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Conditions that affect the gut, like Crohns disease or celiac disease, can damage the intestinal lining, making it difficult for B12 to pass into your bloodstream

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2011 Nov-Dec;18(6):338-48

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These include mild soreness, redness, or a warm sensation at the injection site, brief lightheadedness or flushing shortly after administration, and occasional mild nausea in the first few sessions as the body adjusts to the lipotropic compounds

I took two capsules of 2,000 mcg vitamin B12 the other night, and felt stronger and not as tired