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Both metformin and the PPI (omeprazole) can contribute to B12 deficiency

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When adverse effects occurred, they were typically mild and transient, with the most common being mild to moderate headaches (similar frequency to placebo groups), minor injection site reactions (redness, slight swelling), and gastrointestinal effects at higher oral doses (nausea, diarrhea)

Document possible confounders beside adverse observations: Site irritation, for example, should be recorded along with concentration, injection location, and preparation details

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Insert the needle at a 90 degree angle swiftly and deeply into the muscle