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Other signs may include shortness of breath, pale skin, stomach problems, such as constipation, diarrhea or gas, or nerve problems, like muscle weakness or tingling in fingers or toes. Over time, a deficiency of B12 can cause problems with balance, confusion, depression, poor memory and possibly dementia, and it can even cause permanent damage to the nervous system, Somers says

The skin around the injection site is cleaned and sterilized, and a local anesthetic is applied to numb the area, minimizing discomfort