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IGFBP-1 production from the liver is significantly elevated during insulinopenia while serum levels of bioactive IGF-1 is increased by insulin

A couple of other adjustments may assist, such as decreased insulin-to-carbohydrate ratio, decreased correction factors, and a shorter duration of insulin action

15,17,18 Most of these patients had retinopathy at baseline, and worsening of retinopathy was similarly reported when insulin was started