The only side I was aware of was the visceral enlargement, and that was only in cases of extreme dosing and duration. I have always had at least a moderate carb intake so hypoglycemia was not an issue. I’m sure there are some out there on the anabolic diet that have some experience with IGF that can help.
I’ve used IGF-1 while leaning out with a low carb diet, pinning post workout along with most of my daily carbs. I can’t say I experienced much in the way of noticeable results. I got leaner and held on to LBM, but nothing over and above what I’ve achieved without it.
Now using IGF-1 while eating above maintenance with ample carbs, I did see some noticeable gains in strength and a quick few pounds of muscle. This is just my experience, other may have had more success while carbs were low.