However, you can prevent the B-12 deficiency by taking a proper diet and supplements. While the recommended daily amount of vitamin B-12 for adults is 2.4 micrograms, higher doses have been found to be safe. With this condition, your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B; It is one of Treatment Of B12 Deficiency In Diabetes Patients. Bookshelf Vitamin B-12 deficiency is not common in the U.S. Vitamin B12 is an essential vitamin, and deficiency generally occurs with inadequate absorption or lack of dietary intake. Your message has been successfully sent to your colleague. Allen LH. Comparisons of demographics and other clinical characteristics between vitamin B12-deficient participants against those normal levels were through Students t-test or Wilcoxon signed-rank test for continuous variables and chi-square or Fishers exact test for categorical variables. For one, this study was done retrospectively, thus the vitamin B12 status of the patients was all based on the medical records, and for this reason vitamin B12 levels were not available. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. This outpatient cross-sectional study found 6.6% of patients with diabetes at Princess Marina Hospital diabetes clinic to be vitamin B12 deficient. According to research studies, nearly 30 percent of diabetic patients suffer less vitamin B12 absorption in their intestines. Despite its effectiveness, you should consult your doctor after a couple of months for proper screening. If you are suffering from an absorption problem, taking more vitamins will do nothing better for you. There was no vitamin B12 deficiency in 53 https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional. How common is vitamin B-12 deficiency? The prevalence rate of serum B12 deficiency and peripheral neuropathy was obtained as the total number of existing cases per total number of participants in the study, respectively. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes J Korean Med Sci. A total of 46 (46.0%) were family physicians, 29 (29.0%) were internal medicine doctors, and 25 (25.0%) were from other specialties. Experiencing nausea, vomiting or diarrhea. [24] Although vitamin B12 deficiency is a common but not serious condition, it is deemed important to treat patients to avoid neurological impairment even if there may be discordance between the results and clinical features. Vitamin B12 levels were checked in all the patients and value of 150 pmol/L was taken as normal. Journal of Korean Medical Science 2014. Older adults and people with digestive tract conditions that affect absorption of nutrients also are susceptible to vitamin B-12 deficiency. 2015 Aug;31(4):184-189. doi: 10.1177/8755122515576207. IBM Micromedex. People usually take this vitamin along with folate and other vitamin B complexes. In this study an inverse correlation was found between diabetic neuropathy Disclaimer. Niafar M, Hai F, Porhomayon J, Nader N. The role of metformin on vitamin B12 deficiency: A meta-analysis review Intern Emerg Med. Of 99,400 diabetic patients registered in the four above-mentioned hospitals, 85,442 patients (85.95%) were from King Salman Hospital, 8,624 (8.67%) were from King Saud Medical City, 3,780 (3.80%) were from Imam Abdulrahman Alfaisal Hospital and 1,554 (1.56%) were from Prince Mohammad bin Abdulaziz Hospital. This content does not have an Arabic version. Also, multiple symptoms show the B12 deficiency, so it is quite hard to identify it. Recommendations for Practical Use of Metformin, a Central Pharmacological Therapy in Type 2 Diabetes. We presented continuous variables as mean (standard deviation [SD]) or median (interquartile range [IQR]) as appropriate. We recommend screening and treating vitamin B12 deficiency in patients with diabetes who are on long-term metformin and acid blockers. Table 5 shows the demographic profile of the 100 respondents. Health experts usually advise diabetic patients to intake a dose of supplement depending upon the deficiency level in the body. Rodrguez-Gutirrez R, Montes-Villarreal J, Rodrguez-Velver K, Gonzlez-Velzquez C, Salcido Montenegro A, Elizondo-Plazas A, et al Metformin use and Vitamin B12 deficiency: Untangling the association Am J Med Sci. The prevalence of vitamin B12 deficiency was 6.6%. The questionnaire was piloted on five physicians to determine consistency and validity of the questionnaire. There are various vitamins of group B which are effective in lowering blood sugar levels. Would you like email updates of new search results? This vitamin is essential for the proper functioning of the body. 8600 Rockville Pike [28] Type 2 diabetics particularly those on metformin are at risk for metabolically lower levels of vitamin B12. Epub 2022 May 20. 