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Metformin And Vitamin B12 Deficiency Symptoms

Metformin-induced Vitamin B12 Deficiency Presenting As A Peripheral Neuropathy

Metformin-induced Vitamin B12 Deficiency Presenting As A Peripheral Neuropathy

Home / Specialties / Neuropathy & Pain / Metformin-induced Vitamin B12 Deficiency Presenting as a Peripheral Neuropathy Metformin-induced Vitamin B12 Deficiency Presenting as a Peripheral Neuropathy Chronic metformin use results in vitamin B12 deficiency in 30% of patients. Exhaustion of vitamin B12 stores usually occurs after twelve to fifteen years of absolute vitamin B12 deficiency. Vitamin B12 deficiency, which may present without anemia and as a peripheral neuropathy, is often misdiagnosed as diabetic neuropathy, although the clinical findings are usually different. Failure to diagnose the cause of the neuropathy will result in progression of central and/or peripheral neuronal damage which can be arrested but not reversed with vitamin B12 replacement. Metformin has been available in the United States for approximately fifteen years. Vitamin B12 deficiency, which may present without anemia and as a peripheral neuropathy, is often misdiagnosed as diabetic neuropathy, although the clinical findings are usually different. Failure to diagnose the cause of the neuropathy will result in progression of central and/or peripheral neuronal damage which can be arrested but not reversed with vitamin B12 replacement. Metformin is now recommended as initial therapy for Type 2 diabetes. Because of this, metformin used either as monotherapy or in combination with other antidiabetic oral agents and insulin has become the most widely utilized antidiabetic oral agent. Metformins best known and most feared side effect, i.e. lactic acidosis almost never occurs if metformin is not used inappropriately.The common side effects of metformin are gastrointestinal and can be overcome by initiating metformin therapy at a lower dose and slowly increasing the dose, by giving metformin after meal Continue reading >>

Metformin-induced Vitamin B12 Deficiency Presenting As A Peripheral Neuropathy.

Metformin-induced Vitamin B12 Deficiency Presenting As A Peripheral Neuropathy.

South Med J. 2010 Mar;103(3):265-7. doi: 10.1097/SMJ.0b013e3181ce0e4d. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy. Southside Endocrinology and Division of Diabetes, Endocrinology, and Metabolism, University of Alabama Medical School, Birmingham, AL 35205, USA. [email protected] Chronic metformin use results in vitamin B12 deficiency in 30% of patients. Exhaustion of vitamin B12 stores usually occurs after twelve to fifteen years of absolute vitamin B12 deficiency. Metformin has been available in the United States for approximately fifteen years. Vitamin B12 deficiency, which may present without anemia and as a peripheral neuropathy, is often misdiagnosed as diabetic neuropathy, although the clinical findings are usually different. Failure to diagnose the cause of the neuropathy will result in progression of central and/or peripheral neuronal damage which can be arrested but not reversed with vitamin B12 replacement. To my knowledge, this is the first report of metformin-induced vitamin B12 deficiency causing neuropathy. Continue reading >>

Diabetes And B12: What You Need To Know

Diabetes And B12: What You Need To Know

Vitamin B12 is necessary for a healthy nervous system and healthy blood cells. The best way to get vitamin B12 is through your diet. This important vitamin is found in meat, fish, poultry, and dairy products. If you don’t eat enough of these foods, it could leave you with a deficiency. Consuming enough vitamin B12 isn’t the only problem. Your body also needs to be able to absorb it efficiently. Some medications like Pepcid AC, Prevacid, Prilosec, and Zantac, as well as others used to treat acid reflux, peptic ulcer disease, and infection, may make it harder for your body to absorb B12. Another medication that may interfere with B12 absorption is metformin, a common type 2 diabetes treatment. Simply having diabetes may make you more prone to B12 deficiency. A 2009 study found that 22 percent of people with type 2 diabetes were low in B12. Read on to learn the symptoms of B12 deficiency, what it could mean for your overall health, and what you can do about it. Symptoms of vitamin B12 deficiency may be mild at first, and not always obvious. If you’re slightly low on B12, you may not have any symptoms at all. Some of the more common early symptoms are: tiredness weakness loss of appetite weight loss constipation It may be easy to dismiss these as minor complaints, but over time, insufficient B12 can lead to bigger problems. Very low levels of B12 can result in serious complications. One of these is called pernicious anemia. Anemia means you don’t have enough healthy red blood cells. This deprives your cells of much-needed oxygen. According to a study in the Journal of Oral Pathology Medicine, less than 20 percent of those with a B12 deficiency experience pernicious anemia. Symptoms of anemia include: fatigue pale skin chest pain dizziness headache You may even lose Continue reading >>

