Metformin Side Effects. Metformin and B12 deficiency.

‪@thevoiceofdiabetes‬
In this video, Diana Bytyqi, DNP, FNP-C discusses the link between metformin use and B-12 deficiency.
Vitamin B-12 is essential in keeping our bodies nervous system and blood cells healthy. Deficient in this vitamin can lead to numerous types of symptoms, not limited to, numbness and extreme fatigue.
People on metformin for diabetes management are at higher risk for developing vitamin b-12 deficiency. Therefore, it is important to have b12 levels checked with people who have been on metformin for a long time. Normally, b12 levels should be greater than 300 pg/ml.
Other risk factors for b-12 deficiency include vegetarian diet or people who may have had gastric surgeries in the past. The best source of b-12 is found in animal products.
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[@lorikabytyqi5953]

never thought of Diabetes and b-12 deficiency as being related. very interesting information

[@thevoiceofdiabetes]

Unfortunately, missed so many times. Easy solution, luckily :).

[@mariojakova5155]

lots of good information in this video for a medication that is so widely used. Thank you for sharing

[@maxa3552]

good into. no one brings this up and i've been on metformin for several years. I don't think my b12 has ever been checked. thanks doc

[@chitang7923]

Thank you for talking about this important topic!

[@thevoiceofdiabetes]

Thank you Dr. Tang!

[@lena768]

Your videos are phenomenal!!!

[@thevoiceofdiabetes]

Thanks for the feedback, Lena!

[@wellingtonsboots4074]

Thank you. Glad I watch this channel. I already get burning and tingles around my feet and I do take metformin. Must check my vitamin B . Thanks informative as always

[@thevoiceofdiabetes]

Yes, have any of your medical providers add it on. Good luck!!

[@edonabytyqi5294]

Very interesting, thank you!

[@thevoiceofdiabetes]

My pleasure!

[@xavern81]

Thanks for this video, now I know more about this med which I have been taking since diagnosed maybe 5 years ago. Back in August 2021, I was in a hospital for Covid-19 [category 4] , with need of oxygen supplementation for almost 10 days. I survived and since given meds from the hospital (and later government clinics). However I struggled pretty badly with GI issues in the mornings. Switched to extended release ones in January and with a reduction of meds (2g to 1g) by the family physician at the clinic, seems working okay now. Also seeing a private practitioner (vs govt clinic physician) and is prescribed a med not available in govt clinics - Forxiga. Just sharing since I am reading comments from others in the community

[@HiddenSeven]

hello doctor i have two question:
1- since metformin can reduce b12 absorption i am wondering is this effect only temporary during the day? for example happens just for an hour? cause i dont understand if it reduces the absorption then wouldn't oral b12 tablets also have difficulty being absorbed?
2-i have heard that b12 tests arent always accurate so i was wondering when should a patient ask for Homocysteine tests and Methylmalonic Acid (MMA) tests ? since i read those would give a better picture

[@thevoiceofdiabetes]

Hi Plugged In, 2 great questions.
1. Metformin affects the absorption over a long period of time. Let’s say you were on metformin for a few months, you’d likely have no issues. However, for people who have been on it for a while, a year +, because of the mechanism it works in ( I have a video on that, please check it out as you may enjoy it) it impairs the absorption of b12, therefore those people will require b12 supplementation ( sometimes injections, most times just over the counter b12). Once the b12 is normalized, some patients take b12 only a few times a week, others stay on it chronically. Either way, I continue to monitor their levels every 6 months to 1 year.
So to answer the question, it’s reduces the absorption over a long period of time not just temporarily or for one day…
2. That’s a good point. We use those tests to detect mild b12 deficiency if we are suspecting it. Not because b12 tests are inaccurate, but if I suspect the patient may be developing b12 deficiency and want to catch it very early on, we’d order it. Remember, these tests can be falsely elevated in different patient populations, such as those who have kidney disease, etc. therefore, I prefer b12 tests especially in those who are symptomatic and are on metformin. I rarely have to order these unless I get a b12 that’s normal but I am still suspecting b12 deficiency (very early stage).
I hope I was able to clarify your questions. Please reach out to me if you wish me to go into further detail. Good luck and thanks for the great questions.

[@josegregorioh100]

What tipe of b12 gets more absorption?

[@alexv259]

After number of years taking metformin (4x 500mg/day) few months ago tested for B12 at 221 the range with my age is 232-1245. So I bought Nature Bounty sublingual B12 on Amazon. I wanted my doctor gives me the injection form so I inject it into my muscle. Need to be tested after started the sublingual b12. Question: is it harmful to get monthly b12 injection?

[@thevoiceofdiabetes]

Thanks for sharing that with us. No, monthly injections are not harmful. As long as your levels are within the target range, there should be no issues.

[@oldphilosopher9143]

Have been recently diagnosed pre-diabetic to type two diabetes. I would like to know : IS THERE ANY THING I CAN DO TO BEAT THIS DIABETES DIAGNOSIS. Facts; Blood sugar 147, A1C 6.5 Am Taking Metformin, bouts of diarrhea, Extremely low energy levels, sleeping 3 hours during the day. Thank you

[@billw715]

I have only been on Metformin for two months and my B-12 level was at 273 after 5 weeks being on Metformin. Also, not sure of the metric level but my folate was 33.0 and the upper limit states 25.0. Should this be addressed by my physician?

[@thevoiceofdiabetes]

Hi Bill, I hope you are doing well on metformin and that it is working for you. B12 level at 273 (assuming the lab uses the same parameters as Quest does)-- then that would be considered a low b12 level. Therefore, patients with b12 levels in that range are recommended to start b12 over the counter daily--- would recheck the level again in 3 months. Hope this helps. Best of luck

[@billw715]

@@thevoiceofdiabetes Thank you Diana for your reply. In general, what dosage would be suggested for someone who has low B12 levels? I see there are ranges from 1000 to 5000 mcg. And, when do people require shots of B12 when low?

[@thevoiceofdiabetes]

@@billw715 hi Bill, great question. I normally recommend 1000mcg and then rechecked levels in 2-3 months. I use b12 injections If a patients levels are in the 100’s for a few months then switch over to oral b12. If they’re levels are near 300, I normally recommend over the counter. It’s also patient preference. Some do not want injections no matter what so those patients will normally take 2000mcg b12 instead of 1000mcg. Hope this helps

[@billw715]

@@thevoiceofdiabetes It does. Thanks again for your reply. :)

[@Ann336-]

I'm a diabetic I feel all the symptoms and my feets are very weak. Please tell me what to do.

[@thevoiceofdiabetes]

Hi Tania, are you seeing an endocrinologist?