Diabetes Self-Management Blog

I recently had the opportunity to attend the 72nd Scientific Sessions of the American Diabetes Association in Philadelphia. Here is a sampling of the research presented at the meeting:

Reducing A1C Less Than a Point Cuts CV Risk 45%
In an observational study from Sweden, people with Type 2 diabetes who reduced their A1C level (an indicator of blood glucose control over the previous 2–3 months) from an average of 7.8% to 7.0% decreased their risk of cardiovascular death by 45% over a five-year follow-up compared to people who started with an average A1C level of 7.7% that remained stable or rose. Rates of coronary heart events and cardiovascular events were also significantly reduced in those who lowered their A1C.

For more information, read the article “ADA: Glycemic Control Reduces CV Risk” or see the presentation abstract.

Artificial Pancreas Works in Young Children
In a small study in Boston’s Children’s Hospital, closed-loop insulin delivery via an artificial pancreas — a device consisting of a continuous glucose monitor and an insulin pump that work together to prevent high or low blood glucose without requiring input from the user — helped improve overnight high blood glucose in 10 children with Type 1 diabetes under the age of seven.

The children were all admitted to the hospital and given a snack at 3 PM, along with dinner at 5 PM and another snack at 8 PM. The participants were then assigned to either an artificial pancreas or conventional insulin pump therapy, with all children switching to the alternate form of therapy the following night.

The researchers found that both forms of therapy kept the children in their target blood glucose range about the same amount of time, but that those using the artificial pancreas spent significantly less time above 300 mg/dl. They also experienced better lunchtime blood glucose control — even though they hadn’t received any premeal boluses — and did not have a greater rate of hypoglycemia (low blood glucose) than when using the conventional insulin pump therapy.

“Closed-loop therapy has the potential to improve diabetes care for very young children,” noted researcher Andrew Dauber, MD. “We believe this is an underrepresented group in this area of research.”

To learn more, read the article “ADA: Closed-Loop Artificial Pancreas Works” or see the abstract from the ADA Scientific Sessions.

Metformin-Related B12 Deficiency Linked to Neuropathy
As we’ve previously reported, use of the popular Type 2 diabetes medicine metformin has been linked with vitamin B12 deficiency. A small study in Slovenia suggests that deficiency of this vitamin may be linked with neuropathy, or nerve damage, in people with Type 2 diabetes.

According to researcher Jasna Klen, PhD, “We had a few patients complaining about peripheral neuropathy who hadn’t [had diabetes] very long, but they were on metformin. We decided to look at vitamin B12 deficiency.” They found that, of 84 people taking metformin for at least four years, 15 had vitamin B12 deficiency and 22 had borderline deficiency. Lower blood levels of B12 were associated with more severe peripheral neuropathy. The study authors note that peripheral neuropathy caused by vitamin B12 deficiency can be misdiagnosed as peripheral neuropathy caused by diabetes.

In response, some medical professionals are calling for more research into how much and what form of B12 supplementation is ideal for people with metformin-related B12 deficiency.

To learn more, read the piece “ADA: Deficiency in Vitamin B12 With Metformin Linked to Neuropathy” or see the presentation abstract from the ADA Scientific Sessions.

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Comments
  1. I believe this to be very true- this combined with the fact that some doctors don’t look very far past the initial diabetes diagnosis to see if there are other problems. It wasn’t until I had a DO who requested a series of blood work that it turned out I did not have neuropathy from diabetes and that all my problems were not related to the diabetes but that I had Rheumatoid arthritis, that 3 other doctors had just chalked up to being diabetes related. I stopped taking the metformin which does a number on your stomach and was given Tradjenta instead and my symptoms pretty much went away. Bottom line is dont let your doctors tell you that all your problems are diabetes related.

    Posted by Chris |
  2. Interesting article… I have been plagued with Muscle cramps for about 18 months. My daughter suggested taking the Over the Counter Subliminal B12 tablets. It took almost a month before I noticed that the leg and back muscle cramps (Charlie Horses) were reduced in frequency and intensity. I was convinced that the B12 was responsible for the improvement. This article has just reinforced that conclusion.
    Thanks
    C. Cannon

    Posted by Carol Cannon |
  3. I have been taking b12 supplement for years as one of my earlier drs said this was one of the aftereffects of metformin. Why is this just coming out now??? Aren’t doctors aware of this?

