B12

[Mick1542]

I ended up in hospital after a massive b12 deficiency caused by Metformin and now have to have regular injections to replace my b12..has anyone else suffered this ??

 

[Jofster01582]

Not in my case .....I have b12 jabs due to having a gastric bypass 11 years ago

 

[zand]

Yes, but I was lucky in that I developed burning mouth syndrome when I was only mildly deficient in B12 so it was caught early. So far I have only needed one injection. I have stopped taking metformin.

 

[Albie1]

I ended up in hospital after a massive b12 deficiency caused by Metformin and now have to have regular injections to replace my b12..has anyone else suffered this ??

I've been on Metaformin for over 30 years and during this time my diabetic doctor also presribed Uvedose 100 000UI/2ML amp vitamin D3 every 3 months and once a few years back 7 days of multi vitamin injections, and I never really had any problems with Metaformin side affects, it's a good diabetic drug.

 

[Outlier]

Yes, and I am very cross that I was neither warned nor checked. Very luckily I found out and have gone from a low dose of oral B12 to a higher dose. An interesting side effect was my atrial fib. appears to have stopped.

 

[Oldvatr]

I have been on Metformin for some 25 years since DX. I was on max dose for most of that time (2,000 mg.day) My B12 was tested and found to be ok, but I was suffering from iron deficiency anemia which is often caused by B12 deficiency. In my case it was a D3 deficiency, and I have recovered. I have also stopped the Metformin because my kidney function was damaged by an MRI scan and Met is contraindicated by poor kidney clearance.

So not all of us suffer B12 deficiency caused by Metformin, but it is a known side effect that needs to be checked for.

 

[mariavontrapp]

I recently stopped Metformin, after 3 months, because I began having mental health issues - depression, irritability and mood swings. I really didn't recognise myself. Someone on this forum advised I might need to stop and speak to the diabetic nurse. Thank goodness for that advice! Within 5 days I felt like myself again. I spoke to the nurse today, asked if I could have my B12 levels checked and hit a blank wall. Surely she should recognise this as a possibility? I have M.E/CFS which can also create a need for B12 supplements, so maybe I had a deficiency before I started the Metformin. Anyway, nurse had no clue about it, which I find very worrying.

 

[zand]

I recently stopped Metformin, after 3 months, because I began having mental health issues - depression, irritability and mood swings. I really didn't recognise myself. Someone on this forum advised I might need to stop and speak to the diabetic nurse. Thank goodness for that advice! Within 5 days I felt like myself again. I spoke to the nurse today, asked if I could have my B12 levels checked and hit a blank wall. Surely she should recognise this as a possibility? I have M.E/CFS which can also create a need for B12 supplements, so maybe I had a deficiency before I started the Metformin. Anyway, nurse had no clue about it, which I find very worrying.

I unknowingly also did have lowish levels of B12 before I started metformin. I had ME too and at the time didn't realise there could be a connection. Like you I hit a blank wall when I asked if my B12 levels could be checked. I often feel like I enter an alternative reality when I walk into my surgery. I stay away as much as possible.

 

[Dr Snoddy]

I started on 2000mg Metformin per day as advised and my B12 levels plummeted from medium high to almost deficient within 2 months. I paid for my own spray supplement and with the agreement of my doctor halved the dose of Metformin. My B12 levels improved and when the dose of Metformin halved again and was then abandoned, regained their previous levels.
The leaflet now clearly states that anyone taking Metformin should have their B12 levels monitored routinely.

 

[Mbaker]

Many on this site respond to Metformin questions. I might suggest a mild cognitive dissonance, as words like safe are used, even by the experienced. Even on this short thread, look at the issues some have. I myself had kidney issues. None of these problems are mild side affects. I truly believe mods should inject caution when often Metformin is given a free pass - it is hit and miss, and I am not just talking about the toilet.

 

[Dr Snoddy]

I agree with @Mbaker. No drug is safe for everyone in the population. They all have side effects. However, not everyone gets every side effect and sometimes the benefits outweigh those side effects. We are all different and so are our individual responses.

 

[mariavontrapp]

I unknowingly also did have lowish levels of B12 before I started metformin. I had ME too and at the time didn't realise there could be a connection. Like you I hit a blank wall when I asked if my B12 levels could be checked. I often feel like I enter an alternative reality when I walk into my surgery. I stay away as much as possible.

Yes, same. The joys of m.e !

 

[AloeSvea]

When looking for a local rural town GP (in order to get regular HBA1c and so on tests for T2D, and referrals to specialists), when my old regular GP retired, I made appointments with both the news ones (in the last six months). Appointments were check ups on my response to metformin, taken up in April by me.

