Reply With Quotehow do you feel about marmite?
Hi guys, any Dr's out there? I think maybe 1 or 2 so hopefully they might be able to comment.
I have been T2 diabetic for about 20 yrs. I have been taking metformin for 12 years and injecting byetta for nearly 3.
I have my annual check up in a couple of weeks so have had my bloods tested. My a1c is 5.8 so that's good. However people who take metformin on a long term basis are known to suffer from low Vit B12 levels.
Now I have always been knackered but that generally hasn't stopped me from being active.
My GP had my B12 levels tested. The blood results are back and I have a copy to take with me to hospital. I haven't spoken with my GP, however my B12 level is 230 ng/L (200-900) and Serum TSH is 0.82 mu/L (0.3 - 5)
It occurs to me that these readings are on the low side. Are they so low that supplements might be in order?
I know I should wait until I get to hospital for answers but knowing the talent here and my general disposition towards impatience someone in the know here might be able to explain.
Here's to a bowl of icecream!
thanks
how do you feel about marmite?
Good luck everybody. Have a good one.
Hi, first your HbA1C is very good and keeping that down will do you the most good in the long run.Originally Posted by avantgardaclue
While its true that Metformin can reduce your B12 levels, it is very rare for it to be enough to become a clinical problem. This is because you use a tiny amount of B12 every day, and in you liver at one point is at least a year's worth in storage... assuming you're processing it properly. However, it has been reported that people on Metformin for a few years and eat little meat, liver, fish, dairy and fortified foods (e.g. cereals with it added in) have become deficient.
Fatigue can be a symptom of a low B12 due to an anaemia it can cause. Hopefully your GP knows this too and did a full blood count (FBC)?
If so do you know your haemoglobin(Hb) and mean corpuscular volume (MCV)? Classically a B12 deficiency produces a low Hb and a high MCV.
With regard to the results you do have, its hard to make an interpretation of your B12 as it being free in the blood to test is one thing, and it being used at target organs is another, but you should take some comfort in it being within normal levels. And again, we're talking nanograms here!
Your TSH (thyroid stimulating hormone) is in normal range and that's fine. TSH varies greatly in normal people for various reasons. Did they do a free T4 level? I ask as that's a better indicator of thyroid status. I imagine this test was done due to your tiredness and hypothyroid can make you feel tired. Classically though a hypothyroid patient would have a low T4 (by definition) and usually a high TSH as you body tries to stimulate the thyroid to pump out more T4, though this isn't always the case. With your TSH being in normal levels it would suggest your thyroid is behaving properly.
Hope this is of some help.
@deus1066
>>While its true that Metformin can reduce your B12 levels, it is very rare for it to be enough to become a clinical problem. This is because you use a tiny amount of B12 every day, and in you liver at one point is at least a year's worth in storage... <<
That's interesting, i didn't realise that.
>>Fatigue can be a symptom of a low B12 due to an anaemia it can cause. Hopefully your GP knows this too and did a full blood count (FBC)?
If so do you know your haemoglobin(Hb) and mean corpuscular volume (MCV)? Classically a B12 deficiency produces a low Hb and a high MCV.<<
A whole heap of FBCs, inc...
Hb - 154 g/L (130 - 180)
MCV - 93.7 fL (75 - 100)
>> Did they do a free T4 level? I ask as that's a better indicator of thyroid status.<<
I have 4 pages of test results and to be fair a 'free T4 level' test result is not making its presence obvious!
>> Hope this is of some help.<<
Yes not only helpful but interesting too so many thanks
Is your cholesterol good or bad?
If good, try a few more eggs.
If bad, take a vit B supplement that includes B12
I wont be filed, stamped, indexed, briefed, debriefed, I am not a number, I am a free man, my life is my own!!!
Be seeing you
Toodle pip
Griff.
You mean Satan's sputum? Hmmmm... yuk! However the Mrs loves the stuff.
As I understand it the body is incredibly ineffective at absorbing B12 from any food hence why B12 tablets are ultra mega doses because you will only absorb a tiny proportion of it.
Apparently the best way is to have it injected into you, not a problem to me as i currently inject several times a day anyway or sub-lingually where you put a pastel of the stuff under your tongue and absorb it that way.
I am a peanut butter addict and as way of experimentation i mixed some marmite into a spoon's worth of PB and actually it tasted pretty good!
cheeers
As it happens Griff I have outstanding cholesterol. Last year it was 2.9 when the target is <5.0 but this year for some reason it has gone up to 4.5 which is within tolerance but personally a bit disappointing!
