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For patients with clinical deficiency, effective replacement therapy should lead to a normal blood count after two months of treatment, while improvement in neurologic symptoms begins within one week after initiation of therapy and is usually complete within 6 weeks to 3 months.13 For patients with an asymptomatic biochemical deficiency (ie, subclinical disease), measurement of serum B12 or MMA levels should be done 2 to 3 months after initiation of replacement therapy.12 Once metformin is started, this medication is seldom discontinued unless advanced renal impairment develops

Using an insulin syringe, draw the calculated volume of bacteriostatic water (typically 2 mL)

Ceramides are lipids that help form the skin's barrier and retain moisture

Inappropriate use of testosterone or related steroids can have long-term and possibly irreversible side effects