And as a newish metformin taker, I was well aware of the B12 issue, and yes, now it is supposed to be routinely checked for, with metformin prescriptions. My 'test' on how up with the play both of them were was - will they put B12 down on my lab test form without me asking for it?

Sadly, no, neither of them did. And this in a country which is supposed to and routinely prescribes metformin on diagnosis to basically every T2 case. (I resisted for eight years until I had problems with rapidly rising HBA1c during the pandemic woes.)

I became first aware of B12 and metformin as a nutrient depleter, when a GP in another location ordered a baseline B12 test, which is too, what they are 'supposed to' do. (Recommended practice here in Aotearoa/NZ.) So I am lucky that I had a baseline already.

With the first rural-town GP I was checking out, I forgot to remind her to put it in on HBA1c lab form. With the second one I made sure she did. She was flummoxed. I told her I thought it was important when on a new drug, to make sure that known deficiencies that can be caused by the drug have not occured, especially one as so important to general health as B12. I also said, that is why I want my blood panel done also - to keep an eye on my kidney function on this drug - new to me after all.

She said she was very frustrated by the appointment with me, and did I want some higher impact drugs?

Oh dear. And she is the better of the two. At least she was listening to me in order to be frustrated - the first one wasn't interested in what I had to say about the progression and my target/goals at all. I asked the second one to make a note of my hba1c target - again - mandated in the recommendations to doctors for treating T2D - in my records. Flummoxed by such, again. I mentioned the word 'partnership' between GP and a chronic disease patient (this word is in the literature for doctors and nurses in my country, for treating people with diabetes). She did nod, so I guess she had read the 'diabetes toolbox' for doctors and the nurses framework also. Well - that was good at least.

Anyway - this thread was a good inspiration to me to use the B12 test as a new-doctor check.

Depressing though. Two out of two fail.

I'd better get dressed and out to go get my B12 checked, clutching my lab form with 'B12' written post script. So a happy ending? I should end with that. Power to the Patients!

 

[Oldvatr]

To perhaps ease your mind, the problem of B12 and Metformin takes a long term usage to show depletion. It does not seem to happen in months, but more like years. I believe you are a meat eater, so you will have no problem sourcing it naturally, but make sure you also have folate (B9) also. D3 helps as well. I believe Vit C is also required in the diet. These all are needed to make haemoglobin of the right colour.

 

[jjraak]

To perhaps ease your mind, the problem of B12 and Metformin takes a long term usage to show depletion. It does not seem to happen in months, but more like years. I believe you are a meat eater, so you will have no problem sourcing it naturally, but make sure you also have folate (B9) also. D3 helps as well. I believe Vit C is also required in the diet. These all are needed to make haemoglobin of the right colour.

At risk of disagreeing, I found the information about B12 by accident, thanks to a member on this forum .

While I had had two HBA1c tests completed prior to that knowledge , neither included a check for B12.

I asked for B12 to be added at next HBA1c test , and it was added with no quibbles.

I know ask fur it at each test, so far no one's declined my request.

Mine came out at the lower end of a third of what is defined as the range.

I then began taking supplements.

I'd been DX for almost 5 months & on Metformin the entire time.

You maybe quite right, and I was deficient for some time earlier, and I was lucky in that I was scared into finding out, for sure.

But I find the warning label, doesn't point to "after years of use."

Like I say not disagreeing, but I think it is incumbent upon each of us to heed that warning as it is written.


Personally I think it should be an 'Obligation' on the doctor's part to make this possible deficiency clear.

As to being concerned.
I'd say many come on here being just that, and quite rightly so.

B12 is one all T2D should be aware of, imho.

On a side note,
Whilst being aware is good for many of us on Metformin, many others can also be impacted unknowingly.

For anyone curious about the impact this 'might' have on us or others.

A small b movie under my signature was an eye-opener for me & I don't think it would be a waste of anyone's time putting aside a moment to watch it.

"Is it B12 ? "

 

[jjraak]

I ended up in hospital after a massive b12 deficiency caused by Metformin and now have to have regular injections to replace my b12..has anyone else suffered this ??

Hi @Mick1542 .

So sorry to hear that .

Almost criminal negligence given doctors should be aware of the potential & warn patients.

Hope you can come off them at some point.

Best wishes

 

[jjraak]

I unknowingly also did have lowish levels of B12 before I started metformin. I had ME too and at the time didn't realise there could be a connection. Like you I hit a blank wall when I asked if my B12 levels could be checked. I often feel like I enter an alternative reality when I walk into my surgery. I stay away as much as possible.

You very much have my sympathies @zand .

