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If normal, start 1000 mcg oral b12 daily as prevention given multiple risk factors (age, metformin, PPI, now semaglutide)

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they may advise temporarily pausing semaglutide pending clinical assessment NICE guidance on diabetes management (NG28) and gallstone disease (CG188) emphasises the importance of multidisciplinary support , including dietetic input, which can help optimise nutritional intake whilst achieving therapeutic weight loss

The brand states that this review typically happens within about 24 hours, but that's a general timeline, not a guarantee