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How Much Vitamin B12 Should A Diabetic Take

Best Vitamin Supplements For Diabetics: What You Should Have For Sure

Supplementing your body with the best vitamins for diabetics helps increase intake of nutrients that support your bodys ability to use insulin, thus keeping your blood sugar at healthy levels.

Heres what the scientific research supports, the diabetic supplements that work.

1. Multivitamin:

Taking a high-quality multivitamin and mineral supplement everyday dramatically reduces infections and sick days in diabetics.

According to a study published in American Journal of Epidemiology in 2001, men who took multivitamins had reduced risk of diabetes. Women too benefited, though the gains were marginally lower.

If you prefer to take a high potency multivitamin, you may not need to take individual vitamins separately. However, if you have specific problems that are better addressed by such vitamins or if you have deficiency of a vitamin like vitamin D3, you may want to dose these individually.

2. Vitamin B3:

3. Vitamin B6 and B12

A Randomized Controlled Trial was conducted at 5 university medical centers in Canada between May 2001 and July 2007. 238 diabetic participants who received B-vitamin therapy had reduced kidney damage caused by diabetes. Their arterial health improved too. Diabetics with kidney issues are often found to have too much of the harmful chemical homocystiene in their blood. B-vitamin therapy with folic acid, vitamin B6, and vitamin B12 have been shown to lower the blood levels of homocysteine.

4. Vitamin C

5. Vitamin D

6. Vitamin E

High Dose Vitamin B12

High dose vitamin B12 of around 1000 µg per day is needed if there is an increased requirement, due to a number of factors that we will discuss below, or if B12 deficiency is suspected. It also plays a role in the treatment of a whole range of diseases. 

Since B12 is a water-soluble vitamin, there is no danger of overdose when a high dose is administered; only a small portion of the dose is actually absorbed by the body.

In essence, high dose B12 is useful in treating a deficiency. For healthy people, a B12 dosage of between 250 500 µg will safely cover the daily requirement. It should be noted that this information refers to oral supplements the dosage of vitamin B12 injections is discussed in a separate article.

Study Participants And Baseline Characteristics

Study participants had an average age of 60.0 years , 6713 were male and 9986 were female . Participants had an average vitamin B12 level of 295.9pmol/L , 257 participants had vitamin B12 deficiency, while 10468 participants did not consume meat. The mean FBG level was 5.8mmol/L at baseline, and the exit mean FBG level was 6.3mmol/L . At baseline, 1872 participants had DM, and at the exit visit there were 1589 cases of new-onset DM. When stratified by baseline vitamin B12 quartiles, FBG levels were the highest ) in the fourth quartile . shows that the average age and BMI of the participants in Q4 were lower than those of the other groups, but TC and TG levels were higher than the other quartiles.

Multivariable-adjusted smoothing curves of change in vitamin B12 and change in FBG in a subsample that included a total of 4366 subjects with both baseline and exit FBG and vitamin B12 measurements. Adjusted for age, sex, MTHFR gene C677T polymorphisms, SBP and DBP at baseline, mean SBP and DBP during the treatment period, body mass index, study center, baseline serum concentrations of folate, homocysteine, FBG, vitamin B12, total cholesterol, triglycerides, and high-density lipoprotein cholesterol, treatment group, smoking status, and alcohol consumption status. DBP, diastolic blood pressure; FBG, fasting blood glucose; MTHFR, methylenetetrahydrofolate reductase; SBP, systolic blood pressure.

Screening Approach For Vitamin B12 Deficiency Among Patients With T2dm

Currently, there are no published guidelines advocating for routine screening for vitamin B12 deficiency among patients with T2DM. However among type 2 diabetic patients, it is clinically plausible to screen for vitamin B12 deficiency prior to initiation of metformin and later annually among elderly patients with history of long term use of metformin , use of high doses of metformin , clinically worsening diabetic distal polyneuropathy in the presence or absence of the discussed haematological abnormalities .

The screening approach for vitamin B12 deficiency among diabetic patients and the general population is similar. Measurement of the serum vitamin B12 concentrations should be the preliminary screening step for vitamin B12 deficiency among patients with T2DM. Concentrations <200 pg/ml are usually diagnostic of vitamin B12 deficiency while concentrations >400 pg/ml confirm absence of vitamin B12 deficiency .