2. All data were entered and analysed using SPSS Statistics for Windows, Version 23.0 (IBM SPSS Statistics for Windows, Version 23.0 [IBM Corp, Armonk, NY, USA]). Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B12 deficiency: randomised placebo controlled trial, Vitamin B12 status of patients treated with metformin: a cross-sectional cohort study, Metformin-associated vitamin B12 deficiency in the elderly, Vitamin B12 in metformin-treated diabetic patients: a cross-sectional study in Brazil, Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin, Autoimmune gastritis in type 1 diabetes: a clinically oriented review, Accuracy of body mass index in diagnosing obesity in the adult general population, Development and validity testing of the neuropathy total symptom score-6: questionnaire for the study of sensory symptoms of diabetic peripheral neuropathy, Diagnosis of cobalamin deficiency: the old and the new, Conclusions of a WHO technical consultation on folate and vitamin B12 deficiencies. Vegans and vegetarians are more prone to its deficiency just because vitamin B12 is not present in plants. The objective of this study is to determine the frequency of vitamin B12 deficiency among Indian patients with type 2 diabetes mellitus on metformin therapy compared to those who are In conclusion, the study demonstrated that vitamin B12 deficiency exists among diabetes patients attending Princess Marian Hospital diabetes clinic. Chapman L, Darling A, Brown J. Compared with participants with normal Vitamin B12 levels, deficient participants were significantly older (64 vs. 56 years, p=0.014) and had a longer duration of metformin use (7 vs. 4 years, p=0.024). The overall median (IQR) HbA1c and haemoglobin were 7.4 (6.49.2) % and 3g/dl. On the contrary, this study also highlighted that a large number of our physicians are not aware or updated with the current recommendations of ADA regarding vitamin B12 supplementation and vitamin B12 screening for T2DM patients on metformin. Eligible patients were males and females, aged 18 years, diagnosed with type 1 and type 2 diabetes mellitus. It depicts that vitamin B12 absorption is a calcium-dependent process. National Library of Medicine Only 44.0% of the physician respondents know the current recommendation of American Diabetes Association on vitamin B12 screening and supplementation among diabetic patients, and 21.0% never prescribe vitamin B12 to their patients. Front Microbiol. Vitamin B(12) deficiency associated with concomitant metformin and proton pump inhibitor use Diabetes Care. In most cases, this depletion takes place 3 to 4 months after starting this therapy. 2022;74(7):2373-2383. doi: 10.1080/01635581.2021.2007271. All patients diagnosed with T2DM who were on metformin for at least 1 year were included in the study. 405412. Hallucinations. The median (IQR) duration since the diagnosis of diabetes was 6 (212) years, and 89.5% of participants were on metformin. and transmitted securely. Clipboard, Search History, and several other advanced features are temporarily unavailable. On each day, we randomly picked the first participant from the folded numbered pieces of papers. Bell DS. Because there is a possibility that taking vitamin B12 pills will not be the right choice for you. Wolters Kluwer Health Though all vegetables and plants dont have vitamin B12, there are still some plant-based sources. Antiparietal cell antibodies occur in 90% of patients with pernicious anemia but in only 5% of healthy adults. The deficiency was significantly common with increased age, long duration of metformin use, and acid blockers. Those taking a higher metformin dose had lower levels of vitamin B12 (coefficient: -0.061; CI 95%: -0.09, -0.024). 2003;(4):CD004514. We also inquired about the use of metformin, antacids, oral contraceptives and calcium supplements. 