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B12 And Metformin

Discussion in 'Diabetes Soapbox - Have Your Say' started by sue_marie, Jul 23, 2018.

  1. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    Which symptoms do you have that aren't eased by your B12 injections?
     
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  2. Q007

    Q007 Type 2 · Well-Known Member

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    I feel tired, lethargic, sleepy no energy, I've muscular pain in my shoulders for 4 month that's creeping up, aching muscle groups (enough to take 2 x 30/500 co-codamol) so I have an xray to rule out skeletal.. The injections picked things up during the loading dose period but then fizzled out so we tried 2 month instead. I missed it off my to do list when I saw my GP the other week. I've been deficient since 2011 not long after diagnosis of being T2. I'm back to that date for symptoms.

    Today, for example I had nothing in the diary and slept till 3pm, drifting in and out and this could be any day.

    I'm seeing my cardiologist on Tuesday I was going to ask him but I'm sure he'll say it's a bit left of field for him and point me back to GP. I have become concerned. I'm missing my morning meds and two meals when this happens.

    Thanks for the interest in my question. Q
     
  3. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    Q, do your blood tests improve, but the symptoms don't, because there are a lot of conditions generating those sorts of symptoms. For example, here we have:

    upload_2019-6-1_21-44-27.png

    Those are the NHS's summary list of symptoms for low thyroid function, although most folks don't have them all (thank goodness!).

    Do you have a good, wider panel of bloods done when you have your B12 tested, to include things like folate, ferretin and Vitamin D, for example?

    I'm not challenging that you have B12 issues, but more urging you not to focus of that as the cause for these issues, without checking out a few other things first.
     
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  4. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Just to chime n here.
    In the quoted study posted by @SimonCrox, i did not see that any of these patients was screened for coeliac disease as a possible cause or contributing cause to their B12 deficiency. And thusI question if this might have confounded the results?
    As a story but not as medical advice or opinion:
    I can recall in the past when someone started on B12 injections, the serum B12 level at the 3 month (12 week) mark was checked before the next injection (im) and if near the lower end of the normal range, they would be recommended to change from 12 weekly to say 10 weekly or 8 weekly and then rechecked.
    Of course how accurate the B12 readings are is up for debate.
    Anecdotally, some persons with health professional experience and low B12 tried deep subcutaneous injections and their resultant B12 levels seemed satisfactory from what I was told.
     
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  5. Dr Snoddy

    Dr Snoddy Type 2 · Well-Known Member

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    The more recent inserts in the Metformin packets clearly? recommend that B12 levels are checked every year for patients on Metformin. If my surgery ever refused to do this I would be asking for a written explanation as to why. The B12 spray that I use has methylcobalamin as the active ingredient. It also includes chromium chloride which may support energy release in cells. The sweetners are xylitol and natural apricot favouring. It is also not tested on animals. However, this is not available on prescription.
    IMG_20190601_161222_hdr.jpg
     
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  6. JoKalsbeek

    JoKalsbeek I reversed my Type 2 · Expert

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    @DCUKMod has a really good point... Back when I was too fatigued to walk as a teen, I had vitamin D deficiency, which no-one bothered to check for. 11 Vials of blood, and that they skipped. (It's why my spine is malformed now.). When I was crashing left and right little over 3 years ago, literally toppling over, I figured it was Vit D again, but that didn't help, and it wasn't my thyroid either. Hello, T2. There are so many conditions that can cause your symptoms... The shoulder could be a calcium build up (apple cider vinegar could help with that if it is), for instance... You can't assume it's all always automatically diabetes or B deficiency. If you're concerned, ask for a full work up. Don't get brushed off, (They also tend to blame it on grief or depression). It's quality of life, and it matters. Be a dog with a bone.
     
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  7. Q007

    Q007 Type 2 · Well-Known Member

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    Yes I agree with all you say, actually I am very dominant but as subtle as I can be in not taking no or ' we'll see' as acceptable. I study a lot as I think anyone with any condition should, its just that I have this battle with them now as I'm undoing previous knowledge as I learn from people here. It doesnt go down well and they always throw how working to the XPERT plan brought me to my lowest Hba1c ever, which is tough.

    Would calcium deposits in my shoulders show up on xray and if it is, where has that come from.

    I have to always remember I have heart failure at 30% now so that's working through the gears as they said it would so everything is failing ATM.

    Thank you the kind reply, Q.
     
