Vitamin B12 Injections

[butterflyfarm]

I was recently diagnosed with lack of B12 in my bloods (not anaemic) but most likely due to high dose Metformin and lanzoprasole as I am also diabetic. Since starting the jabs I seem to have had a PMR flare and wonder if I should go from 4 mgs back to 10 for perhaps a week or so as my legs and ankles are very painful and wobbly plus shoulder pains are back. It has taken me a year and a half to reduce from 15 mgs to 4 so very disappointing. My GP surgery is only dealing with emergency cases either f2f or phone but not immediately, so no help there and the nurses who administer the jabs have no idea. Hopefully, only 3 more jabs to go. Thank you all in advance for any ideas or advice and I hope we can all look forward to a healthier and pain free New Year. 🙂XX.

[PMRpro Ambassador]

I would try it and see how you get on - that is standard for a flare and if it is short-lived you should be able to drop straight back to where you were.

What PMR symptoms do you mean? B12 jabs can lead to low potassium which can cause muscle cramps and fatigue and joint pains can be due to the B12. Some high potassium foods could be helpful.

The usual cry is "bananas! but there are far more fun and lower carbs options:

healthline.com/nutrition/fo...

[Theziggy in reply to PMRpro]

"but there are far more fun and lower carbs options" ???

[PMRpro Ambassador in reply to Theziggy]

I don't like bananas particularly - but avocado and salmon tickle the taste buds far better

[butterflyfarm in reply to PMRpro]

Thanks for your prompt reply PMRpro but I eat a slightly unripe banana every morning. I think maybe it's the stress of my daughter having stage 3 breast cancer and the 16 rounds of chemo she is enduring. I have taken your good advice and gone back to 10 mgs of pred for a few weeks to see how things go. I have to get stronger for my daughter's sake as she needs my support to take her for hospital visits.

[PMRpro Ambassador in reply to butterflyfarm]

Doesn't mean it is enough. But yes, stress has a lot to answer for. I assume you are in contact with all the possible support systems? Macmillan and so on? You must look after yourself too though - if you are broken, you are no use to her either. Been there, done that.

[butterflyfarm in reply to PMRpro]

Such very kind advice and sentiments. Yes I have support, but we had only just finished celebrating my husband' s 7year survival from throat cancer at the age of 87 - I am 76. Tough times at the moment!

[Blearyeyed]

It's unusual as B 12 injections usually help reduce the wobbly legs , cramps , numbness and pain in limbs which was made worse or caused by lack of B 12. Some people do get rebound pain in the limbs as they start their B12 injections though if the effect of low B12 has been severe in the nerve if the legs and arms , and , as Pro says if they were also low in Potassium , Magnesium or Vitamin D.That being said there is the possibility that you aren't having a PMR Flare but a flare of neurological pain caused by vitamin deficiency and that is unlikely to be improved by an increase in Pred.

Trial and error is probably the only way you will find out what is happening. Try " Sick Day Rules " to 9 mg for 5 days then drop back to your previous dose. During those 5 days any nominal PMR flare caused by the stress of vitamin deficiency and treatment should be rectified. If you find no substantial change in the pain it's likely to be neurological and you may benefit from paracetamol, heat pads on sore areas , rest , water intake and mineral supplements.

You need to tell the GP as Neurological symptoms that persist , or get worse , mean that your B12 injections should be kept at one a week then one a month until the neuro pain has gone according to NICE guidelines.

The jabs will help but if your system us absorbing the B12 slowly or slow to heal be ready to have more jabs , the loading doses will not simply treat the problem and that's it , no matter what your GP may understand about this.

If you are still taking the drugs you are on they should be offering you a three monthly jab anyway to maintain your levels after the loading doses. As well as taking a B complex orally.

A neuro medication for the pain may be more effective than steroids for this particular acute symptom and you should discuss options with your GP.

If you haven't also had these tests , request blood tests for potassium, sodium , magnesium , Folates and Vitamin D . Sometimes sorting out a deficiency in one vitamin can show up the fact that other nutrients are low . The above nutrients can also cause severe Neuropathy. Sometimes a Folate deficiency can be masked by the effect of low B 12 but it can also cause severe symptoms abd an oral supplement for this may also benefit you.

As Pro says consider a new diet for life from the new year packed with the nutrients you require to support better nerve health , to reduce inflammation and fatigue and help support muscle growth and strength. Bananas are easy and if you aren't on a severe low carb diet . Increase in lean red meat , offal , eggs , dark green vegetables, seafood and oily fish and nuts can help improve folate and B vitamin levels naturally.

[butterflyfarm in reply to Blearyeyed]

Hi Blearyeyed, many thanks for such an in depth reply. All my bloods are fine except for B12 and due to Christmas and staff shortages at my GP surgery my B12 injections have had to be spread over 3 weeks, so hopefully I should feel better in the new year. I have however gone back to 10 mgs of pred for a couple of weeks as I realise I am very stressed about my daughter's health. Hopefully, just a short PMR flare and I can get back to 4 mgs soon. In 2020 I was on 40 mgs of Pred with jaw claudication and suspected GCA as well as PMR.As I am also type 2 diabetic and hypothyroid I can take my pick on the cause of my current neuropathy??? !!!

Happy New Year.

[PMRpro Ambassador in reply to butterflyfarm]

Don't be in too much of a hurry to go back to 4mg - you need extra because of the stress - as I just said, been there, done that.