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Any issue that can affect the stomach, pancreas or the last 3-4 cm of the small bowel (called the terminal ileum): Stomach: gastrectomy, gastric bypass Pancreas: chronic pancreatitis, removal of the pancreas Terminal ileum: Crohns disease, coeliac disease (an allergy to gluten requiring a very strict gluten-free diet), removal of terminal ileum, ileostomy, radiotherapy to the pelvis (e.g

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Angle the needle against the vial wall and release the diluent slowly down the glass, not directly onto the lyophilized cake

But if you need an extra B12 boost thanks to a deficiency, supplements or injections may help