Often, there are some very important things for people with diabetes that are not taken into consideration in their daily treatment routine, as they are overlooked due to lack of time and increased workload in hospitals and clinics. However, every individual must educate themselves and strive for the balance and good health of their body. We will focus our attention on three important elements that are necessary for the smooth functioning of the body, and neglecting them can negatively affect the course of diabetes, such as poor blood sugar regulation and diabetic complications.
Magnesium Deficiency in People with Diabetes
Low levels of magnesium in diabetics are not uncommon. Low magnesium levels in diabetic individuals appear to range from 15 to 50%. They may occur either due to decreased intake through diet, increased excretion by the kidneys, or as a result of chronic diarrhea in autonomic diabetic neuropathy of the gastrointestinal system. This deficiency appears to increase insulin resistance, decrease glucose utilization by the body, and increase blood pressure as well as lipid levels, resulting in the development of diabetic complications, mainly cardiovascular complications.
On the other hand, adequate magnesium levels stabilize glucose metabolism and reduce the risk of micro- and macrovascular complications, thus protecting the cardiovascular system. It is well known that magnesium has a positive effect on the heart and blood vessels. Magnesium helps in vasodilation, reduces platelet aggregation, and decreases inflammation. Therefore, it is necessary for every diabetic to monitor magnesium levels in the blood. Subsequently, extensive education should be provided to the patient regarding foods rich in magnesium, and if there is insufficient increase, magnesium supplementation in tablet form should be administered orally after rechecking the levels to determine the correct dosage to maintain the desired levels.
Vitamin D Deficiency in People with Diabetes
It is now known that the role of vitamin D is not limited to osteoporosis treatment. We know that its action in the body not only improves bone composition but also protects us from inflammation, cancer, depression, and strengthens our immune system. It also seems that low levels of vitamin D increase the risk of developing diabetes. On the other hand, adequate vitamin D levels stabilize glucose metabolism and positively affect the body’s sensitivity to insulin, an important consideration in diabetic individuals where insulin resistance is a major problem. Increases in insulin sensitivity of up to 50% have been noted, correcting vitamin D levels from 10 ng/ml to levels above 30 ng/ml. Satisfactory vitamin D levels stimulate the beta cell to produce more insulin. Therefore, checking vitamin D levels in diabetic individuals is necessary, and in case of deficiency, oral supplementation or intramuscular injections are administered depending on the extent of the deficiency. Foods rich in vitamin D include animal products such as red meat, eggs, liver, dairy products, as well as some fish.
Vitamin B12 Deficiency in People with Diabetes after Several Years of Metformin Treatment
Metformin (Glucophage® or generic) is a first-line treatment for diabetes. The benefits of using metformin, apart from being an economical drug, are many. It effectively reduces glucose, improves cardiovascular mortality, and is a fairly safe drug for long-term use worldwide. However, one of its drawbacks, apart from gastrointestinal disturbances, is its effect on the absorption of vitamin B12. Vitamin B12 deficiency in diabetics on metformin therapy can reach up to 30% and increases with age, dose, and duration of use. If other factors such as reduced intake in vegetarians, the coexistence of atrophic gastritis, celiac disease, or other diseases with reduced vitamin B12 intake coincide, then deficiency in this vitamin occurs. Vitamin B12 deficiency results in macrocytic anemia (low hemoglobin) as well as various neurological consequences that can sometimes be confused with diabetic complications. Therefore, vitamin B12 levels should be checked, especially in elderly patients and those who have been taking metformin for years. Deficiency can be treated with intramuscular injections or oral tablets depending on the extent of the deficiency. Foods rich in vitamin B12 include animal products such as red meat, eggs, liver, dairy products, as well as some fish.
In summary, in diabetic individuals, in addition to administering antidiabetic medications for diabetes treatment, annual monitoring of magnesium, vitamin D, and vitamin B12 levels in the blood is recommended. Subsequently, depending on the result and in case of insufficient intake through diet, the above important substances for the body should be supplemented accordingly.