Neuropathy in DM type 2

It is not very uncommon to see some walk in diabetic patients with complaints of neuropathic pain in the fast track or Family medicine clinic. Often times, we attribute their symptoms to the complications of Diabetes itself. However, as a clinician, it would be advisable to seek the history of the Oral antidiabetic drugs the patient is on and for how many years.
In a recent study, it was found that these neuropathic symptoms were associated to a potentially reversible cause in more than 30 % patients on METFORMIN for more than 10 to 15 years. Metformin reduces Vitamin B12 absorption in the terminal ileum through calcium dependant pathway. It has been recommended  to Supplement these patients with oral B12 and Calcium therapy, and determination of annual B12 level.

(Source: David S.H. Bell, MD; Southside Endocrinology and Division of Diabetes, Endocrinology, and Metabolism, University of Alabama Medical School, Birmingham, AL, "Metformin-induced Vitamin B12 Deficiency Presenting as a Peripheral Neuropathy," South Med J. 2010;103(3):265-267)