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In unclear cases, methylmalonic acid and homocysteine levels may be measured

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Long-term metformin use is recognized by regulators as being associated with reduced B12 levels in some patients, which is one reason clinicians may monitor B12 status over time - and one reason injectable B12 delivery may be particularly relevant for long-term metformin users

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The joint line is easiest to find with the knee bent to 90 degrees