Metformin or Proton Pump Inhibitors?

[GGourmet]

My father has had type II diabetes for many many years and taking Metformin for almost as long. He has also been taking proton pump inhibitors for about 4 years.

His GP never routinely checks B12 and only checked the other day when my dad (age 80) demonstrated potential signs of dementia.

His was deficient. Injections were done in line with NICE but the GP said sometimes B12 deficiency is linked with Metformin - no mention of the Proton Pump Inhibitors whose timing more closely correlated with the deficiency.

Has anyone else experienced a GP blaming something rather than the obvious, or is Metformin more relevant in the condition?

[fbirder]

Both PPIs and metformin can significantly affect B12 absorption.

The cause of the deficiency is irrelevant. What matters is that the deficiency is treated correctly. How often is your father receiving injections? It should be at least every eight weeks.

[GGourmet in reply to fbirder]

Thanks fbirder. I’ll check. I’m thankful they actually did something.

[Gambit62 Administrator]

metformin isn't recommended for treatment of diabetes in older patients - details are on the patient information leaflet - I can't remember if the cut off is 70 or 75. I have no idea if this recommendation is related to the effect metformin has on B12 absorption - which is also mentioned, if I remember correctly, in the patient information leaflet.

[fbirder in reply to Gambit62]

The problem with elderly patients is that they are more prone to kidney problems, which is a contraindication for metformin. Everybody prescribed metformin should have an annual kidney function test. The elderly should be tested twice a year. And their dose may be adjusted downwards. medicines.org.uk/emc/files/...

But there are lots of alternatives to metformin. I think I'm going to find out all about them next week, when I have a telephone consultation with my diabetic nurse and we chat about the possibility of my losing 5 kg, or going back on medication.

[Gambit62 Administrator in reply to fbirder]

Diabetes itself makes people more prone to kidney disease because of the degeneration of blood vessels resulting from poorly controlled blood sugars, along with diabetic neuropathy and diabetic retinopathy. It can also affect the blood flow to the gut.

Yes, there are a lot of alternatives to metformin.

[Liyaelize in reply to Gambit62]

What are the alternatives for Metformin? Thanks so much..

[Gambit62 Administrator in reply to Liyaelize]

Liyaelize - suggest that you discuss with your GP.

[wedgewood]

Proton pump inhibitors, like Omeprazole, are notorious for causing Vitamin B12 deficiencies .if they are taken over a prolonged period . They are for short term use only. They totally annihilate stomach acid , which is so important in the digestion of our food . Can also cause mal-absorption of other vitamins and minerals . They are intended for short-term use only . I knew of someone who took Omeprazole for over 12 years , who ended up with totally numb feet and lower legs . She had 2 spinal operations to correct this , which of course did not help . B12 levels were never tested , until I related how I had numb feet from having Pernicious Anaemia. But it was too late -it’s irreversible now .

[fbirder in reply to wedgewood]

I've just finished my H. pylori eradication procedure, which includes taking a PPI. When I stopped I had terrible stomach pain at around 02:00. It was relieved by taking another PPI.

I'd never had this problem before. Now I'm wondering why PPIs seem to be stopping the pain.

[wedgewood in reply to fbirder]

I suppose that the H.Pylori has caused some inflammation in your stomach making it sensitive to stomach acid, which is relieved by the PPI . But so odd that you haven’t experienced it before, and it happened when you had finished the treatment.

I wonder if , having P.A. and. resulting low stomach acid ,makes H.pylori bacteria easier to establish itself in the first place ? This is just a thought . I have no knowledge of the condition at all .

I hope that the pain was just a hiccup , I do hope that the treatment has worked and that you can soon stop taking the PPI . Do look after yourself and take a multi vitamin and mineral tablet ( but I’m sure that you are fed up with tablet taking ! ) Best wishes for a full recovery ,