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Moreover, the upregulation of glycolytic bypass pathways, such as Hexosamine Biosynthetic Pathway (HBP), exacerbates glycation levels and contributes to cardiac hypertrophy 49

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IGF-1 DES has 20-30 minute half-life, minimal IGFBP binding, highest receptor affinity and potency, localized effects at injection site, and requires frequent dosing for sustained effects

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21,22,24 Although ideally a different choice of anti-pyretic or analgesic may be used, a less than 4000 mg per day use of APAP in the cirrhotic patient may be safe in the short term