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Metformin, commonly prescribed for type 2 diabetes, is known to reduce B12 absorption over time, as highlighted in MHRA safety updates
Reconstitution technique also plays a role
Nevertheless, use of metformin may decrease vitamin B 12 status: a meta-analysis of four short-term intervention trials (up to 4 months duration) in patients with type 2 diabetes found that metformin use decreased serum cobalamin concentrations by 57 pmol/L, which could have clinical implications if such patients have suboptimal vitamin B 12 status (146)
As your B12 levels stabilize, the injections may be administered less frequently
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