Measurement of serum MMA or homocysteine concentrations is a more sensitive and specific approach for screening especially among type 2 diabetic patients with borderline serum vitamin B12 concentrations of 200-400 pg/ml and subtle haematological manifestations. Serum homocysteine and MMA concentrations of 5-15 mol/l and <0.28 mol/l are considered within the normal range respectively .

What Does Research Say About Vitamin B12

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Diabetics generally carry the risk of a vitamin B12 deficiency. A study found that as many as 22% of diabetics are deficient in vitamin B12.

Another study that tracked 785 women after delivery found that low vitamin B12 levels during pregnancy contributed to their risk of gestational diabetes and later full blown diabetes.

Diabetic patients usually suffer from a type of neuropathy that causes numbness, weakness and pain in the hands and feet. Research has concluded that vitamin B12 supplementation has beneficial effects in people with diabetic neuropathy.

Vitamin B12 Dosage: What Is The Proper Daily Amount

July 17, 2019

Vitamin B12, also known as cobalamin, is an essential vitamin for humans. Its vital for maintaining energy levels, metabolism, hormone balance, mood, digestion and skin health. But without enough of the nutrient, we can miss out on the many vitamin B12 benefits. In fact, being deficient in B12 can lead to major health issues, from improper growth and development to cognitive impairment. So what the proper vitamin B12 dosage?

Although a balanced diet including a variety of foods will generally supply enough vitamin B12 for most people, supplementation is sometimes necessary for certain age groups and circumstances or for those with underlying health conditions. Thats why its important to know what vitamin B12 dosage is right for your specific needs. How do you find out? Read on to learn all about vitamin B12 dosage recommendations and more.

What You Can Do

  • If you have been taking metformin for several years, ask your health care provider to have your vitamin B12 level measured, and ask what your level should be.
  • If you have symptoms of a vitamin B12 deficiency, including neuropathy, let your provider know and ask to have your B12 level measured.
  • If your level is below target, talk with your provider about treatment options. You may be able to take a daily B12 supplement, for example, rather than receiving B12 injections.
  • Certain medications can affect B12 levels, including proton pump inhibitors, such as omeprazole and lansoprazole and histamine 2-receptor antagonists, such as cimetidine and ranitidine . Let your provider know if you are taking any of these medications.
  • Because older adults are at risk of a vitamin B12 deficiency, start getting regular blood tests for this when you are in your 60s. Some health experts recommend that older adults take a daily B12 supplement.
  • Eat foods that contain vitamin B12. If you follow a vegetarian or vegan eating pattern, focus on eating foods fortified with vitamin B12 or consider taking a multivitamin.

What Causes Inadequate Consumption Of Vitamin B12

Inadequate consumption of vitamin B12 is often due to dietary choices, for example vegans and vegetarians. People who are vegan are more likely to become deficient in vitamin B12 as they consume no animal products. People who are vegetarian consume no meat but may consume other vitamin B12 containing animal products . Vegetarians are still at risk of developing a B12 deficiency.

In most other people, deficiency due to inadequate consumption of vitamin B12 is unlikely.

What Vitamins Are Diabetics Deficient In

The term vitamin is short for Vital Amino Acid. This means that these are vital for the proper functioning of hundreds of chemical processes in the body which the body cannot manage by itself. Proper blood sugar control is one such function for which vitamins are critical. There are 13 essential vitamins that the human body requires and they must be obtained from an external source through food and/or supplements.

Diabetics need two kinds of vitamins:

Water Soluble Vitamins B1, B2, B3, B6, B12, C, Biotin, and Folate are water-soluble and cannot be stored in the body for longer periods of time. Diabetics are often deficient in these vitamins since they pass greater amounts of urine daily. As their body tries to get rid of extra sugar, diabetics lose more water-soluble vitamins than most others. Thats why diabetics need to to get these vitamins daily in doses larger than what normal people need. Luckily, you can get all of these in a single, high potency multivitamin, which you can take twice a day, and thus make up for most of the vitamins lost.

Fat SolubleVitamins A, D, E, and K are fat-soluble, which is yet another reason why we  highly recommend a Low Carb-High Fat diet for diabetics. If you eat a diet that is high in good fats, the fat soluble vitamins can be stored in the body for longer periods of time.

B12 For Improved Energy

Though vitamin B12 is commonly taken to increase energy levels, evidence showing that B12 supplements improve energy levels in people without a deficiency is lacking.

