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Reports that newborns with a complete lack of insulin effects due to inactivating defects in the INSR gene can now survive for extended time into adolescence when treated with recombinant IGF-I, that stimulate glucose uptake via the IGF1R sharing common signaling pathways with the INSR, support an important direct role of IGF-1 signaling on metabolism (93)

28 However, oral therapy does not improve serum methylmalonic acid levels as well as intramuscular therapy, although the clinical relevance is unclear

Vegan and vegetarian athletes almost certainly need supplementation, as do those over 50 whose absorption naturally declines

While some peptides like semaglutide (a GLP-1 receptor agonist) have FDA approval for weight loss, others are available only through off-label use or experimental stages

Elevated mean cell volume (MCV) and homocysteine levels may indicate a vitamin B12 deficiency