Fast Five Quiz: Vitamin B12 Deficiency

Fast Five Quiz: Vitamin B12 Deficiency

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Romesh Khardori, MD, PhD

December 22, 2020

Vitamin B12 deficiency can cause various neurologic diseases and other clinical manifestations. Its incidence widely varies on the basis of whether the cause is autoimmunity, malabsorption, or dietary insufficiency. In the United States and the United Kingdom, the prevalence of vitamin B12 in individuals aged < 60 years is approximately 6%, whereas it is nearly 20% in those aged > 60 years. In adults in East India and in Kenyan schoolchildren, the prevalence has been reported to be as high as 70%.

Are you familiar with risk factors for the development of vitamin B12 deficiency, as well as related key aspects, clinical manifestations, and best practices for diagnosis and treatment? Test your knowledge of this common nutritional deficiency with this short quiz.

Medscape © 2020 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Romesh Khardori. Fast Five Quiz: Vitamin B12 Deficiency – Medscape – Dec 22, 2020.

Professor of Endocrinology; Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia

Disclosure: Romesh Khardori, MD, PhD, has disclosed no relevant financial relationships.

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Fast Five Quiz: Vitamin B12 Deficiency

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What Is Diabetic Neuropathy?

What Is Diabetic Neuropathy?

Diabetes can harm your nerves. That damage, called neuropathy, may be painful.

It can happen in several ways, and they all seem to be related to blood sugar levels being too high for too long. To prevent it, work with your doctor to manage your blood sugar.

You may hear your doctor mention the four types of diabetes-related neuropathy: peripheral, autonomic, proximal, and focal.

This type usually affects the feet and legs. Rare cases affect the arms, abdomen, and back.

Symptoms include:

Early symptoms usually get better when your blood sugar is under control. There are medications to help manage the discomfort.

What you should do:

This type usually affects the digestive system, especially the stomach. It can also affect the blood vessels, urinary system, and sex organs.

In your digestive system:

Symptoms include:

What you should do: You may need to eat smaller meals and take medication to treat it.

In blood vessels:

Symptoms include:

If you have it:

Avoid standing up too quickly. You may also need to wear special stockings (ask your doctor about them) and take medicine.

In Men:

Symptoms include: He may not be able to have or keep an erection, or he may have “dry” or reduced ejaculations.

What you should do: See your doctor, because there are other possible causes than diabetes. Treatment includes:

In Women:

Symptoms include: Can include less vaginal lubrication and fewer or no orgasms.

What you should do: See your doctor. Treatments include:

In the Urinary System:

Symptoms include:

What you should do: Tell your doctor. Treatments may include:

This type causes pain (usually on one side) in the thighs, hips, or buttocks. It can also lead to weakness in the legs.

Most people with this condition need treatment, such as medication and physical therapy, for their weakness or pain.

This type can appear suddenly and affect specific nerves, most often in the head, torso, or leg. It causes muscle weakness or pain.

Symptoms include:

What you should do: Tell your doctor about your symptoms. Focal neuropathy is painful and unpredictable. But it tends to improve by itself over weeks or months. It usually doesn’t cause long-term damage.

People with diabetes can also get other nerve-related conditions, such as nerve compressions (entrapment syndromes).

Carpal tunnel syndrome is a very common type of entrapment syndrome. It causes numbness and tingling of in the hand and sometimes muscle weakness or pain.

If you think you may have any type of nerve problem, talk with your doctor, so she can check for the cause.


American Diabetes Association (ADA): “Diabetic Neuropathy (Nerve Damage) and Diabetes.” 

ADA: “Additional Specific Types of Diabetic Neuropathy.” 

National Diabetes Education Program: “Prevention and Early Intervention for Diabetes Foot Problems.”


See how one patient learned to manage her weight and diet.

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What Is Diabetic Neuropathy?

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The Best Exercises If You Have Diabetes

The Best Exercises If You Have Diabetes

Exercise is good for pretty much everyone. It’s especially important if you have diabetes. Workouts can do all kinds of things for you, like lower your blood sugar and blood pressure, boost your energy, and help you sleep better. If physical, high-impact exercises aren’t for you, there are plenty of other options.

It’s a simple way to get exercise and fresh air. It can lower your stress, too. A brisk stroll of 30 minutes to an hour 3 or 4 times a week is one way to hit your target. It’s easy to get started: Take Fido around the neighborhood or walk to the store instead of driving. Once you’ve made it a habit, it can be rewarding — and motivating — to track your steps and your progress.

This can be a fun way to get your exercise. Just shake your groove thing for 25 minutes, 3 days a week to help your heart, lower your blood sugar, ease stress levels, and burn calories. You don’t need a partner to get started, either. A chair can be good support if you need it.

This is one aerobic exercise that doesn’t strain your joints like other ones can. It also lets you work muscles in your upper and lower body at the same time. Hitting the water is also good for your heart. It can also lower cholesterol and help you burn serious calories. If a lifeguard is on duty, let her know you have diabetes.

Fighting diabetes can be as easy as riding a bicycle. Whether you use a stationary one or hit the road, 30 minutes a day 3 to 5 times a week can get your heart rate up, burn blood sugar, and help you lose weight without hurting your knees or other joints.

This can be a healthy and easy way to burn calories and get your heart and lungs working faster, especially if you have type 2 diabetes. Going up and down stairs for 3 minutes about an hour or two after a meal is a good way to burn off blood sugar. You can do it anywhere there’s a staircase, like when you need a break from work.

You do this with free weights or resistance bands. It can lower your blood sugar and help make your muscles and bones stronger. You get the most out of it if you do it twice a week — in addition to your aerobic stuff.  You can do many of these exercises at home, like:

If the idea of traditional exercise isn’t for you, don’t worry. Time in your garden counts as both aerobic activity and strength training. It gets your blood going (since you’re walking, kneeling, and bending). It also builds muscles and helps your bones (since you’re digging, lifting, and raking). You’re also outside, where your stress levels can be lower.

It’s worked for some 5,000 years as a low-impact exercise that can make you stronger and more flexible. Yoga can also help with balance. The motions, poses, and focus on breathing may also ease stress and help build muscle. That can keep your blood sugar levels more stable.

This ancient Chinese art uses slow, controlled movements — along with visualization and deep breathing — to build strength. It can also help with mobility, balance, and flexibility. This gentle exercise can also lower your stress level. It may also help prevent nerve damage in your feet.

At least 30 minutes of aerobic activity 5 days a week can help the insulin in your body work better. We’re talking exercise that gets your heart and lungs going and kicks your blood flow into a higher gear. If you haven’t been active in a while, start with 5 to 10 minutes a day and build up over time.  Talk with your doctor before you start.


Medically Reviewed on 2/21/2017

Reviewed by Michael

Dansinger, MD on February 21, 2017


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American Diabetes Association: “Aerobic Activity,” “Injury-Free Exercise – 11 Quick Safety Tips,” “Physical Activity is Important,” “What We Recommend.”

Mayo Clinic: “Diabetic Neuropathy” “Healthy Lifestyle Fitness.”

Cleveland Clinic: “5 Best Exercises for People with Diabetes.”

American Heart Association: “American Heart Association Recommendations for Physical Activity in Adults.”

Diabetes.Co.UK: “Stair Climbing After Meals Improves Blood Sugar Levels In Type 2 Diabetes, Study Reports.”

University of Florida: “Yoga History.”

Tai Chi For Health Institute: “How Does Tai Chi Help For Diabetes?”

Reviewed by Michael

Dansinger, MD on February 21, 2017

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The Best Exercises If You Have Diabetes

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