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A provider may monitor: Symptoms and side effects Injection-site reactions Sleep quality Appetite changes Fluid retention Blood pressure Glucose or A1C when appropriate IGF-1 when appropriate Recovery response Whether treatment should continue, pause, or change Monitoring helps prevent patients from guessing, overusing, or continuing therapy when symptoms suggest the plan should be adjusted

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Kidney function, hydration, medications, cystatin C and the overall clinical picture may be important when interpreting follow-up results

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[3] Treatment is by vitamin B 12 supplementation, either by mouth or by injection