IGF1 and Hyperglycemia: Many factors have been shown to play a role in the development of diabetic myopathy, such as hyperglycemia and increased polyol activation caused by it, protein glycation (AGE), decreased insulin by atrogene expression as a result, impaired GH/IGF-1 axle, increased glycocorticoid, IL-6, PAI-1, and changes in key hormones and cytokines [16].