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High-risk groups who should be considered for monitoring include: Patients taking metformin for more than three years Those on high-dose metformin (2g daily) Older adults (aged 65 years and above), who have reduced gastric acid production and lower B12 stores Patients with pre-existing risk factors for B12 deficiency, including previous gastric surgery, pernicious anaemia, or inflammatory bowel disease Individuals following vegan or vegetarian diets with limited dietary B12 intake Those taking acid-suppressing medications (proton pump inhibitors or H2-receptor antagonists) Patients with symptoms suggestive of B12 deficiency Patients with unexplained anaemia or neuropathy The frequency of monitoring should be guided by clinical judgement and local pathways, with consideration of individual risk factors

2010 Wei, Lilly

Therefore, if you consider 500 mcg of vitamin B12 and a one percent absorption rate, patients should expect to get 5 mcg of vitamin B12, over two times the recommended intake of 2,4 mcg per day for males and females over 18 years of age

The slower onset with injection lessens the immediate threat of acute respiratory depression (57)