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Medications including metformin, proton pump inhibitors, and H2-receptor antagonists may reduce absorption of B12, potentially prolonging the time to clinical improvement

This educational protocol presents a once-daily subcutaneous approach using a practical dilution for clear insulin-syringe measurements

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Protocols vary some clinicians dose once daily before bed

Recent injuries from weeks to months old often show faster improvement than problems persisting for years

Dont freeze Bacteriostatic Water itself as freezing can crack the vial seal and compromise sterility