However, B12 supplements have been found to improve energy levels in those who are deficient in this nutrient .

One review recommended that those with vitamin B12 deficiency take 1 mg of vitamin B12 daily for a month, followed by a maintenance dose of 125250 mcg per day .

People who have issues absorbing vitamin B12, such as those with Crohns disease or other gastrointestinal issues, may benefit from B12 injections, which bypass the need for absorption by the digestive tract .

Metformin Dose Effect On Vitamin B

How much metformin you take and the duration you take it affect your risk of developing vitamin B-12 deficiency, according to a study published in a 2006 issue of the journal “Archives of Internal Medicine.” The study had 155 participants who suffered from vitamin B-12 deficiency resulting from metformin use. The results of the study indicated that each 1 g daily of metformin caused a ratio of 2.88 increase in the risk of developing vitamin B-12 deficiency. Patients using metformin for three or more years had a lower ratio of 2.39. This suggests that it is possible to use metformin, by dosage and duration of treatment, as a basis for devising a method of preventing vitamin B-12 deficiency. The results also help determine how much supplementation is needed to maintain healthy levels of the vitamin B-12.

Vitamin B12 Deficiency And Type 2 Diabetes

Its estimated that 22% of people with type 2 diabetes have Vitamin B12 deficiency, which is much higher than the general population.

Getting enough Vitamin B12 in your diet through the food you eat is only one piece of the picture. After it has been ingested, the B12 then needs to be absorbed from the gut into the body, then travel to the cells to do its work. Vitamin B12 requires something called intrinsic factor in order to be absorbed from the lumen of the gut into the body. Some people dont make as much intrinsic factor, and generally speaking, as we get older, we make less and less, which is a reason why the elderly are at higher risk for B12 deficiency, too.

Additionally, metformin , is one of many medications that interferes with absorption of Vitamin B12. It has been estimated that 10-30% of people who take metformin may not be able to absorb Vitamin B12. Another study showed that of metformin users were deficient. Whether the range is 10% or 75%, its still something to be concerned about if youre taking metformin, you are at higher risk for B12 deficiency.

Interestingly, it also seems to be the case that B12 deficiency may cause hyperglycemia so there may be a bit of a cyclical relationship between the two.

People who have had bariatric surgery are at high risk for deficiency also, since their absorptive area has been reduced and the portion of the stomach that secreted intrinsic factor may be gone or destroyed.

B12 Assessment Techniques And Interpretation Of Laboratory Results

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Several B12 assessment methods are available for providers. They include serum/plasma B12, Mean Corpuscular Volume , Homocysteine , Holotranscobalamin II and serum and urinary methylmalonic acid . includes the list of biochemical B12 assessments along with the traditional and evidence-based deficiency cutoffs. Serum B12 along with MCV seem to be used the most in clinical settings. Unfortunately, these two assessment methods are not always accurate in making diagnoses of B12 status.

Table 1: Traditional and evidence-based vitamin B12 deficiency reference values. View Table 1

Histamine H Receptor Antagonist /proton Pump Inhibitor Induced Vitamin B12 Depletion

Literature suggests that drugs which suppress stomach acid production such as PPIs and HRAs interfere with vitamin B12 absorption, by reducing dietary B12 release from food proteins. A 5389% reduction in protein-bound B12 absorption was noted following HRA treatment,, with ranitidine specifically reported to induce decreases in B12 status. Similarly, there have been other reports of an inverse correlation between vitamin B12 levels and duration of PPI therapy. The enzyme cytochrome P450 2C19 , catalyses the metabolism of PPIs and a polymorphism of this enzyme has been demonstrated to influence levels of vitamin B12 in patients using these medications. Hence, those who poorly metabolize PPIs are likely to exhibit increased suppression of acid production and thus more interference with absorption of vitamin B12. Alternatively, patients who have enhanced PPI metabolism are likely to experience diminished acid suppression with a lower interference with absorption of B12.

Preventing Vitamin B12 Deficiency

If you take metformin, a yearly check of your vitamin B12 status can alert your doctor to any dips in your levels that may be early signs of a deficiency. One way to determine vitamin B12 status is with a test that directly measures levels of B12 in a blood sample. A more sensitive test looking at levels of a metabolite in the blood called methylmalonic acid may be able to detect low B12 levels earlier.

