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Make sure to use an accurate milligram scale to avoid toxic excess amounts

So people at greatest risk for deficiency include those with low stomach acid (e.g., older adults and people on proton pump inhibitors or antacids) or low IF production (known as pernicious anemia), people on medications that interfere with B12 absorption (such as metformin), people who have had gastric surgery, those with GI conditions that impair nutrient absorption (like celiac or Crohn's disease), and people on vegan and vegetarian diets

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If pernicious anaemia is suspected, testing for intrinsic factor antibodies and gastric parietal cell antibodies may be appropriate