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24 Secondly, activated Akt phosphorylates forkhead box O1 (FOXO1), a transcription factor upregulating gluconeogenesis rate-limiting enzyme such as phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase (G6Pase), and translocate it from nucleus to cytoplasm, which inactivate its transcriptional activity, thus inhibiting gluconeogenesis

The initial B12 IV drip can take up to 30 minutes and can be administered weekly

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