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Some common signs and symptoms include: Decreased cognitive function, such as issues with memory or understanding Fatigue Lethargy Constipation Feeling faint Depression or irritability Headache Difficulty maintaining balance Sore, swollen tongue, which may be pale yellow or very red Heart palpitations Mouth ulcers Par anesthesia (pins and needles) Vision changes B-12 deficiency risk factors Both diabetes and some medications for type 2 diabetes can increase the risk of vitamin B-12 deficiency