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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

MIC injections are cheaper and better tolerated but should not be presented as an equivalent alternative only as an option for patients who cannot or will not use GLP-1 therapy, with expectations set accordingly

The earliest subjective improvements after B12 treatment occurred for paresthesia and balance, leading to full recovery [87]

It did not itch as much, but the rash was over a much larger area

Much of the current evidence is preclinical (cell and animal studies), and human data is still limited

These can range from mild to severe and may occur shortly after the injection