I recently did two things that seem, thus far, to have made a huge difference in my energy level. I'd been tracking my energy level, and discovered that it has little correlation to my cyanocobalamin injections. I was increasing my jabs to 2-3x/week with little, if any, improvement, so I looked into cofactors.
My folate level tested as fine (and my B12 level through the roof), but I thought I'd give methylfolate a try instead of folic acid. The difference was noticeable and immediate. Instead of my energy level bouncing all over the place from day to day and hour to hour, I now have fairly steady energy.
The other thing I tried to do was increase my potassium and magnesium through diet. I already have at least one banana a day, so I started drinking tomato juice. It took me a while to realize what was going on, but it also made a dramatic difference -- for the worse. I went from having normal bowels to horrid sludge, and crashing fatigue in the afternoons. As an experiment, I went without any nightshade vegetables, and felt better after a couple of days. Over Christmas, I had some tomato and potato dishes, and again, my energy level began to waver.
So now I'm avoiding nightshades and taking methylfolate daily. For the first time in years, I went an entire month without feeling the need for a B12 shot. This has allowed me to have the energy to walk every morning, which I find has improved my insomnia, which has in turn helped my energy levels. On nights when I feel like I may not be sleepy enough, I've been taking epsom salts baths. I'm not 100% convinced that magnesium can be absorbed transdermally, but it's a helpful bedtime ritual regardless.
In the 7 years I've been suffering from fatigue, there have been times I've thought it was behind me, only to crash again. So a month from now I may be on here saying, "Oh....never mind..." But somehow this does feel different.
The other thing I'm doing moving forward is to NOT get too ambitious about exercise. I've bought a fitness tracker, and I'm trying to make sure that I get plenty of moderate exercise, but avoiding vigorous exercise by keeping my heart rate in check. So when I walk the hills around here, I take them slowly. And I'm not even going to attempt running, or high-intensity interval training, because in the past my fitness ambitions have led to crashes. I'm keeping it slow and steady.
I'm crossing my fingers for a fatigue-free 2019!