So many of my patients who have insulin resistance, type 1 or type 2 diabetes with hyperglycemia and/or obesity have vitamin D or vitamin B12 deficiency. Often they have never had their levels checked or, if they have, were diagnosed with either or both vitamin D deficiency and vitamin B12 deficiency and do not take their prescribed vitamins. Why? It seems to me they don’t think vitamins are as important as taking their “prescribed medications.” With the studies showing the relationship of vitamin D deficiency to these diseases and the risk of low B12 levels with metformin, I have learned the importance of teaching that taking these vitamins is as important as taking prescribed medications and to consider them prescribed medications. I also work with patients who think because these vitamins can be purchased over the counter, they can take more than prescribed, which can also cause problems, sometimes serious ones.
- Check and continue to check vitamin D and vitamin B12 as part of the initial assessment.
- When discussing treatment, discuss patients’ dietary intake of vitamin D and vitamin B12; teach regarding foods that are high/low in these.
- Be cognizant of certain medications that can increase or decrease these levels.
- If vitamin levels are low, assess the cause, and if indicated, recommend at appropriate doses and reassess by checking labs.
- If vitamin levels are high, assess the cause and if due to taking too high of doses of the vitamin, decrease or stop the vitamin and reassess by checking labs.
- When discussing recommending vitamin D and vitamin B12 or other vitamin levels and treatments, treat these as a “prescribed medication.” Write out the recommendation to the patient as a prescription; they may take it more seriously and take as recommended.
Joy Pape, FNP-C, CDE
Diabetes In Control Medical Editor
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