]

I don't think anyone knows exactly how metformin interacts with B12 - but the problems do seem to be absorption in the gut - ie B12 getting from food to blood, so leading to lower serum B12 levels. If you have injections it really shouldn't be a factor. There are others on this forum who do take metformin for diabetes, eg clivealive

[Cetus]

Gambit62 I had this very vague notion that metformin somehow affects the folate cycle but from what you write it's not that. Some articles on metformin refer to lowered B12 serum levels.

Other people's individual experience, such as Clive's, does not always translate to others whose condition is different. I would rather not rely on that.

[Cetus]

Gambit62 fbirder Thank you both for your expertise.

As far as I understand it, HbA1c measures the build up of a compound accumulating on the red blood cells which, according to Wikipedia, "reflects the average level of glucose to which the cell has been exposed during its life-cycle".

In pernicious anaemia defective red blood cells are not getting formed at the correct rate, so would this cause the HbA1c reading to be misleading?

[Cetus]

Turns out I can handle the gut problems from metformin but not the extreme weakness and lethargy. So now I have been put on Sitagliptin (brand name "Januvia"), which I hope will be less troublesome.

Thank you to all who replied here.