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Key markers include fasting glucose and insulin (to assess insulin sensitivity), HbA1c (long-term glucose regulation), lipid panel (triglycerides, HDL, LDL), resting metabolic rate via indirect calorimetry, and body composition via DEXA scan (to differentiate fat loss from lean mass changes)

Despite this, cyanocobalamin has been increasingly criticised in recent years, due to the following reasons: Toxicity: cyanocobalamin is often claimed to be toxic, as the cyano group form the poison cyanide

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UK-licensed hydroxocobalamin injections are typically preservative-free single-use preparations, but it's always advisable to check the specific product's SmPC for excipient information if you suspect a sensitivity

Severe hepatic or renal impairment high-dose protocols may add metabolic burden