Chronic metformin use results in vitamin B12 deficiency in 30% of patients. Exhaustion of vitamin B12 stores usually occurs after twelve to fifteen years of absolute vitamin B12 deficiency. Metformin has been available in the United States for approximately fifteen years. Vitamin B12 deficiency, which may present without anemia and…
Abstract:Diabetic neuropathic cachexia is characterized by bilateral, painful neuropathy usually involving the anterior thighs, with dramatic weight loss. The cause is unknown. Most patients to date have been middle-aged type 2 diabetics on oral agents, and it has rarely been reported in patients with type 1 diabetes. Most patients recover…
Lower extremity amputation is one of the worst complications of diabetes, as it usually has a life expectancy that is below that of most cancers. Four local biologic factors—ulcer, ischemia, neuropathy, and infection—have been shown to be related to amputation. These factors interact with one another, such that neuropathy has…
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