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Vitamin B12 deficiency Having trouble absorbing vitamin B12 from food, lacking intrinsic factors (for example, as a result of pernicious anaemia), having gastrointestinal surgery, taking certain medications for an extended period of time (such as metformin or proton pump inhibitors), and nutritional deficiencies are all causes of vitamin B12 deficiency

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What matters most is consistent technique, proper subcutaneous placement, and adherence to your dosing schedule