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Depressive symptoms and increased anxiety due to diabetes-related distress (i.e., the emotional and psychological burden associated with managing diabetes [140] are associated with poor self-care behaviors and worse intermediate and long-term health outcomes [218]

Furthermore, clinical pharmacokinetic studies demonstrate that cyanocobalamin is poorly retained by the body, with a significant portion being rapidly excreted in the urine

Though the affects you may experience are dose-dependent, it doesnt take a large dose to have a severe reaction

Additional electrophysiological targets currently in the pipeline include previously unrecognized ion channels, regulatory signalling pathways, structural alterations such as fibrosis that may be targeted by upstream therapy and epigenetic modulation of cardiac electrophysiology