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Extra B12 can be prescribed as a pill, nasal spray, nasal gel, injection, or medicine you put under your tongue

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Cyanocobalamin is given through intramuscular or subcutaneous injections

Moderate deficiency may include obvious macrocytic anemia, glossitis, as well as some mild or subtle neurological features, such as distal sensory impairment.[] Severe deficiency is characterized by bone marrow suppression, neurological features, and the risk of cardiomyopathy

Another concept is to measure B12 bound to the plasma protein transcobalamin (holoTC, active B12) before and after administration of three high physiological doses of B12 for two days