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In cases where clinical suspicion remains high despite normal B12 levels, additional testing with methylmalonic acid (MMA) or homocysteine levels may be helpful, though availability is limited in the UK and results can be affected by renal function

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PERIOPERATIVE CONSIDERATIONS FOR GLP-1RAS AND GIP/GLP-1RA THERAPY Increased residual gastric content There is emerging evidence that the use of GLP-1 receptor agonists is associated with increased RGC, based on studies in patients undergoing endoscopy, despite fasting for at least 8 hours [68]

Over time, your provider may recommend increasing the dose gradually to a maximum of 0.4ml (0.8 mg), depending on your response