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Absolute Contraindications Active malignancy Pregnancy and lactation Severe hypoglycemia disorders Known hypersensitivity to IGF-1 Active proliferative retinopathy Relative Contraindications Diabetes mellitus Renal impairment Cardiac impairment History of hyperplasia Family history of certain cancers Severe hepatic impairment Dosing & Administration Starting Dose 2050 mcg/day subcutaneously Begin at the lower end for sensitive patients Assess tolerance for 12 weeks before titration Therapeutic Range 50120 mcg/day for most indications Maximum dose: 200 mcg/day Individualize dosing based on response and tolerance Cycling Protocol 46 weeks on therapy 4 weeks off therapy Helps prevent receptor desensitization Supports long-term efficacy Administration Guidelines Hypoglycemia Prevention: Always administer IGF-1 LR3 with or shortly after carbohydrate-containing meals

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Quantifying the sex-race/ethnicity-specific burden of obesity on incident diabetes mellitus in the United States, 2001 to 2016: MESA and NHANES