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Metformin-induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes

For context on SAMe and related evidence limits, see the NIH NCCIH resource S-Adenosyl-L-Methionine (SAMe): In Depth

This means you cant just buy them over the counter like you would a packet of paracetamol

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If levels get too high or side effects occur, we might lower the dosage