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Check vitamin B12 levels in people treated with metformin who have symptoms suggestive of vitamin B12 deficiency This will also include patients found to have megaloblastic anaemia (raised mean corpuscular volume [MVC]), who may be asymptomatic (MHRA, 2022)

however, unlike nicotinic acid, niacinamide does not usually cause the intense flushing reaction (redness/itching) of the skin

Local NHS protocols should take precedence over general guidance

For long-term health benefits, like improved mood, better cognitive function, and enhanced overall well-being, a consistent and regular schedule of B12 injections is often necessary

These factors suggest starting slightly higher than the minimum effective clinical dose to account for real-world variability

He's also taken the herb echinacea in an attempt to prevent cold and flu, but acknowledges the evidence is a bit mixed