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Here is the mechanism: insulin is not the only way to move GLUT4 transporters to the cell surface

We know that macrocytosis is a very, very late stage of B12 deficiency and that severely deficient patients may not present with this sign, the administration of folic acid also masks macrocytosis by normalising the size of the blood cells

(2022) Comparison of the injection-site experience of semaglutide in a single-dose and a multidose pen-injector