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Some doctors advise taking Vitamin B12 if people have low levels of the vitamin in their blood, malnutrition, or low energy levels

If B12 levels are borderline, additional tests such as methylmalonic acid (MMA) or homocysteine may be helpful

25 Patients diagnosed with vitamin B 12 deficiency whose history and physical examination do not suggest an obvious dietary or malabsorptive etiology should be tested for pernicious anemia with anti-intrinsic factor antibodies (positive predictive value = 95%), particularly if other autoimmune disorders are present

Hypoglycemia awareness: Be vigilant for signs of low blood sugar (shakiness, dizziness, sweating) especially during dose escalation