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The first signs of B12 deficiency include persistent fatigue, weakness, lightheadedness, pale skin, tingling or numbness in the hands and feet, difficulty concentrating, and mood changes like irritability or mild depression

Mol Med 7(9):619623 Arambai J, Mihailovi M, Uskokovi A, Dini S, Grdovi N, Markovi J, Poznanovi G, Bajec D, Vidakovi M (2013) Alpha-lipoic acid upregulates antioxidant enzyme gene expression and enzymatic activity in diabetic rat kidneys through an O -GlcNAc-dependent mechanism

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He says injecting drugs became "normalized" when GLP-1 drugs approved to treat diabetes, such as Ozempic, were also shown to be effective for weight loss and eventually became an approved treatment for obesity

doi: 10.1007/s10661-009-0948-z 26 CrowthersK