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Vegans and Vegetarians Since B12 is found almost exclusively in animal-based foods, individuals following plant-based diets are at a higher risk of deficiency

When initiating tirzepatide, consider reducing the dose of concomitantly administered insulin secretagogue (such as sulfonylureas) or insulin to reduce the risk of hypoglycemia

As clinical signs of cobalamin deficiency include chronic wasting or failure to thrive, malaise, and gastrointestinal signs such as diarrhea, serum cobalamin concentration should be measured in any dog with poor response to enzyme replacement therapy for EPI

They appear to be more likely in younger patients, but it's otherwise impossible to predict who will experience them

doi: 10.3389/fimmu.2022.1039427

However, the therapeutic benefits last much longer