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Symptoms can include developmental regression, irritability, sleep disturbance, seizures, motor abnormalities, and autistic features

As a general clinical principle: Retest HbA1c no sooner than three months after commencing B12 replacement therapy, and ideally once haematological recovery has been confirmed Confirm haematological recovery normalisation of MCV and haemoglobin before interpreting the repeat HbA1c as reliable Use interim glucose monitoring such as fasting plasma glucose, OGTT, or self-monitored blood glucose (SMBG) to assess glycaemic control during the treatment period

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For best results, these injections should be paired with a healthy diet and regular exercise