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Requirements of vitamin B 12 in excess of normal (due to pregnancy, thyrotoxicosis, hemolytic anemia, hemorrhage, malignancy, hepatic and renal disease) can usually be met with oral supplementation
Concurrent insulin or insulin secretagogue therapy
These limitations do not invalidate preclinical findings but emphasize the need for human clinical trials with appropriate sample sizes, standardized protocols, and validated outcome measures before establishing clinical efficacy in human patients
Many patients transition from weekly lipotropic injections during their active weight loss phase to monthly maintenance injections once they reach their target weight
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