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These can include temporary digestive changes, mild headaches (which are often linked to hydration or electrolyte balance), and some muscle soreness as your body adapts to increased fat oxidation

Nevertheless, use of metformin may decrease vitamin B 12 status: a meta-analysis of four short-term intervention trials (up to 4 months duration) in patients with type 2 diabetes found that metformin use decreased serum cobalamin concentrations by 57 pmol/L, which could have clinical implications if such patients have suboptimal vitamin B 12 status (146)

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Some patients may notice symptoms returning before their next scheduled injection, particularly if they have higher metabolic demands or ongoing neurological involvement