In more recent studies, it has been shown that patients with diabetes being treated with Metformin for more than 1 year can get non-diabetic neuropathy from an induced B12 deficiency. In fact, B12 deficiency neuropathy can mimic the symptoms of diabetic neuropathy, but is easily treated with B12 supplementation. So here are my recommendations for any diabetic on Metformin:
1. Monitor your B12 levels - B12 levels should be tested and maintained above at least 400 pg/mL. This is a simple blood test that can indicate low B12 levels.
2. Supplement B12 and Calcium – Metformin has been shown to inhibit calcium channels in the intestine that allow for the absorption of B12. By supplementing with B12 and Calcium, the absorption is increased to allow improvement of the B12 deficient neuropathy.
3. Consider alternate medications to manage your diabetes - Many medications are available for diabetes that should be considered over Metformin. Although this medication works well, the risks of neuropathy may not be worth it. You should discuss options with your physician and decide if the benefits outweigh the risks.
By following these simple steps, Metformin associated neuropathy can be improved if already present or can be prevented by careful self treatment. The good news about this form of neuropathy is that B12 deficiency neuropathy can completely resolve if the levels are brought back to normal.