Metformin And Risk For Vitamin B12 Deficiency

Metformin And Risk For Vitamin B12 Deficiency

Metformin (brand names Glucophage, Glucophage XR, Fortamet, Riomet, Glumetza, and others) is a popular and highly effective oral diabetes drug used to help manage Type 2 diabetes. This drug works by lowering the amount of glucose made by the liver and by making the body’s cells more sensitive to insulin. Metformin also has some other beneficial effects in that it may help lower blood lipid, or fat, levels (cholesterol and triglycerides) and can, in some people, promote a small amount of weight loss. Metformin can be used with other diabetes pills and with insulin. Side effects of taking metformin are relatively rare, the most common being bloating, nausea, and diarrhea, all of which are temporary. Some people shouldn’t take metformin, including people with kidney disease, liver disease, or congestive heart failure, for example, because of an increased risk of a potentially fatal condition called lactic acidosis. In recent years, there’s been some concern over the risk of vitamin B12 deficiency in people who take metformin. Vitamin B12 (also known as cyanocobalamin or cobalamin) plays many important roles in the body, such as keeping your blood cells and nervous system in tip top shape. There’s also some evidence that vitamin B12 may help prevent heart disease and possibly even Alzheimer disease (the jury is still out on this one). This vitamin is found primarily in animal foods, such as beef, seafood, eggs, and dairy products, which is why some vegetarians are at risk for a B12 deficiency. Elderly people are often at risk for deficiency as well, due to problems with absorption from the gastrointestinal tract. Symptoms of B12 deficiency include certain types of anemia, neuropathy, memory loss, confusion, and even dementia. So, why would taking metformin possibly Continue reading >>

Metformin And Risk Of Vitamin B12 Deficiency

Metformin And Risk Of Vitamin B12 Deficiency

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Metformin and Risk of Vitamin B12 Deficiency Hello i have had Diabetes since 1999 --of course i was then on the Norm metformin but the diabetic nurse said after 7 years it's time to go on insulin ?? i was controlling my diabetes ok but she said it was time to go on insulin and after a few months i came off the metformin as i was controlling my sugar better with the slow release insulin the metformin well what can i say i had had diarrhoea for years and found out that was the cause so i stopped taking metformin and just used the insulin. the doctor agreed. i now have changed Doctors as my old doctor retired I went to see the Doctor about getting off the insulin and he prescribed the 1000mg metformin releasing tablet which is helping me reduce my insulin but at what cost. i thought i was not having any side effects well no Diarrhoea. I have been having headaches, always tired, and the worse one---Life-threatening allergic reaction called anaphylaxis , in which you may have trouble breathing, your tongue swells and/or throat closes up, i have had to got hospital 7 times in england and once in tenerife for injections to make me breathe Question Can the Metformin SR cause my B12 Deficiency Have you considered changing your diet in order to reduce the need for medication? Carbohydrates are the main culprits in raising blood glucose levels - all carbs convert to glucose once inside the system. Starchy ones are the worst, plus any that are made with flour. Bread, potatoes, rice, pasta, breakfast cereals etc. Art Of Flowers I reversed my Type 2 Well-Known Member Metformin can cause vitamin B12 deficiency which gives rise to neuropathy symptoms. If you eat a lo Continue reading >>

