B12 deficiency and diabetes — should all patients with diabetes be given multivitamin tablets ? If not, who should get Vitamin B12 ? A 🧵
Vitamin B12 is a water soluble vitamin and its deficiency is pretty common in diabetes. How common ? Depends on the study we look at — but a rule of thumb is 1 in 10 random patients with diabetes may have vitamin B12 deficiency.
This risk is higher in some groups of patients. Before knowing who are at higher risk, basically there are only 3 ways a substance can become deficient in the body
- Poor intake — we don’t take it
- Poor absorption — we take it, but it is not getting absorbed
- Increased excretion — not relevant for B12
So we have higher risk patients who don’t get enough B12 and who don’t absorb it well. These include 1. Vegan 2. Metformin treated, especially for > 4 years 3. Celiac disease — uncommon in south 🇮🇳, but more common in north 4. Elderly 5. Bariatric surgery 6. Taking other drugs — eg. Proton pump inhibitors
Symptoms aren’t always clear cut anemia or neuropathy. B12 deficiency can present in a variety of ways and maintaining a high index of suspicion, especially in one the high risk groups mentioned above helps.
What can the high risk groups(eg.Vegans) do to prevent B12 deficiency ?
- Supplements — tablets, sublingual, spray etc
- Fortified products — plant milk, cereals
- Food additives — nutritional yeast (also known as nooch)
- Improving calcium intake ➡https://pubmed.ncbi.nlm.nih.gov/10977010/
How do I know if I have B12 deficiency ?
your doctor might suspect from your history and routine blood tests. — Check serum B12 levels — in some cases, Homocystein, MMA levels may be useful
If found to be deficient, then the patient should be treated with Vitamin B12. There are two kinds available in India — cyanocobalamin — synthetic , cheaper — methylcobalamin — natural, costlier The difference between them is effectiveness is minimal, with methylcobalamin being marginally better.
Given that vitamins are generally safe, why go through this testing at all. Can I just take it and forget about it?
- Taking one more tablet is additional burden
- Some vitamins may not be suitable for you
- Niacin can increase blood sugar a bit
- Vitamin E interacts with blood thinners and may increase risk of bleeding
- Some components may not be suitable
- chromium intake may not be safe in chronic kidney disease*
- Unexpected side effects — eg. alpha -lipoic acid causing autoimmune hypoglycemia (https://twitter.com/karthik2k2/status/1628674965984755713?s=20)
So what should you do? 1. Discuss with your doctor and get tested if you are at risk of vitamin deficiency 2. Improve diet diversity and make your plate a rainbow 3. Take supplements in the dose / duration advised by your doctor
