How can I manage my thrombocytopenia (low platelet count) while continuing to fast for up to 20 hours and taking various vitamins, including vitamin C, B12, iron, B complex, and fish oil, given my history of diabetes with improved glycemic control (A1c decreased from 12.5 to 6.2) and recent hospitalization for hyperglycemia (blood sugar over 200)?

Managing Thrombocytopenia While Maintaining Glycemic Control

Immediate Priority: Seek Medical Evaluation for Thrombocytopenia

You need urgent medical evaluation for your low platelet count before attempting self-management—thrombocytopenia causing visible bruising requires professional assessment to rule out serious underlying causes, and self-treatment with vitamins and supplements is not appropriate first-line management. 1

Critical Safety Concerns

Your situation presents several red flags that require immediate attention:

• Visible bruising from low platelets indicates significant thrombocytopenia that needs diagnostic workup to identify the underlying cause (immune-mediated destruction, bone marrow issues, medication effects, or nutritional deficiencies) 1
• Extreme fasting (20 hours daily) combined with severe caloric restriction may be contributing to nutritional deficiencies that could worsen thrombocytopenia 2
• Your recent hospitalization with blood sugars >200 followed by dramatic improvement suggests you may have been in a hyperglycemic crisis that required aggressive intervention 3

Why Self-Management of Thrombocytopenia Is Inadequate

The vitamins you're taking (vitamin C, B12, iron, B complex, fish oil) will not effectively treat thrombocytopenia unless a specific deficiency is documented as the cause. 2

Key points about platelet management:

• Vitamin B12 deficiency can cause pseudo-thrombotic microangiopathy with low platelets, but this requires laboratory confirmation of B12 deficiency and specific high-dose parenteral (injection) B12 treatment—not oral supplements 2
• Most cases of thrombocytopenia in patients with your profile require specific medical therapies beyond vitamins, including possible corticosteroids, immunomodulating drugs, or treatment of underlying conditions 1
• Fish oil can actually worsen bleeding risk in patients with thrombocytopenia by affecting platelet function, making it potentially dangerous in your situation 1

Your Glycemic Control: Excellent But Requires Monitoring

Your diabetes management has been remarkably successful:

• Your A1c improvement from 12.5% to 6.2% is outstanding and demonstrates effective glucose control 4, 5
• Your current A1c of 6.2% places you in the prediabetic range, which is an appropriate target for someone who achieved this through lifestyle modification 4, 6
• Your current glucose of 118 mg/dL is excellent and consistent with your A1c 4

Glycemic Target Recommendations

Maintain your A1c between 6.2-7.0%—do not attempt to lower it further below 6.5% as this increases mortality risk without additional benefit. 3, 5

The evidence is clear:

• Targeting A1c <6.5% with aggressive treatment increases mortality based on the ACCORD trial and subsequent analyses 3, 5
• Your current approach of lifestyle modification achieving A1c 6.2% is ideal and does not carry the same risks as pharmacologic over-treatment 4, 6
• The American College of Physicians recommends against pharmacologic therapy for A1c in your range, focusing instead on lifestyle measures 4

Concerns About Your Extreme Fasting Regimen

While your glucose control is excellent, your nutritional approach raises serious concerns:

Your 20-hour daily fasting with only one meal and one protein shake may be causing nutritional deficiencies that contribute to your thrombocytopenia. 2

Specific risks:

• Severe caloric restriction can cause vitamin B12, folate, and iron deficiencies that directly cause low platelet counts 1, 2
• Your diet of primarily cabbage, zucchini, and mushrooms lacks adequate protein, healthy fats, and micronutrients needed for bone marrow function 1
• Rapid weight loss from extreme caloric restriction can worsen thrombocytopenia by affecting bone marrow production 1

Recommended Action Plan

Step 1: Urgent Medical Evaluation (Within 48-72 Hours)

Do not wait until your scheduled appointment. Contact your provider to:

• Request urgent laboratory workup including complete blood count with differential, peripheral blood smear, B12 level, folate level, iron studies, and comprehensive metabolic panel 2
• Review all medications and supplements as some can cause drug-induced thrombocytopenia 1
• Assess for bleeding risk and determine if platelet transfusion or other urgent intervention is needed 1

Step 2: Modify Your Nutritional Approach

Liberalize your eating window to at least 8-10 hours daily and increase meal frequency to 2-3 meals to ensure adequate nutrient intake while maintaining glucose control 6

Specific modifications:

• Add protein sources beyond protein shakes (lean meats, fish, eggs, legumes) to provide complete amino acids and B vitamins 1
• Include healthy fats (avocado, nuts, olive oil) for fat-soluble vitamin absorption 6
• Ensure adequate caloric intake (at least 1200-1500 calories daily for women, 1500-1800 for men) to support bone marrow function 1

Step 3: Stop Potentially Harmful Supplements

Discontinue fish oil immediately as it can worsen bleeding risk with low platelets 1

Continue B12 and B complex only if deficiency is documented, but recognize that oral supplementation may be inadequate if severe deficiency exists—parenteral (injection) therapy may be required 2

Step 4: Maintain Glucose Monitoring

Continue checking blood glucose 2-4 times daily (not 20 times) focusing on fasting and 2-hour post-meal readings to ensure your modified eating pattern maintains control 3, 7

Recheck A1c in 3 months to confirm stability with your modified nutritional approach 5

Common Pitfalls to Avoid

• Do not assume vitamins will fix thrombocytopenia without knowing the cause—this delays appropriate treatment 1, 2
• Do not continue extreme fasting if it's causing nutritional deficiencies—glucose control can be maintained with less restrictive approaches 6
• Do not target A1c below 6.5% thinking lower is better—this increases harm without benefit 3, 5
• Do not delay medical evaluation thinking you can manage this yourself—visible bruising from thrombocytopenia requires urgent assessment 1

Bottom Line

Your diabetes management success is commendable, but your thrombocytopenia requires immediate professional medical evaluation and cannot be safely self-managed with vitamins alone. The extreme fasting regimen that helped your diabetes may now be contributing to dangerous nutritional deficiencies affecting your platelet count. Seek urgent medical care while maintaining your excellent glucose control with a less restrictive, more nutritionally complete eating pattern.