Metformin And Vitamin B12 Deficiency

Metformin And Vitamin B12 Deficiency

Q: I am a 72-year-old woman currently taking metformin for diabetes. My diabetes is well controlled with this medication, but I heard from a friend that metformin can cause a deficiency of vitamin B12. Can you tell me if this is true, and if so, what I can do about it? I do not want to stop taking this medication. A: Many patients who are taking metformin, as well as quite a number of their physicians, are not aware that a deficiency of vitamin B12 (cobalamin) is a potential side effect of the drug. Studies have found that 10-30% of patients taking metformin experience below-normal levels of serum B12; these individuals previously had normal serum B12 levels.1 So your friend is right, and you do have reason to be concerned. However, it is possible to avoid this problem and to safely continue taking metformin by adding daily supplements of vitamin B12 and calcium. Metformin has also been found to interfere with calcium metabolism, which can affect B12 absorption, so calcium supplements are also recommended for metformin patients. Understanding Diabetes About 20% of North Americans over the age of 65 have type 2 diabetes, which too often becomes a chronic, progressive, and irreversible disease. An even greater percentage of American adults suffer from metabolic syndrome or pre-diabetes, which may cause more arterial disease than type 2 diabetes, since so many aging people are affected. The causes of type 2 diabetes (as well as metabolic syndrome) include genetics and normal aging, as well as environmental factors such as obesity, poor diet, and a sedentary lifestyle. Patients with type 2 diabetes initially suffer from “insulin resistance,” which means that the body’s cells do not respond appropriately when insulin is present. The body responds initially by overprodu Continue reading >>

Metformin Linked To B12 Deficiency

Metformin Linked To B12 Deficiency

Peripheral Neuropathy Patients Who Take Diabetes Drug May Have Vitamin B12 Deficiency June 8, 2009 -- The popular diabetes drug metformin may contribute to vitamin B12 deficiency , according to a new study. Researchers found that 40% of type 2 diabetes patients using metformin had vitamin B12 deficiency or were in the low-normal range for the essential vitamin. And 77% of metformin users with vitamin B12 deficiency also had peripheral neuropathy , a common form of nerve damage associated with type 2 diabetes . Peripheral neuropathy is a type of nerve damage most often characterized by pain, tingling, and numbness in the hands and feet. Because peripheral neuropathy is such a major complication of diabetes , researchers say the results suggest that people using metformin be screened for vitamin B12 deficiency or supplemented with vitamin B12 . Also, anyone already diagnosed with peripheral neuropathy who uses metformin should be screened for vitamin B12 deficiency. Vitamin B12 is primarily found in meat and dairy products. In the body, it plays a critical role in making red blood cells and keeping the nervous system functioning properly. Symptoms of vitamin B12 deficiency include anemia (low red blood cell count), depression , or dementia ; but often there are no symptoms if the vitamin levels are just a little low. B12 deficiency can lead to nerve symptoms similar to that of diabetic peripheral neuropathy, although the researchers note that they cannot be certain that B12 deficiency contributed to the peripheral neuropathy seen in their study. Vitamin B12 Screening Urged for Metformin Users The study, presented this week at the American Diabetes Associations 69th Annual Scientific Sessions, looked at the prevalence of vitamin B12 deficiency in 76 people with type 2 dia Continue reading >>

Long-term Metformin Use Linked With Vitamin B12 Deficiency

Long-term Metformin Use Linked With Vitamin B12 Deficiency

With commentary by Jill Crandall, MD, professor of clinical medicine, Albert Einstein College of Medicine, New York. Long-term use of the popular diabetes drug metformin is linked with vitamin B12 deficiency and anemia, according to new research that solidifies some previous research. "We have essentially confirmed what many smaller studies have suggested," says Jill Crandall, MD, professor of clinical medicine at the Albert Einstein College of Medicine, the Bronx, who led the new study. "There is a small but significant risk of developing Vitamin B12 deficiency when people take metformin." The finding, she adds, ''has implications for the consequences of B12 deficiency." These can include cognitive impairment, nerve problems (neuropathy) and anemia (low red blood cell count). B12 is crucial for the proper formation of red blood cells, for neurological functioning and for making DNA. The link between taking the popular diabetes drug and deficiencies in vitamin B12 has been discussed as long ago as 1969, according to Dr. Crandall. However, few studies have looked at long term use, as her new study has done, tracking people for up to 13 years. The new study was published online Feb. 22 in the Journal of Clinical Endocrinology & Metabolism. Overview of the Metformin Study The researchers evaluated more than 2,000 men and women enrolled in the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study. In these studies, researchers enrolled overweight people who had prediabetes (blood sugar levels higher than normal but not high enough to be termed diabetes) to see if modest weight loss or treatment with metformin could prevent or delay the onset of type 2 diabetes, then followed them to see if the effects endured. Half of the participants were given 850 Continue reading >>

Should Metformin Come With A B12 “prescription”?

