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In individuals with PLPBP mutations, the most common metabolic abnormality is an increase in blood lactate and glucose levels, leading to metabolic acidosis shortly after birth, typically on day 1, then returns to normal by day 3 to 4 [11]

In such a study (16-week randomized, double-blind, placebo-controlled), 204 individuals with obesity but not diabetes were treated with self-administered subcutaneous injections of pramlintide (nonforced dose escalation 240 g) or placebo three times a day, 15 minutes before meals without concomitant lifestyle intervention (200)

But for pernicious anemia, its not enough because the body cant absorb it well

Pure metabolic shift