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For deficiency or symptoms I replete b12 IM

Lack of insulin receptor signaling in Leprechaunism may result in the rare event of an alive but severely small for gestational age baby that will only survive if treated with recombinant-IGF-1 to substitute inulin receptor signaling with IGF1R signaling via their common intracellular pathways

The FUT2 secretor variant p.Trp154Ter influences serum vitamin B 12 concentration via holo-haptocorrin, but not holo-transcobalamin, and is associated with haptocorrin glycosylation Hum Mol Genet 2017;26:4975-88

Many Are Unknowingly Are Vitamin B12 Deficient In the United States, about 6% of adults ages 60 and below are deficient in vitamin B12