For patients with clinical deficiency, effective replacement therapy should lead to a normal blood count after two months of treatment, while improvement in neurologic symptoms begins within one week after initiation of therapy and is usually complete within 6 weeks to 3 months.13 For patients with an asymptomatic biochemical deficiency (ie, subclinical disease), measurement of serum B12 or MMA levels should be done 2 to 3 months after initiation of replacement therapy.12 Once metformin is started, this medication is seldom discontinued unless advanced renal impairment develops
Despite a recommended daily intake as low as 6 micrograms, B12 deficiency remains common, particularly among individuals following vegan or vegetarian diets
Weight loss tablets or capsules are a suitable alternative if you do not feel comfortable taking injections
Candidates for B12 Injections You may be an ideal candidate for B12 injections if you struggle with low energy, difficulty concentrating, or if your diet and lifestyle put you at risk of deficiency
The needle is integrated, the dose is pre-set, and you do not need to draw up medication
Individuals over the age of 50 years should augment their dietary intake with vitamin B 12 from supplements or fortified foods because of the increased likelihood of food-bound vitamin B 12 malabsorption with advanced age