B12

Got my B12 results back, along with latest HBA1c result. I spent a good couple of hours researching the blasted levels and what is normal and what isn't this morning, and I'm tired now! Ha! (See if you can guess why my fatigue levels might be up.... haha!) Folate also checked. Anyway. I will come back and write up a summary on my findings, in relation to my results at least. (I also need to find out what my baseline reading was for really good science!) (Love my city GP...) But I had better go to work, after another cup of coffee....More on B12 from me soon...

Outlier said:

atrial fib. appears to have stopped.

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I find this interesting.

Rightio. I'm not sure if this is interesting for folks re metformin and B12 levels, but I shall share my findings just in case.

My last result pre-metformin was 243 picomoles per litre (pmol/l).

Five months post-metformin (2 x 500 mg per day) is 172 pmol/l.

Years previously readings were in the same ballpark as the pre-metformin above - 277, and 261. (When my on-to-it city GP started testing me to provide a baseline in the event I started taking metformin – she is a gem!)

On my online records the new country GP wrote - wnl for the 172 (I had to look it up - Within Normal Limits) (don't we love unknown acronyms - not!).

I was suspicious, because it seemed at the lower end of the scale, and, only 2 numbers off the borderline range provided previously by the city labs (110-170 pmol/l).

The country-region lab had a normal range of 110-650 pmol/l, no stated borderline range.

I believe my roused suspicions were warranted. I have had a few symptoms since taking met – mouth ulcers, unusual fatigue, intermittent lethargy, nausea as obvious side effect of met, early-on an unusual negative mood presentation, which has largely stopped, thank goodness.

Two numbers away from being officially on the border, and the symptoms, I figured it should have been worthy of comment, and supplementation suggested, at best supplementation on prescription. (Apparently there is an intranasal gel out there now , to supplement B12. How cool!)

As for folate (B6). There is a reduction but not such a big one. I went from

22 last result to
18.5

Country-region lab normal range – 7.0-45
City-region labnormal range 5.0-45
City region lab borderline range 7-10

More things to think about, weigh up, consider, with type two, whether or not to use medication, what supplements if any, to take.

Having read the effects of Metformin I automatically started taking B12 supplements daily. Seen three different doctors since diagnosis and once seen the DBN with one planned phone call and not one mentioned the risk of B12 deficiency. Will certainly mention testing next blood test.

Japan have a range starting at 500 rather than the approximate 170/180 the uk Canada and USA have. (They also have much lower rates of Alzheimer’s. Possibly coincidence.) Many medics claim lower end range of b12 misses a large number of deficiencies.

mariavontrapp said:

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.

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Hi, can you not ask for a full blood count including vitamins? I did and found out my ferritin levels were higher than normal which was making sleepy, heady etc. My iron levels, vitamin d and b12 were checked also so I believe it can be done. Perhaps ask your gp.

If the GP won't oblige, I find asking the phlebotomist at the time of the test is much easier.

BTW - I've been popping B12 supplementary tablets like they were candy. (Love that phrase! Oh dear. "LIke candy in the bad old days" it should be ammended to perhaps?) But ripping through the vitamin bottle.

I was reassured that you can't get an overdose of B12, as it is water soluble, and you just pee it out if it gets too much for you to use.

My energy levels have picked up, and an intermittent general feeling of malaise has stopped, at any rate. I am hugely relieved.

Hello. This is an interesting thread because I (and probably many others like me) had never considered B12 as a factor. I have been on Metformin since early 2011 (and diaformin for a few years prior to that). I was then switched to Jardiamet (empagliflozin & metformin) in 2016 and then back to just metformin in early 2022 - due to some Australian government ruling not permitting us to combine empagliflozin and Ozempic (semaglutide).

In a blood test a couple of years ago, my B12 levels were extremely low. I had to have a few B12 injections. After the first course, my nurse (at my GP practice) suggested that instead of the needle I should have the B12 spray (under the tongue, once a week), which is less painful and a lot easier. Obviously you'll need your own GP's advice, but this fairly cheap, OTC medicine (BioCeuticals B12 spray) is working for me. My B12 levels are back to "normal" and I include the B12 test in my quarterly blood tests, just to be sure. Cheers, DB1.

Well just got the latest B12 results back.

A little preface to outline details

Horrific accident end of 2021, left me in so much pain, requiring too many meds.

In a poor state mentally, so I dropped the Metformin while in HDU, and once home.

No testing since 2019 (covid lockdowns etc)

Original B12 was low 300's. (2019)
Began supplementing just after

2022 march (3 months after accident)
Home visit put my B12 at mid 200’s

I'd stopped met from Dec 2021 so around 3 months met free and supplementing B12 (sub lingual ) daily .

Tested Nov 2022
B12 mid 400's.

Now have to say, due to injuries I wasn't able to cook for myself during most of the year, but am now much more able to look after myself.


