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It is recommended that metformin treatment should continue while the B12 deficiency is corrected, in view of the drugs known benefits in type 2 diabetes and its central role in treatment guidelines.

I usually tell my patients to limit the lifting to 15-20 pounds for 6 weeks, after this period most patients are clear to do any type of activities

Things Worth Discussing with Your Doctor: Baseline kidney function testing (eGFR and cystatin C) before starting B12 MTHFR genetic testing if you have a family history of kidney disease Comprehensive nutrient testing (magnesium, zinc, B6, folate) Homocysteine and methylmalonic acid baseline levels Regular urinalysis every 3-6 months if youre on high doses Advanced urine tests if youre high-risk Pulse dosing schedules based on your kidney function Optimal timing for taking supplements Creating Your Personal Approach Rather than following generic guidelines, its worth developing an individualized B12 strategy based on your kidney function, genetic factors, and how your body responds to supplementation

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