i have b12 injections but still tired Feeling tired, foggy, or run-down? It could be From Fatigue to Fabulous: How – 𝘼𝙡𝙬𝙖𝙮𝙨 𝙛𝙚𝙚𝙡𝙞𝙣𝙜 𝙩𝙞𝙧𝙚𝙙 𝙡𝙖𝙩𝙚𝙡𝙮? Low

Who to refer: Patients: with symptoms suggestive of either a spinal cord lesion (subacute combined degeneration or peripheral neuropathy) or visual (optic neuropathy) same day emergency admission not responding haematologically to B12 replacement therapy (where folate and iron stores have been checked and are normal) with suspected malabsorption or disease of the terminal ileum should be referred to Gastroenterology with neurological symptoms should be discussed with Neurology if advice required

Rather than starting at 500mcg, consider beginning at 200-250mcg for the first week

Community protocols describe consistent daily timing for sustained NNMT inhibition

Understanding when elevated B12 requires attention is essential for appropriate clinical management