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The clearest way to know is through diagnostic tests

Sterile water is widely used in medical settings for a variety of purposes

But the difference between something that works and something that doesnt often has very little to do with the name on the vial

Pale or Yellowish Skin A deficiency in vitamin B12 can affect the production of red blood cells, leading to pale or yellowish skin tone

Certain health conditions such as intestinal or stomach problems, poor nutrition, cancer, HIV, pregnancy, old age, veganism, and alcoholism can cause vitamin B12 deficiency

Typically, those who are willing to do more daily at-home maintenance (Lasercap, medications, supplements) can avoid having injections as frequently