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However, it would appear that a small amount of cobalamin can be synthesized by the intestinal flora present in an area unable to absorb it [2], therefore making the vitamin unavailable

For example, your fatigue might be driven by low vitamin D or another cause rather than B12

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Report any episodes of low blood sugar to your healthcare provider immediately, as this may signal the need to adjust or discontinue other medications or change your semaglutide dose