A 77-year-old woman with a CFS of 4 and well-controlled type 2 diabetes has been on Metformin 1 g BD for 8 years. She has no GI symptoms and her eGFR ...

Question

A 77-year-old woman with a CFS of 4 and well-controlled type 2 diabetes has been on Metformin 1 g BD for 8 years. She has no GI symptoms and her eGFR is 62. Recent blood tests show Hb 104 g/L (MCV 108 fL) and vitamin B12 of 118 pmol/L (deficient,

Accepted Answer

Commence intramuscular Hydroxocobalamin loading (1 mg on alternate days for 2 weeks), followed by maintenance injections every 3 months, and consider whether ongoing Metformin use requires B12 monitoring

Answer

No action needed - her B12 is borderline

Answer

Start oral B12 supplements 50 mcg daily

Answer

Stop Metformin permanently

Answer

Commence Folic acid supplementation alone

uk-dgm MCQ (SBA): B12 Deficiency Treatment - Metformin-Related