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[2] Key mechanisms that can elevate serum B12 include: Increased release from damaged tissues (particularly liver disease) Overproduction or abnormal binding to transport proteins (transcobalamins and haptocorrin) Reduced cellular uptake despite adequate circulating levels Haematological disorders affecting B12 metabolism Supplementation, though this rarely causes concern in isolation It is important to understand that elevated B12 is not a disease itself but rather a biochemical finding that may indicate various underlying conditions

Secondary outcomes included patient reported adverse events documented in the EMR, number of patients requiring insulin initiation in Group A, and change in insulin dose for Group B

DNA Repair (Amst) 9:907913 Zhou BBS, Elledge SJ (2000) The DNA damage response: putting checkpoints in perspective

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