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Your GP may recommend blood tests to check thyroid function and electrolyte levels, and possibly vitamin B12 status (particularly if you also take metformin), as deficiencies or imbalances in these areas can contribute to neurological symptoms

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Stage 4: Functional Deficiency Severe complications such as B12 deficiency anaemia, nerve damage, and cognitive decline, and common symptoms like: Constant tiredness or fatigue Pale or yellowish skin Numbness or tingling in hands and feet Difficulty walking or balance issues Mood swings, irritability, or depression Memory problems or confusion B12 deficiency hair loss reversible if treated early Swollen tongue or mouth ulcers If left untreated, the effects of vitamin B12 deficiency can include permanent nerve damage and increased risk of heart disease due to high homocysteine levels

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In addition, patients with hereditary folate absorption disorders also have a folate transporter disorder in the central nervous system, suggesting that PCFT is also involved in the transport of folate to the brain [112]