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  8. JoKalsbeek

    JoKalsbeek I reversed my Type 2 · Expert

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    <-- somewhere in here he mentions calcification of muscles/tendons (which my mom has too), and of the arteries, so this may be of interest for you? I don't remember whether it showed up in a x-ray for my mum or if it was an ultrasound, but it was visible. As for why it happens, apparently, as stated in the video, our ph in the blood drops after we reach 50 years of age. With nothing to help calcium get to where it should be, it just ends up in places where we don't want it. So there's plenty of calcium to go around, but you can still get osteoperosis because it's not going where it's needed. If that vinegar really is the answer that'd be qite convenient, because you don't need a medical team to be on board with that. One less battle. ;)

    Do whatever you need to do.
     
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  9. Q007

    Q007 Type 2 · Well-Known Member

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    Do you mean use apple cider vinegar as a topical or taken orally. I use it already to bathe and soak my feet in to soften my toenails as when I cut them I nick the flesh quite often and then can't stop the bleed because of aspirin I take. Final question I promise, I know we've gone way off subject with this but I appreciate your notes very much. Q
     
  10. SimonCrox

    SimonCrox · Well-Known Member

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    That's interesting about doing the blood test and adjusting the dosing interval based on that.
    Agree, there are sometimes problems with the B12 assay, but I believe that they are rare.
    Always worth doing the blood test for coeliac disease cos more common in diabetic people, easy to do, but coeliac disease predominantly affects proximal small bowel and it is a stomach or distal large bowel problem that leads to B12 problems, I thought?
    I found one guy with B12 deficiency, so I explained this add the treatment of 5 loading doses at which point he interrupted me to say that this was an amazing co-incidence cos he had had the same thing 16 years previously; managed for 16 years just on loading doses?? (did have significant anaemia when I met him)
    I'll probably stick with the IM jabs, (or what I believe are IM jabs cos it is me sticking the needle in and I don't like it particularly so don't really push it hard) but I had often wondered why SC wasn't Ok; I'll look into this and get repeat B12 level sometime
    Best wishes
     
  11. SimonCrox

    SimonCrox · Well-Known Member

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    Sorry to hear of all the bothers that you are having.

    Agree that it may not be B12 deficiency that is causing your symptoms - tired, lethargic, sleepy. From your posts, it could be your heart, or glucose levels or something else making you tired and sleepy. If your HbA1c is around 101 mmol/mol, that is a bit high and would make you feel poorly also; not sure if diet alone will get it down - was your diet that bad before glucose levels went up?

    What side effects did you get from the metformin - aboout 30% folk get SE from metformin.

    Have you asked your GP about this - as above could be something else like hypothyroid, poor renal function, high calcium etc so worth checking for things that one can improve

    Re B12 jabs, I think it is unlikely that making them more frequent will make a difference; if your original B12 level was only a bit low, I would consider sublingual but others have stated not available on NHS; but oral would be no more effective than IM (although less painful and cheaper). It does not take a diabetic specialist to help make this decision, your GP would be fine.

    re the muscular pains and shoulder pains, there are several possibilities. I guess that you have already wondered about statins causing these? Frozen shoulders with calcification in some of the tendons are more common in diabeic people and may show up on X-ray (or may not), but are really a clinical diagnosis; if you swing your arm from relaxed, sideways all the way around to above your head, is there a part where it really hurts (a painful arc) ? Your GP could look at this problem. Vitamin D deficiency is very common (almost universal in UK unless taking vitamin D) as someone else states and can cause muscle aches and pains so worth testing. There is a condition called polymyalgia rheumatica where the muscles are more stiff than tender particularly in morning so worth asking GP about this (and blood test for it). There is also a condition called polymyositis which is incredibly rare but might be worth checking for with creatinine (phospho-)kinase blood test, although the commonest cause of a raised CPK in UK would be statins, and other drugs, and ones activities.

    SOrry about delay in replying; hope that you are feeling better soon

    best wishes
     
  12. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi @SimonCrox,
    I found a study if 80 Dutch patient with newly diagnosed CD, compared to 24 healthy people, with incidence of B 12 deficiency reported in CD patients of 19% ( 67% with zinc deficiency)!. Apparently no correlation of extent of intestinal damage on biopsy with nutritional status. https://doi.org/10.3390/nu5103975
    The guy with 5 loading doses, averages out at some 0.85 mcg B12 per day for the 16 years, but if the minimum daily B12 supplement was 1 mcg daily, maybe he was partly absobing B12?
    Agree that i.m. sounds like the more reassuring route, even if more painful.
    What is perhaps under recognised is undiagnosed B12 deficiency and CD in pregnancy, but with risk of derailing the thread I will leave things there. Best Wishes
     
  13. SimonCrox

    SimonCrox · Well-Known Member

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    Sounds like the difference in prevalence B12 deficiency different in Coeliac disease and non-coeliac disease; I guess that they are both sort of autoimmune conditions?
    Yes - guess the guy untreated for 16 years had some B12 absorption,
    Best wishes
     
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