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Mixing/Dosage Instructions for Vitamin B12 Multi-Dose Vial of Vitamin B12 Clean working space, away from children or pets 1cc Insulin Syringe with needle Rubbing alcohol with cotton pads for disinfection We recommend to inject 1/2cc (half of the insulin syringe) of B12 every 3 days, or 1.5cc if ingested

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NPs who prescribe metformin for an extended period, no matter the indication (eg, T2DM prevention and treatment, polycystic ovary syndrome), should consider B12 supplementation as well as perform routine measurement of vitamin B12 levels, both when starting metformin and at intervals of no more than one to two years thereafter (note that the optimal frequency has not been determined, and metformin can begin to decrease serum B12 levels in as little as three months).6 A recent study showed that clinicians initially prescribing metformin measure vitamin B12 levels less than half the time.10 In this study of 5,131 patients with T2DM who started taking metformin during a 5-year study period (2008-2013), only 44.5% had vitamin B12 tested