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Consider Alternatives If Who Should Avoid Do not use if You have active cancer or a history of cancerIGF-1 can stimulate cell growth including potentially cancerous cells You are pregnant or breastfeedingeffects on fetal/infant development are unknown You have diabetic retinopathyIGF-1 may accelerate eye blood vessel growth You have uncontrolled diabetesblood sugar management becomes extremely difficult You are under 21can affect natural growth plate closure and hormonal development You've had allergic reactions to IGF-1 or similar peptides Use with caution if !You have any insulin resistance or pre-diabetesmonitor blood sugar very carefully !You take medications that affect blood sugar levelsinteractions can be dangerous !You have heart conditionsIGF-1 can cause cardiac tissue growth !You have kidney or liver issuesmay affect peptide metabolism !You have carpal tunnel syndromeIGF-1 can worsen symptoms !You have a family history of cancerdiscuss with your doctor first Administration How do I use it

doi: 10.1136/gutjnl-2018-316723 24 SorbaraMTPamerEG