B12 Loading - why not given?

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   My other half (69) has taken Metformin for many years.  Recently it was discovered that his B12 was very low, possibly as a result. 

   He has recently started on monthly B12 jabs, but did not receive the usual loading dose of 6 shots over two weeks.  Is this unusual?

   He has an appointment with his GP to discuss his most recent test results next week, and I'd like him to be as well-informed as possible before he attends.

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  • Posted

    This is very common in the medical field. Most gps are not well educated on b12. There were new guidelines issued by the British Committee of Standards of Haematology (BCSH) this year. The guidelines state 6 b12 injections on alternate days then 12 weekly and if there is neurological symptoms - alternate loading until no further improvement then 8 weekly injections. Loading to be reviewed after 3 weeks. 

    Check folate is in high level of normal lab range. B12 needs folate to convert to the active form to enter cells. Also check ferritin (iron stores) are at a good level too. 

    When b12 is low this can cause other b vitamins to be low so a daily b complex is good to take. 

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    • Posted

      Hi Heather, thank you very much for getting me up to date on the BCSH's new guidelines - that's a great help.  I had proposed to go with him into his appointment, but he is terrified it will be interpreted as a criticism or as "confrontational" by his GP.

      I was diagnosed with low B12 in March, and had to exert some pressure over the past 8 months to get myself this far with treatment (I have low B12, ferritin and a gastroscopy next week).  There seems to have been a poor grasp of the danger of prolonged low B12 at the practice until recently. 

      Sadly, my partner doesn't realise how "foggy" he is becoming, and is completely unable to memorise anything.  But I doubt this is apparent in a 10 minute appointment!  As a result, he comes back from his GP without detailed information, even though he tries.  I'm fearful that he will slide into senile dementia if I don't manage his health actively, including making sure his GP is covering all the bases.

      I have mild PA myself, and received the loading jabs.  I've moved from quarterly to monthly jabs recently, plus iron supplements, and believe I am improving as a result.  It was only my reading on PA for myself that flagged up the issues with the Metformin he was taking.  I insisted he was tested, et voila, he was very low. 

      Although his GP blustered that they'd been checking him regularly in the past, he'd received no jabs or tablets for it, and I can't help but think they are - sorry - "covering their asses".  He had, after all, been taking Metformin for about 15 years, so it's unlikely that significant B12 deficiency has only arisen suddenly in the last 6 months.

      I am considering typing "bullet points" on a card for him to take with him, so he asks the right questions, and writes down the answers.  But I know he will be uncomfortable with this.  I need his GP to feed back to me, as I have developed some concept of the condition, which my partner simply cannot manage to do anymore.

      Do you think it would be in order for me to write to her prior to his appointment to explain my concerns and ask her - with his consent - to keep me informed of his results?

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    • Posted

      Yes. You could ask for a call back on the telephone to voice your concerns. Do you know the folate levels. It is common for folate to be low with b12. B12 uses folate to metabolise. Many b12 sufferers take a daily 5mg folic acid. You are correct about metaformin, it depletes b12 and is mentioned in the bcsh guidelines too. Antacids do this too. Ask for a print out of all blood results so you can check levels xx
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