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Feb 2019;10(2):398-406

N., Booher, S., Gilron, I., Parada, S

Neurological symptoms are particularly significant and may include: Paraesthesia (pins and needles) in the hands and feet Numbness or altered sensation in the extremities Difficulty walking or problems with balance and coordination (ataxia) Memory problems and cognitive difficulties Mood changes, including depression and irritability Visual disturbances in severe cases Haematological and general symptoms commonly include: Pale or jaundiced (slightly yellow) skin Glossitis (sore, red, smooth tongue) Mouth ulcers and angular cheilitis (cracks at the corners of the mouth) Breathlessness, particularly on exertion Heart palpitations Headaches and dizziness Gastrointestinal symptoms may present as: Loss of appetite and unintentional weight loss Diarrhoea or constipation General digestive discomfort The severity and combination of symptoms vary considerably between individuals

If levels remain low despite supplementation, increase the dose or frequency

Fatigue in patients with diabetes: a review