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As a general clinical principle: Retest HbA1c no sooner than three months after commencing B12 replacement therapy, and ideally once haematological recovery has been confirmed Confirm haematological recovery normalisation of MCV and haemoglobin before interpreting the repeat HbA1c as reliable Use interim glucose monitoring such as fasting plasma glucose, OGTT, or self-monitored blood glucose (SMBG) to assess glycaemic control during the treatment period

Is particularly sensitive to heat-induced aggregation, where individual peptide molecules clump into biologically inactive complexes

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Each injection is still partially active when you take the next one, causing drug levels to accumulate or "stack" over successive doses