I post here for discussion, not as proof, that IF you do receive full blood works levels
That MCV is elevated CAN be a sign you are declining in B12.

It's not perfect, this was the first link I found whilst looking.

Diagnostic value of the mean corpuscular volume in the detection of vitamin B12 deficiency - PubMed

In clinical practice, the finding of an elevated mean corpuscular volume (MCV), macrocytic anaemia or specific neurological symptoms is often the reason to test for vitamin B12 (B12) deficiency. Use of the MCV as a test for the detection or exclusion of B12 deficiency is only justified if the...

pubmed.ncbi.nlm.nih.gov

Due diligence is required, but my rise of MCV did follow a lowering of my B12, as established over two HBA1c tests.


I'd just add to a previous post, that like many, I lost out on testing during pandemic.
I never had any for almost two years...covid & personal situation at the time.

so I doubt I'd get a B12 checked anymore then once a year, but I do feel that ONE test is so important.


Also I saved a NZ study, saying anyone post 50 should be tested.

I think something worth considering for many.

 

[jjraak]

I recently stopped Metformin, after 3 months, because I began having mental health issues - depression, irritability and mood swings. I really didn't recognise myself. Someone on this forum advised I might need to stop and speak to the diabetic nurse. Thank goodness for that advice! Within 5 days I felt like myself again. I spoke to the nurse today, asked if I could have my B12 levels checked and hit a blank wall. Surely she should recognise this as a possibility? I have M.E/CFS which can also create a need for B12 supplements, so maybe I had a deficiency before I started the Metformin. Anyway, nurse had no clue about it, which I find very worrying.

Interesting point about the depression etc.

I was very out of sorts when I first started Metformin.

I put a lot of it down to the Change in diet, shifting glucose, etc.

Might have to look into that a little more.

I became very irritated & over agressive on occassions.

A customer facing role, rough environment sadly, but I was know as the steady calm one, chilling down the most scary, agressive customers.... until I started scaring them back , (and my colleagues )

It calmed down over many months.

But good to know there might be a connection .

 

[Oldvatr]

At risk of disagreeing, I found the information about B12 by accident, thanks to a member on this forum .

While I had had two HBA1c tests completed prior to that knowledge , neither included a check for B12.

I asked for B12 to be added at next HBA1c test , and it was added with no quibbles.

I know ask fur it at each test, so far no one's declined my request.

Mine came out at the lower end of a third of what is defined as the range.

I then began taking supplements.

I'd been DX for almost 5 months & on Metformin the entire time.

You maybe quite right, and I was deficient for some time earlier, and I was lucky in that I was scared into finding out, for sure.

But I find the warning label, doesn't point to "after years of use."

Like I say not disagreeing, but I think it is incumbent upon each of us to heed that warning as it is written.


Personally I think it should be an 'Obligation' on the doctor's part to make this possible deficiency clear.

As to being concerned.
I'd say many come on here being just that, and quite rightly so.

B12 is one all T2D should be aware of, imho.

On a side note,
Whilst being aware is good for many of us on Metformin, many others can also be impacted unknowingly.

For anyone curious about the impact this 'might' have on us or others.

A small b movie under my signature was an eye-opener for me & I don't think it would be a waste of anyone's time putting aside a moment to watch it.

"Is it B12 ? "

Metformin and reduced vitamin B12 levels: new advice for monitoring patients at risk

Decreased vitamin B12 levels, or vitamin B12 deficiency, is now considered to be a common side effect in patients on metformin treatment, especially in those receiving a higher dose or longer treatment duration and in those with existing risk factors. We are therefore advising checking vitamin...

www.gov.uk

I note the use of the phrases long term use and high doses in this official advice to doctors. The other cases where it may occur early seem to be associated with other conditions which should also trigger at risk monitoring in their own right.

 

[jjraak]

Metformin and reduced vitamin B12 levels: new advice for monitoring patients at risk

Decreased vitamin B12 levels, or vitamin B12 deficiency, is now considered to be a common side effect in patients on metformin treatment, especially in those receiving a higher dose or longer treatment duration and in those with existing risk factors. We are therefore advising checking vitamin...

www.gov.uk

I note the use of the phrases long term use and high doses in this official advice to doctors. The other cases where it may occur early seem to be associated with other conditions which should also trigger at risk monitoring in their own right.

Pretty sure we are both arguing for the same side here

Team "be careful & take note."

Better to check, then just assume all is ok , me thinks.

A simple request for those unaware or newly DX, to get at least one test, as a baseline...then progress from there.

The current literature suggest that the frequency of this adverse drug reaction is higher than previously thought