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The MHRA (2022) recently issued guidance on the increased risk of vitamin B12 deficiency in people treated with metformin, highlighting increased risks with higher metformin doses, longer treatment duration and in patients with risk factors for B12 deficiency, including the following: Existing low B12 levels

The vitamin is composed of a corrin ring surrounding a central cobalt atom that is bound to a lower ( alpha-axial ) and an upper ( beta-axial ) ligand

Before these products can be prepared, they must first be reconstituted with a suitable diluent

B12 may also optimize metabolic functioning, making it an adjunct in weight management goals

I self inject EOD and Ive told him, he doesnt object but wont sanction it as he says it would be untenable for the surgery to cope