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It is knowing which patient needs a GLP-1 and which one needs a workup, how to titrate through the nausea window without losing the patient, how to protect lean mass during rapid loss, how to screen for the contraindications that matter, and how to tell a patient honestly what an adjunct will and will not do for them
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Also, IM is not necessary at all, as B12 has a long, documented history of effective SQ delivery
PMID 8969275
Signs include persistent fatigue, paraesthesia (pins and needles) in hands and feet, difficulty with balance, memory problems, mood disturbances, and megaloblastic anaemia
