Should Doctors be Testing Vitamin B12 Status in Diabetics?
The short answer is yes. Four reasons come to mind immediately, but there are others. Firstly, because vitamin B12 deficiency is known to cause peripheral neuropathy and diabetic neuropathy is present in about 20% of patients when they are first diagnosed and present in the majority of diabetics in due course. Secondly, B12 deficiency is present in up to 40% of people who take metformin, the most commonly prescribed first line oral medication for diabetes in the world. The bigger the dose and the longer the patient has been taking it, the greater the likelihood of developing B12 deficiency. Thirdly, B12 deficiency is one of the causes of elevated homocysteine, which is a well recognized risk factor for heart disease and stroke - common complications of poorly controlled diabetes. What is the fourth reason? Diabetics will tell you that watching a strict diet, taking multiple tablets or shots to control blood sugars, other medications as needed for high blood pressure, elevated cholesterol and checking blood finger-stick blood glucose levels several times a day is hard work. Very hard work. So, it makes sense that a simple test that leads to discovery of low B12, which is present in up to a third of diabetics and much higher (75%) in countries like India with high vegan or vegetarian populations, is very worthwhile if it leads to supplementing B12. This is a simple fix, that is not difficult, and may bring huge relief for neuropathy and reduce cardiovascular risk.