NPs who prescribe metformin for an extended period, no matter the indication (eg, T2DM prevention and treatment, polycystic ovary syndrome), should consider B12 supplementation as well as perform routine measurement of vitamin B12 levels, both when starting metformin and at intervals of no more than one to two years thereafter (note that the optimal frequency has not been determined, and metformin can begin to decrease serum B12 levels in as little as three months).6 A recent study showed that clinicians initially prescribing metformin measure vitamin B12 levels less than half the time.10 In this study of 5,131 patients with T2DM who started taking metformin during a 5-year study period (2008-2013), only 44.5% had vitamin B12 tested
The same is true of B vitamin complex supplements, which deliver 50 to 500 micrograms (i.e., 20 to 200% of the RDA), as well as for most supplements containing only vitamin B12, which deliver up to 1,000 micrograms (about 400% of the RDA)
Suggested Use Dissolve 1 lozenge slowly in mouth and swallow per day or as directed by your health-care practitioner
Ensuring accurate documentation of symptoms, laboratory findings, and treatment plans is vital for successful reimbursement
This concern can disrupt daily routines and make it tough to maintain a lively social or work schedule
Please read the book Could it Be B12
