this leads to a malabsorption of the vitamin Certain medications use long term metformin use and chronic acid-reducing drugs decrease the absorption of vitamin B12 from food particles Malignancy of the pancreas or bowel Folic acid deficiency Semaglutide Semaglutide is contraindicated in patients with a history of angioedema, anaphylaxis, or other serious hypersensitivity reaction to semaglutide
further notes that a restricted maintenance dose of just four injections per year is what is normally allowed, which can leave people physically and mentally unable to contribute to either family or society, and lead to permanent neurological damage
From a laboratory medicine perspective, the Association for Clinical Biochemistry and Laboratory Medicine (ACB) and the Royal College of Pathologists (RCPath) advise that: HbA1c may be unreliable in the presence of haemolytic anaemia, haemoglobinopathies, or nutritional deficiencies affecting red cell biology and the direction of distortion may be high or low Clinicians should document any known haematological conditions when requesting HbA1c, so laboratory staff can flag potential inaccuracies Serum B12 testing should be considered in patients on long-term metformin who are symptomatic or have risk factors for deficiency, in line with MHRA and NICE advice Alternative tests fasting plasma glucose, OGTT, or interim use of fructosamine/glycated albumin should be considered when HbA1c reliability is in doubt The NHS website (nhs.uk) provides patient-facing information on the HbA1c test and factors that can affect its accuracy, which patients may find a useful starting point
But if your deficiency is caused by an absorption problem, lifestyle tweaks will not replace the injection schedule, they only support it