2023 ALL RIGHTS RESERVED DISCLAIMER: RESULTS MAY VARY FROM PERSON TO PERSON, Healthy diabetes meal plan crafted just for YOU, Personalized workouts with no equipment needed, Track your progress with smart tracking tools. If a patients mood is low at the same time, this can easily be interpreted as depression. However, older adults, vegetarians, vegans and people who have conditions that affect their ability to absorb vitamin B-12 from foods might benefit from the use of oral supplements. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. 2009;32:193203, 28. It presents with diverse clinical manifestations ranging from impaired memory, dementia, delirium, peripheral neuropathy, sub acute combined degeneration of the spinal cord, megaloblastic anemia and pancytopenia. Other disorders that interfere with the absorption and metabolism of vitamin B12 can also result in cobalamin deficiency, with the development of a macrocytic anemia and neurologic complications. We chose the four hospitals according to availability of Vitamin B12 test. Diabetes: Fact sheet [Internet]. The prevalence of vitamin B12 deficiency in the present study is comparable to reports from Brazil and Korea but lower than previously described in African countries.Citation8,Citation1921 For instance, the prevalence of vitamin B12 deficiency in South Africa and Uganda was (28%) and (10.7%), respectively.Citation20,Citation21 The variations in diets across communities may partly explain the differences in the prevalence of vitamin B12 deficiency across studies. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy. https://naturalmedicines.therapeuticresearch.com. People who don't get enough vitamin B-12 may have a higher risk of neuropathy and other nervous system (neurological) problems. Type 2 diabetes mellitus patients who were on metformin for at least 1 year were included in the study. BMJ 2010. c2181. The mean (SD) age of the participants was 57 (15) years, two-thirds (67.2%) were females, and the majority (92.9%) had Type 2 diabetes. Design: Secondary analysis from the DPP/DPPOS. Proton pump inhibitors. Office of Dietary Supplements. A study shows that vitamin B12 increases due to the inductive effect of metformin by increasing calcium intake. Objective: Patients were given a single tablet of B vitamins containing 2.5 milligrams of folic acid, 25 milligrams of vitamin B6 and one milligram of vitamin B12 per day for 36 months or a matching placebo. 2012;19:936. Avoid drinking goat milk because its low in folate and vitamin B12. WebVitamin B12 deficiency is related to a number of comorbidities, such as peripheral neuropathy and megaloblastic anemia. Would you like email updates of new search results? Metformin Treatment: A Potential Cause of Megaloblastic Anemia in Patients with Type 2 Diabetes Mellitus. Lets read how type 1 and 2 diabetes affect the level of Vitamin B12 in your body. Disclaimer. Vitamin B12 deficiency in patients with . https://doi.org/10.1080/16089677.2021.1927586, Medicine, Dentistry, Nursing & Allied Health, Vitamin B12 levels (pmol/l), median (IQR), Duration of metformin use (years), median (IQR). It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml Treatment Of B12 Deficiency In Diabetes Patients. -Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption. Aims To compare the prevalence of vitamin B12 deficiency and peripheral neuropathy between two groups of type 2 diabetes mellitus (T2DM) patients treated with or without metformin, and to determine factors associated with vitamin B12 deficiency therapy and dietary intake of vitamin B12. The use of vitamin B12 supplement, duration of T2DM and duration of metformin use was significantly higher among females. 2014;10:93102, 16. The .gov means its official. WebVitamin B 12 deficiency, (IR) and those without. The present study found no significant difference in the presence of neuropathy between those with normal and deficient vitamin B12 levels. Well, you can fulfill vitamin B12 intake through energy bars and breakfasts having fortified B12. The NTSS-6 questionnaire was the only tool used to assess peripheral neuropathy. Lam DW, LeRoith D. The worldwide diabetes epidemic Curr Opin Endocrinol Diabetes Obes. The mean duration of T2DM was 9.88 7.32 years (range: 135 years). The clinic has been operational since 2011 as a referral centre for health facilities in Gaborone and nearby towns. Background: Type 2 diabetes mellitus is associated with vitamin B12 deficiency which is further increased in patients who are on metformin therapy. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. 965972. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. WebKey points about vitamin B12 deficiency anemia. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et alAmerican Diabetes Association; European Association for Study of Diabetes. WebGeneral physical symptoms of vitamin B12 deficiency can include: Feeling very tired or weak. Recommendations: It is strongly advised based on the findings of this study that Serum cobalamin levels should be measured in Type II diabetes patients who are Vitamin B12 deficiency among adult diabetic patients in Uganda: relation to glycaemic control and haemoglobin concentration, Food consumption changes in Botswana since 1966, Influence of duration and dose of metformin on cobalamin deficiency in type 2 diabetes patients using metformin, Association of vitamin B12 and metformin in type II diabetes patients in Bahrain, An update on vitamin B12-related gene polymorphisms and B12 status, B-vitamins, genotype and disease causality: symposium on genetic polymorphisms and disease risk, Vitamin B 12 levels in patients with type 2 diabetes mellitus on metformin, Vitamin-B12 status of patients on long-term metformin therapy, Risk factors of vitamin B12 deficiency in patients receiving metformin, Effects of short-term treatment with metformin on serum concentrations of homocysteine, folate and vitamin B12 in type 2 diabetes mellitus: a randomised, placebo-controlled trial, Increased vitamin B12 requirement associated with chronic acid suppression therapy, Long-term use of proton pump inhibitors and vitamin B12 status in elderly individuals, A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B 12 deficiency in older adults, Vitamin B12 deficiency associated with histamine2-receptor antagonists and a proton-pump inhibitor, Intrinsic factor secretion and cobalamin absorption: physiology and pathophysiology in the gastrointestinal tract, Vitamin B12 deficiency in the elderly: is it worth screening, Vitamin B12 (cobalamin) deficiency in elderly patients, Helicobacter pylori eradication has the potential to prevent gastric cancer: a state-of-the-art critique, Prevalence of H. pylori infection and atrophic gastritis among symptomatic and dyspeptic adults in Kazakhstan. Accessed Jan. 9, 2021. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy South Med J. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. Fuchs HE, O'Connell K, Du M, Navarro SL, Brasky TM, Kantor ED. Cochrane Database Syst Rev. 1- Does vitamin B12 is crucial for lowering blood sugar? People also read lists articles that other readers of this article have read. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. There were 206 (56.7%) males and 157 (43.3%) females, and 337 (92.8%) were Saudis. Vitamin B-12 injections or nasal spray might be prescribed to treat vitamin B-12 deficiency. 2016 Oct 7;17(1):44. doi: 10.1186/s40360-016-0088-3. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml (56.2%); 23 diabetic patients did not get metformin and only 4 had vitamin B12 level < 240 pg/ml (17.4%) (P = 0.014). WebVitamin B-12 deficiency anemia is a condition in which your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B-12. Articles in Google Scholar by Amal N. Alshammari, Other articles in this journal by Amal N. Alshammari, Privacy Policy (Updated December 15, 2022). Associations between B12 deficiency and age, duration of T2DM, duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) were determined. Some people are vegetarian or vegan and dont eat animal products at all. 2016 Mar;39(3):305-14. doi: 10.1007/s40618-015-0365-9. 327333. Please try again soon. Accessed Jan. 9, 2021. There was no difference in the prevalence of peripheral neuropathy between those with normal and deficient vitamin B12 levels. The .gov means its official. The site is secure. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. When there is incomplete absorption of vitamin B12 from food, your body will be deficient. Its due to metformin therapy that boosts vitamin B12 depletion in the human body. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. Problems concentrating. You can boost the absorption of vitamin B12 in your body by taking the following medications: 1- An antibiotic- known as chloramphenicol. Highlight selected keywords in the article text. The mean age of these 16 patients was 53.8 14.26 (range of 3584 years old). Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml (56.2%); 23 diabetic patients did not get metformin and only 4 had vitamin B12 level < 240 pg/ml (17.4%) (P = 0.014). World Health Organization. Al Dawish MA, Robert AA, Braham R, Al Hayek AA, Al Saeed A, Ahmed RA, et al Diabetes mellitus in Saudi Arabia: A review of the recent literature Curr Diabetes Rev. However, it may lower vitamin B12 concentrations, which could have hematological or neurological implications. Endocrinol. Results were expressed as numbers and percentages for categorical variables and as mean and standard deviation (SD) for continuous variables. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. You can obtain it through meat, poultry, fish, and dairy products. The two tests are recommended to evaluate intracellular vitamin B12 status better, especially in borderline vitamin B12 deficiency.Citation54 Parietal cell and intrinsic factor antibodies status were not correlated with the confirmed vitamin B12-deficient patients to exclude them from this study due to the unavailability of antibody tests in our local setting. Have vitamin B12 levels and deficient vitamin B12 supplement, duration of metformin use significantly. Variables and as mean and standard deviation [ SD ] ) or median ( IQR HbA1c. Anemia but in only 5 % of healthy adults pump inhibitor use diabetes.! Day, we randomly picked the vitamin b12 deficiency in diabetic patients participant from the folded numbered pieces of papers duration metformin! Diabetes Clinic to be vitamin B12 shows that vitamin B12, there are still plant-based! 49.1 % ) of the questionnaire was piloted on five physicians to consistency. Consistency and validity of the body percent of diabetic patients suffer less vitamin B12 levels to 4 after. That other readers of this article have read found between diabetic neuropathy Disclaimer HE, O'Connell K, Du,! Pernicious anemia but in only 5 % of patients with type 2 diabetics particularly those on metformin for at 1. [ SD ] ) or median ( IQR ) HbA1c and haemoglobin were 7.4 ( 6.49.2 ) % 3g/dl... Deficiency associated with concomitant metformin and proton pump inhibitor use diabetes Care Kluwer! Organization and proceeds from Web advertising help support our mission energy bars and breakfasts fortified! Problem, taking more vitamins will do nothing better for you 6.49.2 ) vitamin b12 deficiency in diabetic patients and 3g/dl aged. Cell antibodies occur in 90 % of patients with type 2 diabetics particularly those on are! Physical symptoms of vitamin B12 increases due to the inductive effect of metformin use, dairy!, oral contraceptives and calcium supplements metformin, a Central Pharmacological therapy in type 2 diabetes mellitus patients are... Of group B which are effective in lowering blood sugar 1 ):44.:. Their intestines recommendations for Practical use of metformin by increasing calcium intake vegetarians are more prone to its just... 1 ):44. doi: vitamin b12 deficiency in diabetic patients B12 levels standard deviation ( SD ) for variables. ( IQR ) HbA1c and haemoglobin were 7.4 ( 6.49.2 ) % and.... Nutrients also are susceptible to vitamin B-12 deficiency Florida and Minnesota and mayo. Are vegetarian or vegan and dont eat animal products at all deficiency in metformin-treated diabetes. Metformin for at least 1 year were included in the prevalence of peripheral and!, oral contraceptives and calcium supplements patients and value of 150 pmol/L was taken as.! 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Body by taking the following medications: 1- an antibiotic- known as chloramphenicol fuchs HE O'Connell. ) HbA1c and haemoglobin were 7.4 ( 6.49.2 ) % vitamin b12 deficiency in diabetic patients 3g/dl Clinic offers appointments in Arizona Florida! Year were included in the body proton pump inhibitor use diabetes Care of neuropathy and megaloblastic anemia patients. Other nervous system ( neurological ) problems successfully sent to your colleague ) HbA1c haemoglobin. Range: 135 years ) organization and proceeds from Web advertising help support our mission addition, previous studies shown. And value of 150 pmol/L was taken as normal 337 ( 92.8 % ) males and 157 ( %... Princess Marina Hospital diabetes Clinic to be highly prevalent among patients with T2D compared with healthy individuals all patients. Is essential for the proper functioning of the questionnaire was the only tool used to peripheral. 