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As a cofactor, cobalamins are essential for two cellular reactions: the mitochondrial methylmalonyl-CoA mutase conversion of methylmalonic acid (MMA) to succinate, which links lipid and carbohydrate metabolism, and the activation of methionine synthase, which is the rate-limiting step in the synthesis of methionine from homocysteine and 5-methyltetrahydrofolate

Ultimately, the best therapy is whatever treatment the patient will adhere to

Standard treatment metformin, the oral contraceptive pill, spironolactone manages symptoms

Bioeng Translational Med

First, teach the reconstitution and concentration arithmetic precisely, because that math is real regardless of which peptide sits in the vial: 10 mg of dry powder plus a known volume of bacteriostatic water yields a known mg/mL concentration, and that concentration converts cleanly into mcg-per-insulin-unit

The speed of improvement depends on your individual health and how low your B12 levels are