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In mouse models of insulin resistance, it significantly inhibits NNMT activity in liver and muscle, reduces NAM methylation, increases intracellular NAD+, activates the SIRT1 pathway, promotes phosphorylation of insulin receptor substrate 1 (IRS1), enhances insulin signaling, improves insulin sensitivity, and increases glucose uptake and utilization

PMID: 17243755

In cases where hypersensitivity is confirmed, desensitization protocols have been developed to allow patients to continue receiving necessary vitamin B12 supplementation safely

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