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Some of the key signs of low B12 to look out for include: Muscle weakness Numbness and tingling in the hands and feet Difficulty walking Nausea Weight loss Irritability Fatigue Rapid heart rate (7) One of the other tell-tale symptoms of a B12 deficiency is constant fatigue or being tired all the time, which can also manifest as sleep disturbances, including insomnia in some people, often requiring sleep medications