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In my own practice, especially if an older person has risk factors for vitamin B12 deficiency, I consider a vitamin B12 level of 200-400 pg/mL borderline, and I usually order a methylmalonic acid level as a follow-up
The condition is often associated with being tired and weak
After this phase, we usually shift to a maintenance schedule of one injection every one to three months
Work with healthcare providers to monitor metabolic markers (HbA1c, lipids, liver function) throughout the protocol
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