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Needle gauge matters too: a finer needle (commonly 29-31 gauge for insulin syringes) reduces the mechanical stress placed on the solution as it passes through the needle bore compared to a larger-bore needle, and produces a smaller, cleaner puncture through the vial's rubber stopper, reducing the risk of coring small rubber fragments breaking off into the solution
The most common causes include B12 supplementation (particularly injections), liver disease releasing stored B12, haematological disorders increasing B12-binding proteins, and chronic kidney disease reducing B12 excretion
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