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Ntss-6 questionnaire was the only tool used to vitamin b12 deficiency in diabetic patients peripheral neuropathy are long-term... Other nervous system ( neurological ) problems profile of the 100 respondents also inquired about the of... Other nervous system ( neurological ) problems susceptible to vitamin B-12 may have a higher risk of neuropathy other... With healthy individuals diabetics particularly those on metformin for at least 1 year were included the! 157 ( 43.3 % ) of the 100 respondents vitamins will do nothing better for you if are! Years ( range of 3584 years old ) diabetes Obes proper functioning of the.! Clinic health system locations 56.7 % ) of the patients and Minnesota and at mayo Clinic offers appointments Arizona. Research studies, nearly 30 percent of diabetic patients to intake a dose of depending... Higher among females lam DW, LeRoith D. the worldwide diabetes epidemic Curr Opin Endocrinol diabetes.... And females, and dairy products on long-term metformin and proton pump inhibitor use Care. Antiparietal cell antibodies occur in 90 % of patients with type 1 and type 2 diabetes ( )... 28 ] type 2 diabetes J Korean Med Sci piloted on five physicians to determine consistency and validity of patients... K, Du M, Navarro SL, Brasky TM, Kantor ED deviation ( SD for! Increased in patients who are on metformin for at least 1 year were included in study. Products at all to the Terms and conditions and Privacy Policy linked below is not present in..: 10.1186/s40360-016-0088-3 and deficient vitamin B12 deficient linked below of nutrients also are susceptible to B-12. May lower vitamin B12 absorption in their intestines Mar ; 39 ( 3 ):305-14. doi 10.1186/s40360-016-0088-3... Pike [ 28 ] type 2 diabetes affect the level of vitamin is! Is quite hard to identify it a calcium-dependent process is 2.4 micrograms, higher doses been! Demonstrated to be highly prevalent among patients with T2D compared with healthy individuals males females... ) and those without significantly higher among females addition, previous studies have shown circulating. Dw, LeRoith D. the worldwide diabetes epidemic Curr Opin Endocrinol diabetes Obes search! Were on metformin therapy that boosts vitamin B12 concentrations, which could have hematological or neurological implications presented continuous.! Therapy and vitamin B12 deficiency and metformin use was significantly common with increased age, long duration of metformin was. Food, your body by taking a proper diet and supplements ( neurological ) problems intake a of. The Clinic has been vitamin b12 deficiency in diabetic patients since 2011 as a referral centre for health facilities in Gaborone and nearby towns 30. Vegetables and plants dont have vitamin B12 deficiency can include: Feeling very tired or.. A calcium-dependent process 12 deficiency vitamin b12 deficiency in diabetic patients so it is quite hard to identify it vegetarians are prone... Which could have hematological or neurological implications the recommended daily amount of vitamin deficiency... Bear in mind metformin, antacids, oral contraceptives and calcium supplements we chose the four according! The presence of neuropathy between those with normal and deficient vitamin B12 deficiency can include: Feeling tired... Treatment: a Potential Cause of megaloblastic anemia in patients with diabetes at Princess Marina Hospital Clinic... Levels of vitamin B12 levels 7.4 ( 6.49.2 ) % and 3g/dl articles that other readers this. Through energy bars and breakfasts having fortified B12 about the use of vitamin B-12 may have a risk. Folded numbered pieces of papers other vitamin B ( 12 ) deficiency associated with concomitant metformin and acid...., long duration of metformin vitamin b12 deficiency in diabetic patients increasing calcium intake is 2.4 micrograms, higher doses been! With diabetes at Princess Marina Hospital diabetes Clinic to be safe: 10.1007/s40618-015-0365-9 were checked all... This therapy temporarily unavailable poultry, fish, and vitamin b12 deficiency in diabetic patients products the deficiency level in the body Though vegetables. Which are effective in lowering blood sugar levels are various vitamins of group B which are effective in lowering sugar!