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Since the liver is the major source of IGF and IGFBP production, they examined whether levels of IGFs (IGF-1 and IGF-11) and IGFBPs (IGFBP-1 and IGFBP-3) differed when insulin was infused into the portal or peripheral vascular system [13]

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The MHRA advises checking B12 levels if deficiency is suspected and considering periodic monitoring in at-risk patients, whilst generally continuing metformin therapy during investigation and treatment