Metformin and B12

Brie912 said:

Hi, I'm type 2 diagnosed nearly a year ago. When I had my last HbA1c my nurse also decided to check B12 and found it was low at 109. I've had the 6 loading injections which finished about a month ago. I was getting symptoms like excessive tiredness, lightheadedness, needing to pee more frequently, low mood, pins and needles in hands and feet. I was really scared that my HbA1c had gone up but it seems that was all done to B12. Most of that improved a bit after the injections, but now I'm getting pins and needles again, not as frequently as before though. And I'm feeling depressed a lot of the time, but I have a history of anxiety and depression and uni is really stressful right now. And I'm still wanting to sleep all the time, but that might be the depression.

HbA1C in May 2018 was 96. September 2018 was 46. January 2019 43. I'm taking Metformin 500mg twice daily. I was on a strict low carb diet for the first 3 months but now I have no motivation to cook or exercise. I'm eating junk food to get through assignments. I think I could reduce the metformin to once daily and see if that improves my mood and I can try being stricter with the low carb. Does anyone have any suggestions? I'm planning to ask for B12 to be retested before my next injection in a couple of months. I've also read that when there's neurological involvement, like pins and needles, B12 should be every 2 months, not 3 months. I've also not been tested for folate levels or had FBC done, but I don't know how useful that will be.

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Any and all tests would be useful really, get everything put in order so you know how to work on it. Do you have a meter too? It may be that the junk and stress is causing a massive increase in your blood sugars so that could explain a few things. As for low carb try to keep it to simple things or perhaps prep a little ahead of time and just replace the junk with some snacks from the low carb camp. A lot of the mental issues too could be exacerbated by the rise in sugars too which leads to a dangerous spiral so just make sure to get everything you can covered. Wishing you the best of luck with your Uni work though!

Hi @Brie912

Eating junk food again will very likely cause you to feel tired etc so may I suggest you really try to get back to controlling your carb intake - you will feel so much better.

Do you have a meter to test your blood glucose levels? This is essential if you are wanting to see how different foods affect your glucose levels. Different people react differently to the different carbs. There are some good glucometers available which don't have such expensive test strips but I can't think of them just now. Maybe someone else can advise? Certainly check out the cost of test strips as these are the ongoing costs.

Regarding Metformin, you would be best continuing with the Metformin as it does help blood glucose levels to some extent but is also beneficial for other health reasons.

Once having B12 injections there is no value having further blood tests to check the levels. The levels will be likely to be quite high, although may drop as next injection becomes due. This is also documented in NICE guidelines. You're quite right in that, if neurology, maintenance injections should be 2 monthly, not 3 monthly. Also, again re NICE guidelines, or maybe BNF, the alternate day intitial injections should continue if neurological symptoms, until no further improvement. This has been recently updated, ie a couple of years ago, so not all HCPs are aware of this change.

Folate is essential for B12 to be able to work and therefore, YES, you must have Folate checked and it needs to be well within the normal range. It's not advisable to supplement unless your levels are low or in the low end of the range.

For further info/advice re B12/Pernicious Anaemia, may I suggest you take a look at the Pernicious Anaemia Society, and their forum (https://healthunlocked.com/pasoc/posts )

At least it seems you have a sensible Diabetes Nurse who understands how avoiding carbs will help to keep your glucose levels to the minumum. Also, I'm very pleased the nurse also recognised your B12 levels might not be too good. Just a shame s/he didn't appreciate the importance of Folate along with B12. Hopefully, s/he will be agreeable to have your Folate checked

Wishing you all the best

Perhaps you could suggest to your GP that you stop the metformin and go diet only for a while.
I was almost suicidal after only a few weeks on Metformin, in such a state that I stopped the tablets and went low carb. It took some time for the side effects to vanish entirely, but the episode was all the more galling for me never needing the tablets in the first place.
I was still suffering the side effects when my blood glucose was normal.

Hi @Brie912 I have a son at Uni and completely understand how difficult getting meals can be leading up to exams, course work etc. At those times you could your LC eating simple by buying in a selection of cold meats, cheese, mixed salad tub, olives, coleslaw, eggs to hardboil (do 6 at a time keep in shell in fridge so they dont smell will keep up to a week) or making a 3 egg omlette cooked in butter with a handful of spinach only takes minutes or scrambled eggs. Just some suggestions. All best wishes.