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Though diabetes authorities recommend annual B12 screening for people who have diabetes and use metformin, many clinics fail to test B12 levels every year, according to an article published in Clinical Diabetes

Subjects have given their written informed consent and that the study protocol was approved by the institutes committee on human research

Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley GP Jr (2012) Association of biochemical B deficiency with metformin therapy and vitamin B supplements: the National Health and Nutrition Examination Survey, 19992006

2009;60(Suppl 7):107114

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Other symptoms are neurological and may include tingling in the extremities, confusion, memory loss, depression and difficulty maintaining balance