Should Metformin Come With A B12 “prescription”?

Metformin is widely considered to be a first-line treatment for type 2 diabetes, and it has been prescribed to over 120 million people worldwide. It’s a safe bet that a large proportion of those people are deficient in vitamin B12, thanks to the use of this medication. While the percentages vary, studies consistently show that metformin impairs vitamin B12 absorption. In one multicenter randomized trial, metformin was associated with a 19% decrease in vitamin B12 concentration compared to placebo (de Jager J, et al. BMJ (Clinical Research Ed.) 2010; 340, c2181). In a cross-sectional cohort study, patients on long-term metformin therapy had 26.7% lower cobalamin levels, 21.6% lower holotranscobalamin and 9.7% higher homocysteine compared with people in the control group (Hermann L, et al. The British Journal of Diabetes & Vascular Disease. 2004; 4(6), 401–406). Commonly cited figures are that 10-30% of people with diabetes who take metformin will have decreased vitamin B12. This is most likely an underestimation. Given its impact on vitamin B12 absorption, it might make sense for doctors to consider pairing B12 supplements with their metformin prescriptions. Signs of Deficiency Vitamin B12 is the largest and most complex of the vitamins. It is the only one that contains a metal ion—cobalt--and the only one that requires a transporter in the small intestine. It is required for proper red blood cell formation, neurological function, and DNA synthesis. It is also a co-factor for methionine synthase and L-methylmalonyl-CoA mutase. The former is needed for the formation of S-adenosylmethionine (SAMe), a universal methyl donor for almost 100 different substrates. Symptoms of B12 deficiency include: megaloblastic anemia, fatigue, weakness, constipation, loss of appetite, Continue reading >>

B12 Deficiency Caused By This Popular Drug

B12 Deficiency Caused By This Popular Drug

People taking metformin for several years may have an increased risk of vitamin B12 deficiency and anemia New research showed nearly 20 percent of those taking metformin had borderline low vitamin B12 levels compared to 10 percent of those taking a placebo If you take metformin, the researchers recommend monitoring your vitamin B12 levels By Dr. Mercola Vitamin B12 is a water-soluble vitamin that your body does not make, which means you must get it via your diet or supplements. Vitamin B12, along with other B vitamins, is used by your body to convert the carbohydrates you eat into glucose that your body uses for energy. Vitamin B12 also plays a role in the production of DNA and RNA and works closely with folate to make red blood cells and produce S-adenosylmethionine (SAMe), which is involved in immune-system function and mood.1 Vitamin B12 is also important for the maintenance of your central nervous system, including the conduction of nerve impulses and producing the myelin sheath, which protects and "insulates" your nerves.2 A deficiency in vitamin B12 can be difficult to detect and may lead to numerous, sometimes-irreversible issues with your health, including nerve damage. If you take the diabetes drug metformin, it's important to be aware that you're at an increased risk of this potentially serious vitamin deficiency. Diabetes Drug Metformin Linked to Vitamin B12 Deficiency Researchers from Albert Einstein College of Medicine in New York City used data from the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study to look into the effects of metformin use on vitamin B12 levels. Data from participants taking metformin twice daily or those taking a placebo were included, and the participants had their vitamin B12 levels measured after five a Continue reading >>

