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The MHRA recommends considering periodic B12 monitoring in patients on metformin who have risk factors for deficiency, and testing if symptoms develop

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[6] [68] [69] Long-term effects [edit] Regular use of large amounts of kava may cause mood swings, apathy, dry, scaly skin, malnutrition, weight loss, increased susceptibility to infections, and shortness of breath

Advanced Physiologic Rationale: Inflammation, Endothelium, and Plaque Stabilization Cardiovascular protection arises from more than glucose control: Endothelial function improves via nitric oxide signaling, reducing vascular stiffness and enhancing perfusion