So MIGHT have been a much looser LCHF diet (just ate what I was given, & too grateful for that to be too demanding of food replacements etc )

Or may have been the zero Metformin during that time.

Either way, I feel it's in a much better place now.

Back on Metformin now most other meds required less often
Still supplementing as I still think it offers me a benefit (others free to disagree )

Shall be interesting to see what next years testing brings .

Apparently any supplementation within 4 months of a serum b12 gives an unreliable result according to many b12 information sources, and apparently even NICE say not to test during treatment. If you’re able to get an active b12 test (thriva medichecks in the uk) the withdrawal period is just a week or so and this test shows the accessible to cells b12 (apparently a fair proportion of serum b12 is unusable).

Hi Jjraak. I'm sorry to hear about your bad accident and subsequent pain, but I'm glad that you are on the mend now. I have never given up the metformin (except for a few days around some minor surgery) but metformin has never troubled me - that I know of, anyway. However my B12 levels dropped to 194 in 2016 (but no one picked it up then, until 2020). After the Neo-B12 jabs in mid-2020 (noting what HSSS has said), and the weekly B12 spray ever since, my B12 levels are now 313 (my next blood test is due next week).

As you no doubt know, the ideal B12 range (according to the internet) is between 200 and 950 (quite a large range!) . The highest I've ever been is 590, which was not long after the course of B12 injections. Accordingly, I can't say for certain that metformin is THE culprit for my low B12 levels, in my case, as my 1000mg dose of metformin per day hasn't changed for many years. Likewise, I don't know what my HbA1c would be without metformin (it was 8.9 - or 74 in SI units - in 2013). Cheers, DB1.

DiabeticBloke1 said:

Hi Jjraak. the ideal B12 range (according to the internet) is between 200 and 950 (quite a large range!) .

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That’s likely not an ideal range. It’s usually a lab reference range. Not the same thing. Lab ranges are what they typically see in 95% of tests (baring in mind people are usually getting tested for a reason), the other is where a body functions best.

Hi @DiabeticBloke1

Pleased to see you tolerate the meds so well & numbers seem to be stabilising...(though do note the high of 500 )

Best wishes it carries on, with next week's tests.

Looking back over thread/s related to B12, I think it's clear there can be other reasons for a decline in B12. (age being one)

But the potential for a deterioration in B12 levels was raised on the forum due to the warning that Metformin COULD impact diabetics taking it.

At the very least we need to be aware it can be an issue for some & to get it checked if possible.

I personally had to ask for it to be tested, something I think should be completed once a year if on Metformin

As you know too well, it's easy to not be aware, and then require injections, etc .

I quite like that it's being talked about.

I think we are all deserving of as much knowledge about how diabetes & the methods used to treat it works & affects us.
But what people do with that knowledge is for individuals to decide for themselves.

And if it turns out not to impact others, all the better in my book.

As long as those it does affect are made aware of the possibility it can, as close as possible to DX.

Whether they pay attention or not is up to them.

We can only inform others & look after ourselves as best we can.

Cheers .

HSSS said:

That’s likely not an ideal range. It’s usually a lab reference range. Not the same thing. Lab ranges are what they typically see in 95% of tests (baring in mind people are usually getting tested for a reason), the other is where a body functions best.

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Hi HSSS. I got that figure (200 - 950) from a health-related website. My pathology lab's recommended range for B12 is actually: 162 to 811. However, that too probably varies from lab to lab. I try to always get my blood tested at the same laboratory each quarter, so that hopefully we can compare "apples with apples", if you know what I mean. Cheers, DB1.

For my test
NHS.
Range was ...

For which I suspect the lower limit is too low.
Bearing in mind how often 'figures' can be just referred to as 'normal', no matter how near the edge we might be.

I would seriously advise anyone following a plant based diet and especially if taking Metformin, to supplement with B12. Some vegetarian foods are specially fortified in this respect but apparently iron deficiency anemia is more prevalent in non meat eaters. B12 deficiency is a major cause in this anemia, but also D3 which is also usually animal based. Beware of multivits and Vit B supplements since these do nort normally include B12. Neither does Brewers Yeast. B12 needs Vit C to help absorbtion of supplemented B12 and iron but not if eating animal products.

Mick1542 said:

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 ??

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Ihad this problem. It was soon solved when I took 500mg B12 tablets sublingually,ie just placed tablet uinder my tongue.

jjraak said:

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 .

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I have found the so called diabetes nurses absolutely useless. They have a very mechnical approach to management of diabetes and seem to be utterly ignorant of the real issues, even worse than the GPs.

Dr Snoddy said:

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.

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Well done, I am a T2 Diabetic exacerbated by having to take high Cortisone doses daily For an autoimmune disease. As you say not everyone experiences the side effects but should be aware of the possible side effects to take appropriate action if needed.