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Metformin users, common among type 2 diabetes patients who then add semaglutide, face a double hit since metformin independently reduces B12 absorption by 10-30% over long-term use

Some users double the dose during periods of intense training or after physical strain, but it's always best to begin with the base dosage and adjust gradually

Consistency: Missing doses, inconsistent injection timing, or halfhearted diet adherence dramatically reduces effectiveness

Blahova J, Martiniakova M, Babikova M, Kovacova V, Mondockova V, Omelka R (2021) Pharmaceutical Drugs and Natural Therapeutic Products for the Treatment of Type 2 Diabetes Mellitus