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Extend your current dose step if: Nausea persists beyond 10 days at the current dose You are experiencing vomiting more than twice per week Diarrhea is disrupting daily activities You have lost significant amounts of food intake due to GI symptoms Your quality of life is substantially affected Stay at the current dose for an additional 2 to 4 weeks, then attempt the escalation again

These include: Older adults, as they absorb B12 less easily Vegetarians and vegans, because B12 is mostly in animal products People with stomach problems like celiac disease or Crohns disease Those who have had gastric bypass surgery Knowing these risk factors helps find who might need to check their B12 levels

INCREASED PREVALENCE OF VITAMIN B12 DEFICIENCY IN PATIENTS WITH T2D ON METFORMIN THERAPY: CLINICAL EVIDENCE Determining the prevalence of vitamin B12 deficiency in patients with T2D on metformin therapy is difficult because of the different cutoff values used to define vitamin B12 deficiency, the use or lack of biomarkers in diagnostic criteria, and the heterogeneity of studied populations concerning age, geographical origin, dietary patterns, and duration of metformin use

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