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NPs who prescribe metformin for an extended period, no matter the indication (eg, T2DM prevention and treatment, polycystic ovary syndrome), should consider B12 supplementation as well as perform routine measurement of vitamin B12 levels, both when starting metformin and at intervals of no more than one to two years thereafter (note that the optimal frequency has not been determined, and metformin can begin to decrease serum B12 levels in as little as three months).6 A recent study showed that clinicians initially prescribing metformin measure vitamin B12 levels less than half the time.10 In this study of 5,131 patients with T2DM who started taking metformin during a 5-year study period (2008-2013), only 44.5% had vitamin B12 tested

However, the optimization of treatment route and dosage requires further research

While the active transport protein for vitamin B12 transcobalamin ll (TCll) is expected to carry around 205 of the vitamins in the circulation

So, start taking folic acid supplements immediately

The most common injection areas are the gluteus, thigh, or deltoid muscles

Cardiac ECs also have a larger Golgi apparatus, fewer vesicles, and higher metabolic activity than vascular ECs [20, 24]