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Decreased vitamin B12 absorption due to altered gut microbiota Potential for megaloblastic anemia in prolonged use Increased risk of neuropathy and other neurological complications Dose and Duration Considerations The risk of B12 deficiency with metformin depends on the dose and how long you take it

It uses nicotinamide, which is linked to the cellular NAD + pathway, and it also uses SAM, which supplies methyl groups for many other reactions in cells

Missing occasional doses won't significantly impact your results

The likelihood increases with improper dosage, contaminated material, or non-sterile injection technique which is exactly why sourcing, reconstitution, and storage matter

Heidi Spratt for advice regarding the statistical analyses