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These may include mild reactions at the injection site, fatigue, or nausea

Overgrowth of bacteria: Some people develop vitamin B 12 deficiency as a result of conditions that slow the movement of food through the intestines (diabetes, scleroderma, strictures, diverticula), allowing intestinal bacteria to multiply and overgrow in the upper part of the small intestine

If the first round of tests indicate a vitamin B12 deficiency, then your doctor may refer you to a specialist for more tests and treatment

Additionally, niacin has been noted to increase fasting blood glucose by inducing insulin resistance in some cases

If youre low or deficient in B12, youll likely feel fatigued

H2 Receptor Antagonists: Ranitidine and Other Acid Reducers H2 receptor antagonists, like ranitidine, can lower vitamin B12 absorption