    Posted by Dan kashefska |
  4. The B12 deficiency is interesting and the malabsorbency effects should be studied further. Ever since I was diagnosed with Type 2 -and placed on Metformin- I have had deficiency in several vitamins and minerals. The first they discovered was extremely low levels of vitamin D. Then Iron (accompanied by severe anemia), Calcium, B6, B12 and who knows what else. A daily multivitamin did nothing to effect these deficiencies. Only megadoses were able to raise the levels to normal. Among my questions are why aren’t diabetes patients routinely tested for deficiencies, and are these 100% attributable to Metformin, or is it possible that they are common to most diabetics regardless of treatment?

    Posted by Joe |
  5. I have also noticed that B12 has helped with nightime leg cramps. Interestingly I have also noticed that doctors seem to only treat diabetes and never discuss anything about the medicenes they prescribe. I always read the paperwork that comes with the prescription. Good article though.

    Posted by Karen |
  6. Hi, I read your article with interest and I wanted to know how much B12 should one take per day. Could you give the answer in micrograms per pill?

    Posted by Pat Buongiorne |
  7. Is there any information that there may be a connection between metformin and bladder cancer as is the case with actos and bladder cancer? anyone with any info?

    Posted by b. Schultz |
  8. 7-6-12 I too have had muscle cramps in my legs since taking the metformin. Article and research is very informative. Thank you. I would suggest that as diabetics, we have our primary care doctors request a blood lab to chech our B-12 levels.

    Posted by b. Schultz |
  9. i also would like to know how much b12 you should take a day, i have terrible pain in my feet , but even with the nerve test the dr giving the test said i didnt have neuropathy, family doctor says i do, the meds i hace tried for the pain and burning and numbness doesnt do much to help, thanks for any info you can give me and i do take metformin 500 mg er twice a day

    Posted by nancy |
  10. Hi Pat and Nancy,

    Thanks for your questions regarding how much vitamin B12 is recommended per day. According to the Institute of Medicine (IOM), the recommended daily allowance for vitamin B12 for people ages 14 and older is 2.4 micrograms daily. (Recommendations are slightly different for pregnant and lactating women.) In people age 50 and older, the IOM recommends that B12 be consumed from either fortified foods or supplements. Currently, these recommendations are not any different for people with diabetes.

    For more information on vitamin B12 dosing, please see this page from the Mayo Clinic:

    http://www.mayoclinic.com/health/vitamin-B12/NS_patient-vitaminb12/DSECTION=dosing

    Best,
    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  11. I have Type 2 diabetes for 31 yrs & have suffered greatly with leg pain especially at night. I was on Metformin for many years & was always told the pain was from neuropathy. About 2 yrs ago I had to stop the Metformin & the leg pains decreased slighty. Then I found Topricin & Horse Chestnut (available at the health food store). I have NO pain in my legs anymore & if I overexert myself walking etc. I apply the Topricin & Shazam!! no more pain. What I am trying to say is we are MUCH more a disease.. diabetes is not responsible for ALL of our ailments & we have to be proactive for our own care.

    Posted by Kathy |
  12. I have been a type 2 diabetic for the past 15 years.Recently a year ago I had to start taking Novolog and Levimir along with oral glycemics…my blood sugars have improved greatly and I have also lost weight…however it is interesting to note about the metformin…last year I had a borderlin low of vitamin D,in which I never had….I am going to discuss this with my primary care physician…thanks for the comments.

    Posted by Karen |
  13. Interesting information. For all those suffering with leg cramps, I have had them for at least 40 years, long before Type II diagnosis and since. I take Requip for restless leg but that didn’t help cramps. Up sometimes as often as 10 times in a night and hobbling aroound for 10 minutes or so. Two and a half years ago, I was diagnosed with sleep apnea and started using a CPAP. My leg cramps almost completely stopped. I traveled once without the machine and had terrible nights again. So, sleep apnea, gasp, startle, cramp was the sequence. I have an occasional one, usually brief if something startles me. I took B12 at one time and got above lab ranges. You might get checked for sleep apnea as a cause. I do not have neuropathy at this time.

    Posted by Jean |
  14. Jean: Very interesting. I was once diagnosed with fibromialgia, but it turned out the pain was related to apnea… low blood oxygen levels.

    Posted by Joe |
  15. I am taking various supplements before but now I am just taking one. I learned that the ones that I am taking before have almost similar benefits, hence I opted for one right now that was really advised by my physician. It is still important to get advise from your physician even in just taking supplements.

    Posted by Denise Ricks |

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Diane Fennell
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