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In type 1 diabetes mellitus ( T1DM ) there is an absolute deficiency of insulin secretion due to autoimmune destruction of the insulin-secreting beta cells in the endocrine pancreas

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Avoid fatty, greasy, oily, processed, or spicy foods that can slow digestion and worsen nausea

The combination of a DPP-4 inhibitor with insulin is particularly attractive because it does not significantly increase the risk of hypoglycemia, as the insulin secretagogue effect is glucose-dependent

Finally, the biggest risk is for people who have pernicious anemia, a rare condition in which a person is unable to absorb any B12 through their stomach or intestines people with this condition are the ones who actually need B12 injections