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Office of Dietary Supplements (ODS)

It is also important to note that different conditions affect HbA1c in different ways: Haemolytic anaemia and acute blood loss shorten red cell lifespan and tend to lower HbA1c Iron deficiency anaemia is associated with increased HbA1c, likely due to prolonged red cell survival Haemoglobin variants (haemoglobinopathies) can cause variable or assay-dependent interference the effect depends on the specific variant and the HbA1c method used B12 or folate deficiency alters erythropoiesis and red cell indices, making HbA1c potentially unreliable in either direction Clinicians should therefore: Review the full blood count (FBC) alongside HbA1c Check serum B12 and folate when anaemia or macrocytosis (raised mean corpuscular volume, MCV) is identified Consider alternative glucose assessment methods specifically fasting plasma glucose or a 75 g OGTT for diagnostic purposes, or self-monitored blood glucose (SMBG) or fructosamine/glycated albumin for interim monitoring when HbA1c is unreliable Not sure where to start

NZMJ 10:1436 Tuba-Kartal A, ala-Mutlu Z (2020) Comparison of sublingual and intramuscular administration of vitamin B12 for the treatment of vitamin B12 deficiency in children

This method bypasses any barriers to absorption and ensures that you get the full dose of B12 without delay