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GIP, GLP-1,
Conditions include alcoholic liver disease, viral hepatitis, cirrhosis, and primary or metastatic liver cancer Renal dysfunction : Impaired kidney function reduces B12 elimination, causing accumulation even with normal intake Haematological conditions : Myeloproliferative neoplasms, chronic myeloid leukaemia, polycythaemia vera, and hypereosinophilic syndrome increase transcobalamin production, elevating total serum B12 Laboratory interference : Macro-B12 (immunoglobulin-bound B12) and assay interference can cause spuriously elevated results without true excess In clinical practice, unexplained hypercobalaminaemia should prompt investigation for underlying disease, particularly in patients without obvious supplementation history
Similar results have also been seen in T1DM patients who received Liraglutide (A GLP1R agonist) in conjunction with insulin therapy (Kielgast et al, 2011
Possible Long-Term Considerations Some early studies suggest that prolonged or repeated use may cause desensitization of the melanocortin system
Store upright in the refrigerator at 2 to 8 degrees Celsius
