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NICE guidance (NG28) on type 2 diabetes acknowledges that bariatric surgery can lead to remission in many patients, and medication requirements should be reassessed regularly

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Beyond mutations in the genes coding for these intracellular cobalamin proteins, there are also multiple mutations which affect the transcriptional regulation of MMACHC, leading to a similar phenotype of CblC deficiency ( Regardless of the cause, the diagnosis of B12 deficiency is complex and can present at all ages with a wide spectrum of symptoms

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Escalate: Increase by 2.5 mg every 4 weeks as tolerated