Metformin-related Vitamin B12 Deficiency

Metformin-related Vitamin B12 Deficiency

Medical and Geriatric Unit, Shatin Hospital, New Territories, Hong Kong, China Address correspondence to: Kin Wah Liu. Email: [email protected] Search for other works by this author on: Medical and Geriatric Unit, Shatin Hospital, New Territories, Hong Kong, China Search for other works by this author on: Medical and Geriatric Unit, Shatin Hospital, New Territories, Hong Kong, China Search for other works by this author on: Age and Ageing, Volume 35, Issue 2, 1 March 2006, Pages 200201, Kin Wah Liu, Lok Kwan Dai, Woo Jean; Metformin-related vitamin B12 deficiency, Age and Ageing, Volume 35, Issue 2, 1 March 2006, Pages 200201, Metformin is an invaluable hypoglycaemic agent. We report two cases who had symptomatic vitamin B12 deficiency related to metformin use; the mechanisms are discussed. The clinician must be aware of the possibility of metformin-associated B12 deficiency in users who suffer cognitive impairment, peripheral neuropathy, subacute combined degeneration of the cord or anaemia. Metformin , elderly , Vitamin B12 deficiency The UK Prospective Diabetes Study Group 34 showed metformin to be an effective hypoglycaemic agent with less weight gain, and decreased hypoglycaemia, myocardial infarction, stroke and death [ 1 ]. Gastrointestinal side-effects and lactic acidosis related to metformin are commonly recognised; however, the associated vitamin B12 deficiency is less well known. Two cases illustrate the problem. An 82-year-old Asian non-vegetarian had type 2 diabetes mellitus for 20 years. Medications included metformin 1 g BD for many years and famotidine for gastritis. She presented with memory loss and progressive leg weakness. Her legs were hypotonic with decreased power, absent reflexes and bilateral extensor plantar reflexes. Vibration and propriocept Continue reading >>

Vitamin B12 Deficiency In Diabetic Subjects Taking Metformin: A Cross Sectional Study In A Lebanese Cohort

Vitamin B12 Deficiency In Diabetic Subjects Taking Metformin: A Cross Sectional Study In A Lebanese Cohort

Highlights • Thirty three percent of the patients were found to have borderline values of the serum vitamin B12 (148–220 pg/dl) while 22.5% had a clear, unambiguous deficiency (levels less than 148 pg/dl). • We found a highly significant inverse correlation between the dose and duration of metformin treatment and the serum levels of vitamin B12. • Furthermore, both borderline and low levels of vitamin B12 were associated with the presence of different neuropathies and macrocytic anemia in a dose dependent manner. • Based on our results, we strongly recommend the routine screening of T2D patients on metformin for vitamin B12 deficiency due to its high prevalence and the significant clinical effects it may result in. • Furthermore, we recommend, based on our data to start treating patients with B12 once a borderline or low level is detected. Abstract Metformin is the only biguanide derivative used to treat type 2 diabetes mellitus (T2D). Several studies documented that its use contributes to vitamin B12 deficiency in 10–30% of diabetics. The incidence of deficiency varies among populations and studies reported. There has been no reports documenting this incidence in the Middle East and Lebanon. The objectives of this study were to establish the incidence of vitamin B12 in our population, to investigate and characterize any specific associations between taking metformin and vitamin B12 deficiency to establish clear recommendations based on this data. During the first 6 months of 2015, we conducted a cross sectional study on 200 Lebanese individuals. The cohort consisted of subjects with an established diagnosis of T2D and who have been on metformin for at least three months. The patients were subjected to a questionnaire, medical record review, and vitamin B1 Continue reading >>

The Low Down On Metformin And Vitamin B12 Deficiency

The Low Down On Metformin And Vitamin B12 Deficiency

So many women with PCOS are prescribed Metformin (an insulin-sensitizing drug) to manage their Polycystic Ovarian Syndrome. And for good reason too. Metformin has been shown to improve many aspects of PCOS, including weight loss, fertility and improved testosterone levels (1). But, it also leads to Vitamin B12 deficiency if used at high doses or for long periods of time. So, here’s what you need to know about Metformin and Vitamin B12 deficiency with PCOS. What is Metformin? As I have already mentioned, Metformin is an insulin sensitizing drug that is often prescribed for women withPCOS. It works by decreasing absorption of glucose through the intestines, lowering the amount of glucose produced by the liver and making the body more sensitive to the insulin that is being produced. The overall effect of Metformin use for PCOS is lowered testosterone levels, improved ovulation and fertility as well as a more regular menstrual cycle. This is all sounding good, right? Well, it is good although there are some nasty side effects. A full discussion on Metformin is not going to be dealt with now, though. I really want to hone in on Metformin’s effect of Vitamin B12 levels as this could be affecting you right now. A free 6 lesson course that has helped women with PCOS around the world learn how to see lasting changes in their PCOS symptoms. Ready to join? Vitamin B12 Vitamin B12 is a vitamin that is vital for the body’s functioning. It is important for red blood cell formation, neurological function and DNA formation. If you are deficient in this important vitamin, it could lead to anaemia and neurological problems. (including memory loss – something that I have seen cropping up more often in PCOS communities). (2) Metformin and Vitamin B12 Right, so this is where it gets Continue reading >>

