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The nasal spray is typically reserved for maintaining B12 levels after injections bring particularly low levels back to normal (5)

However, left untreated, it may cause symptoms like: Weakness, tiredness, or lightheadedness

One posited mechanism is the activation of phospholipase C (PLC), which, according to some researchers, might subsequently facilitate the release of inositol triphosphate (IP3) and diacylglycerol (DAG)

Insert the needle straight into the upper outer quadrant of the gluteus medius at a 90-degree angle to the skin

Female heterozygotes may be hard to diagnose because of X-chromosome mosaicism leading to a partial deficiency that will not be detected reliably with screening tests