Meanwhile, including plenty of foods rich in vitamin B12 in your diet, such as eggs, beef, salmon, chicken, and nutritional yeast; and/or taking supplemental B12 may help to prevent a deficiency .

The methylcobalamin form of vitamin B12 in a sublingual format is best absorbed by the body, but you should consult your doctor about the ideal supplement and correct dosage for you.

Heart Beat: Diabetes Drug Interferes With Vitamin B12

Metformin is a first-line drug for treating type 2 diabetes. It limits the amount of sugar the body absorbs from food, cuts down on the amount of sugar the liver produces, and makes muscles and other tissues more sensitive to insulin, the hormone that ushers blood sugar into cells. Although metformin is very safe, one-third of those who take it develop low levels of circulating vitamin B12. The body needs this vitamin to make new red blood cells and to keep nerve cells healthy. In a Canadian study, diabetics taking metformin had half the blood levels of vitamin B12 of those who weren’t taking metformin; 31% of the metformin takers had levels significantly below normal. They also had more advanced neuropathy, the degeneration of nerves that often accompanies diabetes .

Older people are prone to vitamin B12 deficiency because aging reduces the body’s ability to absorb this vitamin from food; adding metformin can worsen the problem. A severe deficiency can lead to anemia and confusion, and sometimes masquerades as dementia or Alzheimer’s disease.

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Who Is At Risk Of B12 Deficiency

People who may not get enough vitamin B12 or who have trouble absorbing it include:

  • Many older adults
  • People who dont make enough hydrochloric acid and intrinsic factor in their stomachs
  • People with pernicious anemia
  • People who have had some types of stomach or intestinal surgery
  • People with digestive disorders, such as celiac disease or Crohns disease
  • People who follow a vegetarian or vegan eating plan

How Is Vitamin B12 Absorbed

Vitamin B12 is absorbed in our small intestines.

In order for vitamin B12 to be absorbed, it binds with an important protein called intrinsic factor. Intrinsic factor is produced in the stomach. Without intrinsic factor, B12 would not be able to be absorbed.

When vitamin B12 and intrinsic factor bind, it is called the vitamin B12-intrinsic factor complex .

Who Can Take Metformin

Metformin can be used with most other diabetes pills, with insulin, and with noninsulin injectables, such as GLP-1 inhibitors. Side effects of taking metformin are relatively rare, the most common being bloating, nausea, and diarrhea, all of which are temporary for most people. Some people shouldnt take metformin, including people with stage 4 or 5 kidney disease, liver disease, and people with type 1 diabetes.

Vitamin B2 Or Riboflavin

Vitamin B2 has not been studied directly to impact Type 2 diabetes or its complications. However, since it works to support production of Glutathione, a powerful antioxidant, addition of this element to a B Complex may support diabetics. Diabetics have excessive oxidative stress compared to non-diabetics.

Is It Safe To Take Supplements If You Have Diabetes

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You will find supplements for anything and everything these days. Even when you do not suffer from an ailment, supplements are suggested to keep you healthy and ailment-free. According to CDC, use of supplements is common among US adult population over 50% adults used supplements during 2003-2006, with multivitamins/multiminerals being the most commonly used.

So when you are a diabetic, especially if you have prediabetes and type-2 diabetes, you may find yourself confronting a large number of options for supplements that claim to support, reduce and even cure your diabetes. Diabetes is quite a frustrating disorder and you may find yourself tempted to try out these supplements one after another. But is it really safe to take supplements when you are a diabetic? Let us find out. But before that you need to understand what exactly supplements are.

Foods That Contain B Vitamins

The vitamin B family is present in so many foods that this cannot be an exhaustive list by any means. However, weve picked some of the foods that have a high balance of all the  Vitamins B.

Beef, beef liver, oats, tuna, turkey breast, eggs, bananas , avocado, kidney beans, summer squash, spinach, kale, almonds, milk . Several of the recipes listed in our diabetes-friendly diet can give you interesting and tasty ways to incorporate these foods into your daily diet.

Vitamin B12 Dosage Recommendations

You may be confused about your personal recommended daily dosage of vitamin B12. Well, stages of life and lifestyle changes impact the amount of vitamin B12 you need in order to avoid deficiency. That means that your vitamin B12 requirements will change throughout the course of your life.

