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NSPs are synthesized as inactive zymogens and activated primarily by the ubiquitous enzyme dipeptidyl peptidase 1, also known as cathepsin C

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Some patients feel as though they want more frequent injections, and occasionally we test levels to see if they are receiving adequate replacement, but Im not sure how strong the evidence is to support this. GPs should consider periodic vitamin B12 testing of higher-risk patients who take metformin, even if they dont display symptoms of deficiency, the UK medicines regulator said earlier this year

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