That sub-lingual stuff is nonsense... apparently!Apparently the best way is to have it injected into you, not a problem to me as i currently inject several times a day anyway or sub-lingually where you put a pastel of the stuff under your tongue and absorb it that way.
cheeers
Snorting it like cocaine is the way to go! (Not that i have ever snorted cocaine that is). Drs presumably wouldn't agree with this!!....
If you do not like the idea of getting shots of B-12, you should be aware that intra-nasal (that is, by way of the nose) absorption is the next best thing. It sounds pretty weird, as duly promised at the beginning of this section, but it is an efficient delivery method for large-sized molecules whether you like the sound of it or not.
Your nose has two choices:
1) Buy ready-to-use, over-the-counter B-12 gel, which you will occasionally find for sale in a pharmacy or health food store. Some products come in individual disposable packets. These are pricey.
2) Make your own B-12 intra-nasal supplement. It is cheap, easy and best done behind closed doors. Obtain your doctor’s OK before trying this procedure. Take any B-12 tablet (between 100 to 1,000 mcg) and grind it into a powder between two tablespoons. Add water, just a few drops at a time, to make a soft paste. With a “Q-Tip,” its generic equivalent, or your clean pinkie finger, gently swab the paste inside your nose up to a comfortable level. Do not push; use no force whatsoever. The excipients (tableting ingredients) are more likely to bother your schnoz than the B-12 is. If it irritates you, try using less, or a different brand of tablet. I’d try this two times a week for a month or two.
Feel free to quit at any time, and get B-12 shots instead.
It's an urban myth eggs raise cholesterol- it's saturated fats that raise it.
Cholesterol levels are governed by family history & liver function.
It's an urban myth eggs raise cholesterol- it's saturated fats that raise it.
Cholesterol levels are governed by family history & liver function.
and apparently, it's not good news to have too low cholesterol levels - and eggs are now proven to be beneficial, as is the chol. in avocados - not sure about the levels from shellfish though ? ( raise the HDLs and reduce the LDLs I think it was ) :wink:
Right, so your Hb and MCV look to be just about perfect so I think its safe to say you're not getting the classic B12 deficiency anaemia.
T4 is also known as Thyroxine, or they may measure its more active form, T3. Anyway, with your TSH being normal that'll probably be normal too.
Oh, and your right in thinking its difficult to absorb B12 in your diet, as its a complicated process involving something called Intrinsic Factor and the small bowel. Presumably you have both so should be okay.
... Oh I'm not a doctor by the way, so don't take my words as gospel truth!
I am and your interpretation is accurate. All those blood results are normal.
Most labs in the UK won't measure free T4 or T3 unless the TSH is abnormal (at least, not for screening tests; there are reasons to check in certain thyroid conditions).
Fatigue has more causes than I care to think about, but not B12 deficiency or thyroid disorder in avantgardaclue's case.
Thanks, I'm a med student.... I've got finals in a couple of weeks so this is helpful revision for me!I am and your interpretation is accurate. All those blood results are normal.
As mentioned earlier, there are other tests that need to be performed in conjunction, and this link will show alternate test too:
http://www.veganhealth.org/b12/
Rob.
Good luck! Your finals are a bit late, our local med school finished a couple of weeks ago; a relief to see some of those I came across are now MBs!
Back from the hospital and am pleased to mention that diabetically I'm fine.
As for the B12 issue my reading was low but well within range so nothing to worry about there!
Thanks for all your helps :)
What are considered 'normal' B12 levels in the UK would be considered 'low' in the USA. Lots of info. ref same available. TTBOMK if you take a high dose B12 supplement it will not do you any harm and might do you some good ... if you believe the USA figures.
dunk
"Well they would say that ... wouldn't they!"
http://www.nlm.nih.gov/medlineplus/e...cle/003705.htm
Blimey my reading of 230 ng/l (pg/ml) and being in my early 50s must mean i'm likely gonna die before i get to 100!Values of less than 200 pg/mL are a sign of a vitamin B12 deficiency. People with this deficiency are likely to have or develop symptoms. Older adults with vitamin B12 levels between 200 and 500 pg/mL may also have symptoms.
Causes of vitamin B12 deficiency include:
Not enough vitamin B12 in diet (rare except with a strict vegetarian diet)
Diseases that cause malabsorption (for example, celiac disease and Crohn's disease)
Lack of intrinsic factor
Above normal heat production (for example, with hyperthyroidism)
Pregnancy
Increased vitamin B12 levels are uncommon. Usually excess vitamin B12 is removed in the urine.
Seriously, my diabetologist wants to continue monitoring my b12 level as metfartin has been shown to effect your level.
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