The National Institutes of Health recommends the following vitamin B12 dosages for each category:

Infants, Children and Teens

The recommended daily vitamin B12 dosage for infants, children and teens is as follows:

  • Birth to 6 months: 0.4 micrograms
  • Infants 712 months: 0.5 micrograms
  • Children 13 years: 0.9 micrograms
  • Children 48 years: 1.2 micrograms
  • Children 913 years: 1.8 micrograms
  • Teens 1418 years: 2.4 micrograms

Vitamin B12 is essential for many body functions in babies, children and teens, including proper growth and brain function. A deficiency is associated with an increased risk of adverse child health outcomes, according to research published in Advances in Nutrition. Dietary intake of vitamin B12 through breast milk, infant formula and table foods is vital.

Adults Ages 1850

The recommended daily dosage for adults over 18 years old is 2.4 micrograms. Most adults consume at least this amount from their diets alone, given that they eat animal products like meats, seafood, dairy and eggs.

Adults Over 50 Years Old

Pregnant Women

Breastfeeding Women

Vegans and Vegetarians

Now Is Endocrinologa Diabetes Y Nutricin More Information

Index Medicus/MEDLINE, Excerpta Medica/EMBASE, SCOPUS, Science Citation Index Expanded, Journal Citation Reports/Science Edition, IBECS

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.© Clarivate Analytics, Journal Citation Reports 2021

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal’s impact.

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

To test vitamin B12 plasma levels in type 2 diabetic patients treated with metformin in our area.

A cross-sectional, observational study of consecutive type 2 diabetic patients on drug treatment attending an internal medicine outpatient clinic.

One hundred and nine patients were enrolled into the study. Mean time on metformin treatment was 43.5 months and mean drug dose was 1779mg/day. Patients treated with metformin had significantly lower vitamin B12 plasma levels . Seven of 81 patients treated with metformin and none of the 28 patients not treated with the drug had vitamin B12 plasma levels lower than 197pg/mL. No correlation was found between vitamin B12 plasma levels and metformin treatment time or dosage.

6.9±0.9  NS 

The authors state that they have no conflicts of interest.

Why Does Vitamin B12 Deficiency Occur With Long

Its thought that metformin possibly interferes with absorption of the vitamin in the digestive tract. Of note, the body stores between 1,000 and 2,000 times as much vitamin B12 as one would typically eat in a day; for this reason, symptoms of vitamin B12 deficiency can take several years to appear.

The American Diabetes Association recommends that people taking metformin periodically have their B12 status assessed, as a deficiency may contribute to anemia or peripheral neuropathy. Vitamin B12 status is assessed by a blood test.

Vitamin B12 Deficiency Among Patients With Type 2 Diabetes Mellitus And The General Population: A Comparative Review

Due to the diverse definitions of vitamin B12 deficiency used in most studies and the cultural and religious beliefs in different regions of the world, comparison of the prevalence of vitamin B12 deficiency among T2DM patients and healthy general populations is difficult. In one population based study among 1048 elderly Finnish subjects aged 65100 years, the total prevalence of definite vitamin B12 deficiency was 12.1% . Previously diagnosed vitamin B12 deficiency was reported among 2.6% of the participants. Vitamin B12 replacement therapy was documented among only 2.6% of the participants. In this study, vitamin B12 deficiency was defined as total serum vitamin B12 concentrations <150 pmol/l or total serum vitamin B12of 150250 pmol/l and holotranscobalamin 37 pmol/l and homocysteine 15 mol/l.

In India, a country with a large proportion of vegetarians due to cultural and religious beliefs, very high prevalence of vitamin B12 deficiency among the general population has been reported. In one study by Yajnik et al. to determine the frequency of vitamin B12 deficiency and hyperhomocysteinemia among 441 healthy middle aged Indian men, vitamin B12 deficiency as defined by vitamin B12 concentrations <150 pmol/L was reported among 67% of the study participants . Vegetarian diet was the sole significant factor associated with low vitamin B12 levels in this study on multivariate analysis .

What Causes Inadequate Storage Of Vitamin B12

Vitamin B12 is stored in the liver. If a person has a liver disorder, for example liver disease, then the liver is unable to store vitamin B12 and this can lead to a B12 deficiency.

The liver is able to store large amounts of B12. Vitamin B12 stores in the liver can take between 3-5 years to be completely depleted.


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