Type 2 diabetes is one of the most common conditions affecting people in the United States. The National Diabetes Statistics Report estimates that about 29.1 million people were living with diagnosed diabetes in the U.S. in 2023, including 28.8 million adults 18 and older.
But even more people likely have undiagnosed diabetes—about 11 million people. It’s vital to get your blood sugar checked because untreated and uncontrolled diabetes can raise your risk of heart disease, kidney failure and even death. When someone is diagnosed with diabetes, Metformin is one of—if not the first—medications endocrinologists prescribe. It’s an oral medication that can help people with Type 2 diabetes manage their blood sugar. Endocrinologists call it effective, safe and affordable.
“It works by lowering the amount of glucose (sugar) your liver produces and helping your body respond better to the insulin it naturally makes,” explains Dr. Jennifer Cheng, DO, the section chief of endocrinology at the Hackensack Meridian Jersey Shore University Medical Center. “It helps to decrease insulin resistance.”
Dr. Cheng, who is also an internal medicine professor at the Hackensack Meridian School of Medicine, states that Metformin is also frequently prescribed “off-label” to help with other conditions. For instance, she reports that doctors often use it to prevent diabetes in people with prediabetes. They may also use it to treat Polyendocrine Metabolic Ovarian Syndrome (PMOS, formerly PCOS), because it can improve insulin resistance and help to regulate menstrual cycles.
If you’re taking Metformin, especially for diabetes or prediabetes, chances are, your endocrinologist checks your A1C every 3 to 6 months. However, endocrinologists also want everyone on Metformin to have other blood tests done regularly. They reveal what it is below.
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The Blood Test Endocrinologists Want Everyone on Metformin to Get
Metformin helps control blood sugar, but it can interfere with Vitamin B12 absorption. For this reason, endocrinologists, including Dr. Heather Saran, DO, at HonorHealth, advise people taking Metformin to have their vitamin B12 levels checked.
Backing up, what is vitamin B12?
“Vitamin B12 is a water-soluble vitamin naturally found in foods from animals, such as meat, eggs, fish and dairy,” Dr. Saran says. “Vitamin B12 has many roles in the body, including the nervous system, red blood cells and even our DNA.”
Endocrinologists say that vitamin B12 can affect diabetes (and confuse people with the condition (and confuse people with the condition) because it can cause nerve damage.
“Diabetes itself can cause a type of nerve damage called diabetic peripheral neuropathy, which leads to numbness, tingling or pain in the hands and feet,” Dr. Cheng says. “Because B12 deficiency causes those same symptoms, doctors and patients might mistakenly think their diabetes is getting worse when, in reality, they just need more of the vitamin.”
Therefore, a blood test is needed, especially since severe B12 deficiency can contribute to anemia, a condition in which your body lacks the healthy red blood cells it needs to carry oxygen.
“This can make you feel incredibly fatigued and weak, making it much harder to stay active, exercise and cook healthy meals—all of which are vital for successfully managing diabetes,” Dr. Cheng says.
Related: This Popular Lunchtime Drink Could Be Wrecking Your Blood Sugar, Endocrinologists Warn
Does Metformin Cause Vitamin B12 Deficiency?
Endocrinologists say that Metformin can contribute to vitamin B12 deficiency. “Metformin can sometimes interfere with how your body absorbs vitamin B12 from the food you eat,” Dr. Cheng explains.
She says it’s not fully understood why, but the current hypothesis is that Metformin changes how calcium functions in your small intestine. “Your body relies on calcium to help absorb a specific protein complex that carries vitamin B12 into your bloodstream, and Metformin seems to disrupt this necessary step,” Dr. Cheng says. “That is why doctors will tell you to take B12 supplements when taking Metformin or do lab testing to check for vitamin B12.”
The risk of vitamin B12 deficiency increases with dose (1,500 mg or more daily) and how long you’ve been on Metformin, according to research and Dr. Sapna Naik, MD, an assistant professor of endocrinology, diabetes and metabolism at UTHealth Houston.
“Because the liver stores years’ worth of B12, deficiencies often develop gradually over 4-5 years of Metformin use rather than immediately after starting treatment,” she says.
Dr. Naik adds that other factors that can influence how Metformin affects vitamin B12 levels include:
Older age, especially for adults over 65, “since B12 absorption naturallybecomes less efficient with age.” Vegetarian and especially vegan diets, “which may provide less B12because it’s primarily found in animal products.” Certain medications, including acid-reducing drugs like omeprazole(Prilosec). Previous stomach or intestinal surgery, including weight-loss surgery, orconditions affecting nutrient absorption, such as Crohn’s disease (a form of inflammatory bowel disease).“People with multiple risk factors may benefit from more frequent B12 testing,” Dr. Naik points out.
Related: Here’s Exactly What Happens to Your Blood Sugar When You Eat Peanut Butter
How Often Should You Get Vitamin B12 Levels Tested on Metformin?
Dr. Cheng points to the American Diabetes Association recommendations that people on Metformin have their vitamin B12 levels tested “periodically,” especially if they’ve been on the medication for over four years or have other risk factors, like older age. “While there isn’t a strict universal schedule, many experts and doctors advise getting a blood test for B12 once a year to catch any declining levels early,” she says.
Dr. Cheng stresses the importance of monitoring vitamin B12 levels because deficiency can develop slowly.
“If caught early, it is incredibly easy to treat, but if left unchecked, prolonged low B12 can cause permanent and irreversible damage to your nervous system and nerves,” she explains.
Needles may make you squeamish, but endocrinologists say the blood test matters because vitamin B12 deficiency often doesn’t cause symptoms at first.
Dr. Naik says that, when symptoms do occur, they may include:
Numbness or tingling in the hands and feet Fatigue Weakness Shortness of breath Difficulty with balance or walking Memory problems Difficulty concentrating Mood changesDr. Naik adds that symptoms can develop gradually, and you may chalk them up to another medical condition (or life stress).
If you are vitamin B12 deficient, your endocrinologist will likely help you treat it.
“Some forms of low B12 can easily be treated with a once-daily vitamin,” Dr. Saran says. “Those who can’t absorb B12 through the gut may need monthly B12 shots or sublingual drops that don’t require the stomach to absorb it.”
Dr. Cheng emphasizes that you shouldn’t stop taking Metformin without first talking to a doctor.
“Metformin is a safe, effective and protective medication for managing blood sugar, and stopping it abruptly can cause your diabetes to become uncontrolled, leading to much more immediate and dangerous health complications,” Dr. Cheng says.
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Related: We Asked 3 Diabetes Experts the Biggest Blood Sugar Mistake People Make and They All Said the Same Thing
Sources:
National Diabetes Statistics Report. CDC. Dr. Jennifer Cheng, DO, the section chief of endocrinology at the Hackensack Meridian Jersey Shore University Medical Center Your Diabetes Care Schedule. CDC. Dr. Heather Saran, DO, an endocrinologist with HonorHealth Dr. Sapna Naik, MD, an assistant professor of endocrinology, diabetes and metabolism at UTHealth Houston Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. World Journal of Diabetes. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2023. American Diabetes Association.Hence then, the article about endocrinologists want everyone on metformin to ask for this blood test was published today ( ) and is available on Parade ( Saudi Arabia ) The editorial team at PressBee has edited and verified it, and it may have been modified, fully republished, or quoted. You can read and follow the updates of this news or article from its original source.
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