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An already-elevated baseline IGF-1 is a reason not to push the axis higher, and because GH antagonizes insulin, glucose handling deserves attention in patients with diabetes or prediabetes

Received for publication April 24, 2025

Two bi-functional proteins (DBP and LBP (dicarboxylic acids only)), which may contain cis -3, trans -2-enoyl-CoA epimerases, carry out the next two steps of hydration (enoyl-CoA hydratase) then dehydrogenation (hydroxyacyl-CoA dehydrogenase) to yield 3-keto intermediates