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Vitamin B-12 deficiency is not super common in the U.S
Some patients feel as though they want more frequent injections, and occasionally we test levels to see if they are receiving adequate replacement, but Im not sure how strong the evidence is to support this. GPs should consider periodic vitamin B12 testing of higher-risk patients who take metformin, even if they dont display symptoms of deficiency, the UK medicines regulator said earlier this year
The mechanism might involve direct antiemetic effects of B12, or it might reflect improved overall metabolic function when vitamin status is maintained
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References: Office of Dietary Supplements, NIH
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