Diabetes seems to be the most difficult to manage. But it is a disease that must be managed well. There are so many drugs for treating diabetes, and certain medications used can potentially lead to nutrient depletions. If you take diabetes medicine for a long time, you may lack these nutrients.

Coenzyme Q10
CoQ10 is effective in recovering from fatigue, maintaining cardiovascular health, preventing aging, gum health, strengthening the immune system, weight loss, and improving symptoms in patients with depression. It is very crucial element for improving insulin sensitivity in diabetics. But this helpful nutrient coenzyme Q10 is easy to diminish when taking certain medications like metformin or sulfonylurea.
Meformins reduce glucose production in the liver. Metformins are a widely used medicine to get clear results in glucose metabolism. Mechanisms are not fully understood, but it reduce glucose production in the liver through AMPK pathways. Physiologically, metformin acts directly or indirectly on the liver to lower glucose production (1).
It causes deficiency by inhibiting NADH-oxidase enzymes involved in synthesis. Sulfonylureas, another type of diabetic drug, are also may decrease CoQ10 levels. In the case of the sulfonylurea family, which promotes insulin secretion, it inhibits enzymes in energy metabolism. Taking sulfonylureas except glimepiride may deplete coenzyme Q10.
The heart needs plenty of coenzyme Q10 for its regular functions, such as supplying blood to the whole body. Lack of CoQ10 can lead to poor heart function. It can develop into cardiovascular disease. Without CoQ10, serious problems such as angina, high blood pressure, and congestive heart failure can occur. We should find foods or supplements while taking metformin. Foods to supplement this are abundant in meat such as beef, eggs, cod, mackerel, salmon, sardines, spinach, broccoli, whole grains, vegetable oil, and the liver. Although the amount of CoQ10 required by our body is 30-60mg, it is insufficient to intake the proper amount only with the naturally produced CoQ10. So, it should be taken in the form of nutritional supplements.

Vitamin B12
Long-term use of metformin has been associated with lower levels of vitamin B12. Metformin may bother B12 to be absorbed well. Serum vitamin B12 deficiency occurred in 22% of patients with a megadose of metformin (2). Use of Similar to metformin, thiazolidinediones have been associated with lower vitamin B12, too.
This deficiency can lead to megaloblastic anemia, neuropathy, and other neurological complications. There is a symptom similar to numbness in the feet of diabetes, so it is better to eat it well on a daily basis. Whoever takes these kinds of medicines should be monitored for the risk factors for vitamin B12 deficiency.
Foods include meat, poultry, seafood, and carnivorous foods like egg, and milk. It is also good to take group B nutritional supplements containing B12.

Iron
Some drugs lower sugar absorption to prevent high blood sugar after meals. Alpha-glucosidase inhibitors lower blood glucose by delaying the digestion and absorption of complex carbohydrates. However, iron absorption could also be reduced by these Alpha-glucosidase inhibitors like acarbose and miglitol. Iron deficiency anemia should be monitored when taking these inhibitors. Lack of folic acid caused by metformin can lead to anemia and tongue pain

Nutrients to Help?
Magnesium plays a huge role in diabetic patients. Magnesium boosts the insulin reaction itself and improves sugar transport. Chromium is also a mineral necessary for carbohydrate and fat metabolism. Suppose you eat a lot of refined carbohydrates. In that case, chromium is often insufficient, so it is good to check the chromium content of regular vitamins. Zinc also helps to produce and secrete insulin. Selenium is also helpful in preventing oxidation of the pancreas and complications of diabetes. Alpha lipoic acid (ziotric acid) is a powerful antioxidant and is also used to treat diabetic neuropathy. It stabilizes blood sugar levels by improving sugar transport. Vitamin B (1,2,3,5) group for carbohydrate metabolism. Omega 3 lowers inflammation levels in diabetics, and it is recommended to take it, especially in people with diabetes with high triglycerides. Corosolic acid may have a blood sugar control effect as the active ingredient of the Barnabar leaf extract.

It’s important to note that individual responses to medications can vary, and not everyone will experience these nutrient depletions. If you are taking medications for diabetes, Regular monitoring of nutrient levels through blood tests can also help identify and address any deficiencies.

References
1) Graham Rena,1 D. Grahame Hardie, corresponding author2 and Ewan R. The mechanisms of action of metformin. Diabetologia. 2017; 60(9): 1577–1585.
2) Jiwoon Kim, MD,a Chul Woo Ahn, MD, PhD,b Sungsoon Fang, PhD,c Hye Sun Lee, PhD,d and Jong Suk Park, MD, PhDb,∗ Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov; 98(46): e17918.