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In terms of diet adjustments, focus on reducing histamine intake 18 while supporting overall gut health and enzyme function

Every diabetes clinic should perform annual screening for DPN to identify the risk of diabetic foot disease using a monofilament and tuning fork (or biothesiometer)

IGF-1: When to Order This Test and What the Results Mean At a glance IGF-1 is a liver-derived peptide that reflects 24-hour integrated GH secretion Reference range varies by age and sex / typical adult range is 100 to 350 ng/mL Primary indication is suspected GH deficiency or GH excess (acromegaly) Fasting is not required but morning draws improve reproducibility GH-deficient adults show IGF-1 below the age-adjusted lower tertile Acromegaly screening uses IGF-1 plus an oral glucose tolerance test IGF-1 is the preferred monitoring marker during GH peptide therapy (e.g., sermorelin, tesamorelin, CJC-1295/ipamorelin) Malnutrition, liver disease, and uncontrolled diabetes can suppress IGF-1 independent of GH status The Endocrine Society recommends keeping treated IGF-1 within the upper half of the age-adjusted normal range Persistent IGF-1 above the reference ceiling may raise long-term cancer risk What Does IGF-1 Mean

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Classification and diagnosis of diabetes: standards of care in diabetes-2024

Guan X, Rodriguez-Cruz V, Morris ME