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Pernicious anaemia , an autoimmune condition affecting approximately 2% of the UK population over 60 (and about 0.10.2% overall), destroys gastric parietal cells, eliminating intrinsic factor production and severely impairing B12 absorption

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Insulin normally suppresses gluconeogenesis while promoting lipogenesis, however, under insulin resistant states such as T2D, hepatic lipogenesis remains insulin sensitive and suppression of gluconeogenesis is insulin resistant, leading to a metabolic state called selective hepatic insulin resistance (199)

Cautious use of parenteral cyanocobalamin is also recommended in patients with renal impairment, including premature neonates, because of the possibility of greater aluminum accumulation, which may cause central nervous system and bone toxicity