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Often, the next test is serum methylmalonic acid (MMA), a functional marker of B12 deficiency that's produced when there's not enough active vitamin B12 present

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Common experiences after the first injection include: Mild soreness or redness at the injection site (usually resolves within 1–2 days) Slight improvement in energy levels or mood No immediate noticeable change (particularly common if deficiency is severe) Rarely, mild side effects such as headache or dizziness Some patients report their urine becoming brighter or more intensely coloured following injection, which occurs because excess B12 is excreted renally