Should You Take B12 Supplements If You Take Metformin?

Should You Take B12 Supplements If You Take Metformin?

Metformin is the most widely prescribed medication to treat diabetes (usually type 2 diabetes) in the world. Its effectiveness equals or exceeds many of the other oral medications available and has an excellent safety profile for most individuals. However, for the last ten to fifteen years there has been a question as to whether metformin causes B12 deficiency in those who take the drug for long periods of time. Several studies and clinical cases have noted suboptimal blood levels of B12 in those who have taken metformin for extended periods. The National Nutrition and Health Examination reviewed the blood work on 1,621 people with diabetes, more than a third of whom were taking metformin, and demonstrated a reduction in serum B12 levels in people who took metformin compared to those who did not. But just because these people taking metformin had lower levels of B12 in their bloodstream doesn’t necessarily mean the B12 that’s there isn’t getting the job done. New measurements of B12 activity have indicated that although metformin does seem to reduce blood levels of B12, this may not reduce the vitamin’s effectiveness in carrying out it its functions in the body. When B12 doesn’t work the way it’s supposed to, levels of something called total plasma homocysteine (tHcy) go up. But newer studies looking at the levels of tHcy in people who take metformin have found that they have not been elevated. According to an article published this year in Diabetes Care, “low serum B12 alone without disturbances in the metabolic markers has no diagnostic value.” From a practical standpoint, this means that if a B12 deficiency is suspected from a serum B12 test, further testing should be undertaken before assuming the patient is B12 deficient. B12 is one of the B-family Continue reading >>

Long-term Metformin Use And Vitamin B12 Deficiency In The Diabetes Prevention Program Outcomes Study

Long-term Metformin Use And Vitamin B12 Deficiency In The Diabetes Prevention Program Outcomes Study

Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study Vanita R. Aroda , Sharon L. Edelstein , Ronald B. Goldberg , William C. Knowler , Santica M. Marcovina , Trevor J. Orchard , George A. Bray , David S. Schade , Marinella G. Temprosa , Neil H. White , Jill P. Crandall , and the Diabetes Prevention Program Research Group MedStar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; George Washington University (S.L.E., M.G.T.), Rockville, MD 20852; University of Miami (R.B.G.), Miami, Florida 33146; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; University of Washington (S.M.M.), Seattle, Washington 98185; University of Pittsburgh (T.J.O.), Pittsburgh, Pennsylvania 15260; Pennington Biomedical Research Institute (G.A.B.), Baton Rouge, Louisiana 70808; University of New Mexico (D.S.S.), Albuquerque, New Mexico 87131; Washington University School of Medicine (N.H.W.), St. Louis, Missouri 63110; and Albert Einstein College of Medicine (J.P.C.), Bronx, New York 10461 Address all correspondence and requests for reprints to: Jill Crandall, MD, Diabetes Prevention Program Coordinating Center, The Biostatistics Center, The George Washington University, 6110 Executive Boulevard, Suite 750, Rockville, MD 20852. E-mail: ude.uwg.csb@liamppd . Received 2015 Oct 22; Accepted 2016 Feb 17. Copyright 2016 by the Endocrine Society This article has been cited by other articles in PMC. Vitamin B12 deficiency may occur with metformin treatment, but few studies have assessed risk with long-term use. To assess the risk of B12 deficiency with metformin use in the Diabetes Prevention Program (DPP)/DPP Outcomes Study (DPPOS). Secondary analysis from the DPP/DPPOS. Participants were ass Continue reading >>

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