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I started B 12 injections 3 monthly after the loading injections and it helped a little but the fatigue didnt clear as quickly as my doctor expected

Who to refer: Patients: with symptoms suggestive of either a spinal cord lesion (subacute combined degeneration or peripheral neuropathy) or visual (optic neuropathy) same day emergency admission not responding haematologically to B12 replacement therapy (where folate and iron stores have been checked and are normal) with suspected malabsorption or disease of the terminal ileum should be referred to Gastroenterology with neurological symptoms should be discussed with Neurology if advice required

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Then, your doctor inserts a thin, flexible tube (catheter) with a balloon at the tip through the needle