In the randomized placebo-controlled HOME trial of 390 adults with type 2 diabetes (de Jager and colleagues, Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency, BMJ, 2010), metformin lowered serum B12 by a mean of 19 percent over 4.3 years
Infection signs, worsening injuries, or unusual neurologic symptoms need symptom-based review
Going a little deeper, you see the GHK-Cu role in gene-modulating signals
Furthermore, mutations in other ALS genes disrupt the cellular redox balance and induce oxidative stress (Carter et al., 2009)
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