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Some medications can reduce the absorption of vitamin B12 including me dull, tobramycin, gentamicin, and other medications such as tributyl antihistamines

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Contraindications for use B12 injections should not be administered to children or pregnant or breastfeeding women

Early warning signs of hypoglycemia may be less obvious in patients with hypoglycemia unawareness which can be due to a long history of diabetes (where deficiencies in the release or response to counter regulatory hormones exist), with autonomic neuropathy, intensified diabetes control, or taking beta-blockers, guanethidine, or reserpine