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Multiple approaches were investigated across academic and industrial laboratories, including enteric coatings to bypass stomach acid, protease inhibitor co-formulations, nanoparticle encapsulation, mucoadhesive delivery systems, and permeation enhancers

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summarized that, "In multi-ingredient (B1 + B6 + B12) preparations cyanocobalamin is unstable and degrades from 28% to 37% with concomitant formation of hydroxocobalamin (1.7% to 25.5%) and oxidation products amounting to 56.4% 9.3

It has been shown to help lower blood sugar levels and promote cartilage healing without increasing long bone growth, increasing IGF-1 levels, or altering insulin sensitivity

You may need to push and pull the plunger back and forth a couple of times to ensure proper filling