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Systemic Reactions : Although rare, some individuals may experience more widespread symptoms such as fatigue, headaches, or gastrointestinal issues

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124 The British Society of Haematology published its guidelines on vitamin B12 and folate screening in 2014, at which time they stated that no definitive advice can be given on the desirable frequency of monitoring of vitamin B12 in those with T2DM having metformin therapy but recommended that serum B12 be measured in the presence of strong clinical suspicion of deficiency, 149 which we would opine may be difficult since deficiency is often asymptomatic

Intramuscular therapy leads to more rapid improvement and should be considered in patients with severe deficiency or severe neurologic symptoms