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Site rotation: Move injection sites (abdomen, thighs, upper arms), keeping each at least 1 inch from the last to limit irritation [15]

(Yu et al., 2021) and Wang et al

D., & Harris, J

How is the treatment administered

Several factors can impair B12 absorption: Reduced stomach acid production (achlorhydria or hypochlorhydria), common in older adults and those taking proton pump inhibitors or H2-receptor antagonists long-term, impairs the release of B12 from food proteins Pernicious anaemia , an autoimmune condition destroying parietal cells and reducing intrinsic factor production, completely blocks the primary absorption pathway Gastrointestinal disorders including Crohn's disease, coeliac disease, or surgical removal of stomach or ileum sections directly damage absorption sites Metformin , commonly prescribed for type 2 diabetes, may reduce B12 absorption through unclear mechanisms

In primary care, orlistat is commonly prescribed, working by inhibiting pancreatic lipase to reduce dietary fat absorption