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Typical technique steps (not detailed here) include cleaning the site, drawing in air equal to the dose, injecting it into the insulin vial, drawing up the insulin dose, removing air bubbles, then injecting the insulin under the skin

Treatment should start urgently and should not be delayed for laboratory confirmation if neurological features strongly suggest B12 deficiency

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Measurement of serum methylmalonic acid The analytical procedures most frequently used for serum methylmalonic acid involve liquid chromatography-tandem mass spectroscopy (LCMS/MS)