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It is a reasonable precaution, not a strict requirement

Initial treatment for B12 deficiency with neurological involvement: When elderly patients present with neurological symptoms (peripheral neuropathy, cognitive impairment, subacute combined degeneration of the cord), urgent and aggressive replacement is essential to prevent irreversible damage

Push on syringe plunger to release 2 to 3 drops of B12, ensuring that there is no more air in the barrel

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Interestingly, a recent study in Danish population showed that lower serum vitamin B12 concentrations were significantly associated higher BMI, but a genetic risk score related to vitamin B12 concentrations associated variants was not associated with BMI

You want a clinic that uses high-quality ingredients, keeps dosing safe and appropriate, listens to your goals, and helps you set realistic expectations