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If present, gently tap the syringe barrel with your finger to move the bubbles to the top, then slowly push the plunger until a tiny drop appears at the needle tip

This subjective improvement could reflect placebo effect, improved overall nutritional status from paying more attention to diet, natural adaptation to the medication over time, or actual b12 repletion if deficiency existed

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3,1014 In a large study 10 of 406 patients with known vitamin B 12 deficiency, 98.4 percent had elevated serum methylmalonic acid levels, and 95.9 percent had elevated serum homocysteine levels (defined as three standard deviations above the mean)