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MECHANISM CATEGORIES RESEARCH CONDITIONS SAFETY Side effects Hypoglycemia (binds insulin receptor at higher doses) Theoretical organ enlargement with chronic high-dose Theoretical concerns in active malignancy (IGF-1 axis) Known interactions Insulin / sulfonylureas (hypoglycemia risk) Concurrent rhGH not standard Contraindications Active malignancy (IGF-1 axis growth signaling) Pregnancy/lactation (unstudied) Diabetic retinopathy (theoretical exacerbation) REGULATORY STATUS FDA Not FDA-approved

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doi:10.3389/fphar.2022.1026182