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This randomized controlled trial found that intramuscular cobalamin injection produced dramatically higher peak blood concentrations (Cmax ≈38.5 nmol/L) than intranasal administration (≈1.0 nmol/L) in elderly patients, consistent with injection bypassing the gut’s limited absorption pathway entirely

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Insulin resistance stimulates AMPK (an energy-sensing enzyme in low energy), increases FFAs intake in the heart via CD36