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Medical conditions contributing to a deficiency include intestinal problems, gastric surgeries, atrophic gastritis, anemia, Crohns disease, celiac disease, lupus, and Graves disease

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Response to treatment varies considerably: Paraesthesia and early sensory symptoms often improve within weeks Cognitive and mood symptoms may take several months to resolve Established spinal cord damage (subacute combined degeneration) may show incomplete recovery, particularly if treatment was delayed Gait disturbances and proprioceptive loss may persist despite adequate treatment Monitoring during treatment should include clinical review of symptom progression and full blood count

Injections are typically given intramuscularly (into a muscle) or subcutaneously (under the skin)