In the primary healthcare setting, the most commonly seen causes of vitamin B12 deficiency are related to abnormalities of digestion (atrophic gastritis, achlorhydria or the consequences of gastrectomy) or absorption (autoimmune pernicious anaemia, chronic pancreatitis, Crohns disease, the effect of medications that alter the mucosa of the ileum, or the consequences of surgical resection), and, to a lesser extent, a lack of exogenous supply
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Although the 100 mg of niacinamide in this injection is relatively modest compared to gram doses used to treat cholesterol, diabetic patients should still have their blood sugar observed, as even moderate niacinamide supplementation could necessitate small adjustments in diabetes medications
Additionally, growing evidence suggests a potential association between low levels of B12 and a higher risk of developing diabetes