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This is, unfortunately, a common occurrence as we age Vegan or vegetarian diet as most B12 foods are from animal sources Excessive alcohol consumption Toxic metal exposure Some Auto-immune conditions Certain genetic polymorphism Some medications like antacids, anti-histamines, and some blood-sugar-lowering drugs

Insulin syringes have a fixed, non-removable needle, which eliminates "dead space"the small amount of fluid that gets trapped in the hub of a traditional syringe with a detachable needle

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The conservative approach is to continue using the vial but be aware that effectiveness may be reduced