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Unlike oral supplements, intramuscular B12 injections bypass digestion to deliver the vitamin directly into your bloodstream

Marso SP, Bain SC, et al

Products may be supplied as the free acid or as an acetate salt, and the molecular weight differs between these forms

and Lee M-H

1B), the liver will catabolize its glycogen stores and also perform gluconeogenesis using metabolites coming from the systemic circulation, such as glucogenic amino acids, lactate, and glycerol, to form glucose

This persistent challenge likely reflects multiple factors including prior metabolic adaptations, changes in body composition, lifestyle factors, and possibly residual metabolic effects not fully corrected by thyroid hormone replacement alone