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Some patients may notice symptoms returning before their next scheduled injection, particularly if they have higher metabolic demands or ongoing neurological involvement

Nevertheless, use of metformin may decrease vitamin B 12 status: a meta-analysis of four short-term intervention trials (up to 4 months duration) in patients with type 2 diabetes found that metformin use decreased serum cobalamin concentrations by 57 pmol/L, which could have clinical implications if such patients have suboptimal vitamin B 12 status (146)

Typical administration guidelines: Dosage: 1 to 2 mL per injection

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