IGF1 and Insulin resistance: However, reports of blood glucose normalization postsurgery are comparatively infrequent.[8–13] The primary pathophysiological processes through which acromegaly contributes to diabetes mellitus involve heightened lipolysis and modified fat distribution, leading to increased insulin resistance.[9] The pivotal factor is the mutual antagonism in insulin action by GH and IGF-1: GH promotes insulin resistance, while IGF-1 increases insulin sensitivity.