IGF1 and diabetes mellitus: Patients who need high doses of PEGV (dose > 30.0 mg/d, exceeding the highest allowed dose of 30.0 mg daily that is mentioned on the label) to normalize IGF-1 have more aggressive disease, as they are younger, have higher baseline IGF-I levels, and had a higher incidence of hypertension, sleep apnea, diabetes, and overweight (18).