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Am J Physiol 269:R1204R1212 Federici M, Porzio O, Lauro D et al (1998) Increased abundance of insulin/insulin-like growth factor-I hybrid receptors in skeletal muscle of obese subjects is correlated with in vivo insulin sensitivity

When one is missing, the whole system gets backed up

It is contraindicated in certain conditions such as active malignancy and must be used cautiously in those with diabetes, prediabetes, or a history of pituitary disease, which is why careful screening and regular monitoring are essential