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The most important thing to realize is that blood tests for B12 are highly inaccurate at detecting actual cellular levels of B12 (meaning the B12 thats available for the cells to use)

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[DOI] [PubMed] [Google Scholar] 198.Huang T., Zhang K., Sun L., Xue X., Zhang C., Shu Z., Mu N., Gu J., Zhang W., Wang Y., et al

Advanced insulin resistance, mitochondrial damage from chronic oxidative stress, or inflammatory states can create barriers to AMPK activation and NAD+ utilization that require co-interventions (caloric restriction, anti-inflammatory compounds, or antioxidant support)