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What laboratory and clinical tests should be used to determine whether my relative, who has been on longterm vitamin B12 injections for presumed pernicious anemia despite negative intrinsicfactor and parietalcell antibodies and no current anemia, actually needs continued B12 supplementation?

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Serious but Rare Side Effects In rare cases, metformin can cause a serious side effect called lactic acidosis, which requires immediate medical attention

Reason for escalation: gradual increase allows researchers to assess metabolic response and tolerability

Gradually increase to twice daily (morning and evening) over 12 weeks as your skin acclimates