Vitamin Deficiencies in People With Diabetes: the Supplements You Need

As an orthopedic surgeon, I have many patients with diabetes who tell me, “I can’t have surgery because I won’t heal.” That is certainly not the case, however.  Diabetes does affect the small blood vessels and the function of immune cells when blood sugar is high, but with proper nutrition and blood sugar management, people with diabetes are very safe to undergo knee replacements, abdominal surgery, and many elective procedures.  

It is critical, of course, that people with diabetes who undergo elective or traumatic surgery work closely with their doctor to manage their blood sugar, but supplementation is also a vital part of recovery. Diabetes frequently causes nutritional deficiencies, often initiated by changes in diet or medications. As a result, people with diabetes must use supplements. Helping my patients identify their nutritional deficiencies and educating them on the importance of essential vitamins has made an overwhelming difference in their recovery from surgery and their overall daily health.

The following essential vitamins are often deficient in people with diabetes.

Vitamin B12
Vitamin B12 is bound to protein in food.  The activity of hydrochloric acid and gastric protease in the stomach releases vitamin B12 from its protein.  Once it is released, vitamin B12 begins to work quickly.  It is important for the formation of red blood cells, neurological function, and DNA synthesis.  It also supports the digestive system in keeping glucose levels stable.  

A simple blood test can determine the level of B12 in the body.  Adults who have a value below 170 to 250 pg/mL are considered deficient in the vitamin.  An elevated blood homocysteine level or elevated methylmalconic acid level may also suggest a B12 deficiency.  

Symptoms of vitamin B12 deficiency are megaloblastic anemia (red blood cells that are larger than normal), fatigue, weakness, constipation, loss of appetite, and weight loss.  Additional symptoms include difficulty maintaining balance, depression, confusion, dementia, poor memory, and soreness of the mouth and tongue. Some people experience numbness and tingling in the hands and feet.  If the B12 deficiency is not remedied, permanent nerve damage can occur. Neuropathy is a common problem for people with diabetes, who experience pain, tingling, and numbness in their arms, hands, legs, and feet, resulting in sores.  

Vitamin B12 supplementation can be taken orally or, if the body is unable to absorb B12 due to medications or other medical complications, by injection.

Vitamin D
We all know that calcium is a building block for strong bones, but calcium needs the presence of vitamin D in order to do its job. One of the physical complications faced by people with diabetes is loss of bone density, and a deficiency of vitamin D puts them at greater risk of fractures and osteoporosis.  

A shortage of vitamin D also hinders blood sugar levels, making it more difficult to control diabetes. Vitamin D deficiency can result in muscle weakness, increased incidence of infection, increased risk of falling, defects in the skeletal mineralization process, bone discomfort, and aches and pains in the joints and muscles.

The major source of vitamin D for most people is exposure to sunlight, leading to a considerable seasonal variation in hormonally active vitamin D in the bloodstream. Only a few foods naturally contain significant amounts of vitamin D. Those that do include fatty fish such as salmon, mackerel, and herring and fish oils such as cod liver oil. Farm-raised fish tend to have only 100 to 250 IU of vitamin D per 100-gram serving, versus 500 to 1,000 IU for the same-size serving of wild-caught fish. Certain foods are fortified with vitamin D, including milk, some juice products, some breads, yogurts, and cheeses.

The recommended daily intake of vitamin D is 600 IU for healthy adults. Supplementation is usually necessary to achieve optimal levels of vitamin D.

Vitamin E
Vitamin E acts as a powerful antioxidant, protecting cells against the damaging effects of free radicals, and is also intimately involved with healthy immune function. It promotes eye health and can prevent hardening of the arteries by controlling cholesterol levels.  The risk of heart disease, stroke, and heart attack can all be linked to deficiency in vitamin E.  

Foods that contain ample amounts of vitamin E including nuts, seeds, and vegetable oils. Supplements such as dl-alpha-tocopherol provide the synthetic form of vitamin E, but it has only half the bioactivity of naturally occurring vitamin E.  

Magnesium is needed for more than 300 biochemical reactions in the body. It helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong.  It also helps the body digest, absorb, and utilize proteins, fats, and carbohydrates.

Researchers have become very interested in the role magnesium plays in preventing and managing disorders such as diabetes. It is an essential mineral in the regulation of blood sugar, playing a part in the secretion and function of insulin by opening cell membranes for glucose.  Low blood levels of magnesium are frequently seen in people with type 2 diabetes. A deficiency can cause insulin resistance, so that they require greater amounts of insulin to maintain their blood sugar within normal levels.  

The recommended daily allowance of magnesium is 400 mg. Foods high in magnesium include rice, wheat and oat bran, certain herbs, seeds, and nuts.   

It is absolutely critical that people with diabetes not only work closely with their doctor to control their blood sugar, but also pay equally close attention to nutrition and nutritional supplementation.  People with diabetes are always at risk for wounds and slow healing, but with proper medical management and nutrition, these hurdles can be overcome.


Holick, M.F. & Chen, T.C. (2008). Vitamin D deficiency: A worldwide problem with health consequences. American Journal of Clinical Nutrition. 87(Suppl.), 1080S-1086S.

NIH Office of Dietary Supplements. (2011). Dietary Supplement Fact Sheet: Vitamin D.

NIH Office of Dietary Supplements. (2011). Dietary Supplement Fact Sheet: Vitamin B12.

Holick, M.F. (2006). High prevalence of vitamin D inadequacy and implications for health. Mayo Clinic Proceedings. 81(3), 353-373.

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