Posts Tagged ‘diabetes’

Diabetes Basics – Audio

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

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Diabetes Basics

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

 

Fashion scares me.  I am very glad I have a uniform at work.  White shirt, tie, dark pant and a lab coat.  No decisions.  Even Barret’s quip last week about me being comfortable with my hair style, bald, wasn’t a decision.  It just kinda happened.  My daughter Emily loves fashion.  She is even telling me how to dress.  Last Wednesday she told me to change my tie.  “Dad, you have to wear a blue tie.  It is World Diabetes Day.”

 

Diabetes is very common in Manitoba.  A couple of years ago, I went on a fishing trip with some high school friends.  In the year before the trip, one of the fisherman had developed diabetes.  Our trip organizer sent out an email telling us all to not make any food with sugar in it.  The newly diabetic fisherman sent another email telling the rest of us not to panic.  We could prepare any food we wanted.  He could eat anything he wanted, in moderation, as long as he kept taking his meds.  I had forgotten about this story until I heard an interview on World Diabetes Day.  It was with a twelve year old girl with type 1 diabetes.  A friend’s parent wouldn’t let her come over to the house any more.  The parent said her diabetes made her too much work.  Then one of this twelve year old diabetic’s classmates told her she couldn’t eat anything or play any sports because of her diabetes.  She has even had well meaning adults snatch Halloween candy out of her hand.  Despite being a common disease, it seems like we need some more information out there.

 

What is diabetes?  Diabetes is when your body has trouble using sugar.  There are 3 main types of diabetes: type 1, type 2, and gestational diabetes.  Type 1 diabetes is when your pancreas doesn’t produce insulin.  You must inject insulin or you will die.  Type 1 diabetes accounts for about 10% of diabetics.  In Type 2 diabetes, your body may produce normal, or even above normal amounts of insulin.  However, other parts of the body like your muscle and fat cells aren’t listening to the insulin signal.  Type 2 diabetes can be treated with diet, exercise, pills or insulin.  Type 2 diabetes accounts for about 90% of diabetics.  Gestational diabetes is a temporary condition that occurs during pregnancy. It affects approximately 2 to 4 per cent of all pregnancies.  Gestational diabetes increases the risk of developing diabetes later in life for both mother and child.

 

Let’s start with a person without diabetes.  They eat something.  The carbohydrates in their food get broken down into sugar.  That sugar goes into the blood.  The pancreas produces insulin in response to the sugar.  The insulin is a signal to all the cells in the body.  I think of insulin like a key.  It goes into locks in the cells.  When the insulin key goes into the lock, little doors open in the cell.  These open doors let the sugar leave the blood and get into the cell.  The cell then burns the sugar to produce energy.

 

What is happening in diabetes?  In Type 1 diabetes, the body can’t produce any insulin keys.  So there is no way to open the doors in the cells.  The sugar stays in the blood stream.  That means the blood sugar level stays high, but the cells have no energy to use.  Type 2 diabetes is a little different.  The pancreas produces insulin.  It may even produce higher than normal amounts of insulin.  The problem seems to be with the little locks on the sugar doors in the cells.  The little locks seem to have gotten rusty.  Even if insulin keys go into the locks, the keys can’t turn and the doors won’t open.  We call this insulin resistance, and we think this is the main problem in Type 2 diabetes.

 

It should make sense why we inject insulin for Type 1 diabetics.  The pancreas doesn’t produce any insulin so we inject it.  In Type 2 diabetes it is not as straight forward.  We can inject insulin.  With enough insulin keys, we can force those rusty lock open.  We can give pills that force the pancreas to produce more insulin.  They have names like glyburide.  They work well, but eventually the pancreas will get tired and stop producing insulin.  Or we can give medications like metformin which act like WD-40.  This makes the locks easier to turn.

 

What can a diabetic eat?  Can a diabetic, type 1 or type 2 eat chocolate bars, regular pop, honey, jam and fruit juice?  Yes, of course they can.  Should they eat just candy, pop and fruit juice?  No, of course not.  In general, a diabetic should be eating according to the Canada Food Guide just like the rest of us.  So yes a diabetic child can have Halloween candy as a treat.  A diabetic can and should play sports and exercise like everyone else.  A doctor or dietician may prescribe certain dietary changes to a diabetic, but they won’t be too far off from the Canada Food Guide.  In general, we want a diabetic to have a healthy diet, to exercise and to take their pills or insulin.  And don’t be afraid if a diabetic child comes to your house for a sleep-over.  Yes, talk to the child’s parents about the child’s routine.  Yes, the child will probably have to check their sugar with a finger poke and may have to give themselves some insulin.  But these are things the child does everyday like brushing their teeth.  The diabetic child is going to be no more or less trouble at the sleep over than any other kid.

 

Diabetes is a complicated condition, but it is nothing to be afraid of.  Diet and exercise should always be part of any diabetes treatment plan.  My little stories about locks and keys are an overly simplified sketch of diabetes.  But I hope they shed a little more light on a disease that effects around 9 million of us Canadians.  Don’t be afraid of fishing with diabetics or having diabetic children over to your house.  Knowledge is the key to fighting fear.  And now I have to fight my fashion fears and to go talk to my 10 year old daughter.

 

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

 

Canadian Diabetes Association – www.diabetes.ca

Hemoglobin A1C Testing for Diabetes

 By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

 

If your pants are on fire, that is really more painful in Britain than it is in Canada.  In Dauphin I work with a couple of Lori’s.  In Manchester I might work under a lorry or even in one.  I love how different people say English words and how the words we use change depending on what part of the world we are in.  In England when they say pants, they are talking about underwear.  When they say lorry, they are talking about a truck.  My favorite group of English speakers are Doris’s relatives.  Both of my wife’s parents are from Germany.  When Emily was small we went to Hamburg to visit Doris’s mom’s side of the family.  They were lovely people and they all spoke excellent English except one uncle.  They all sounded the same to me when they spoke German as my German is non-existent.  However, they all spoke English differently.  One of Doris’s aunts went to University in Arizona.  So to my ear she sounded “normal”.  Another of the aunts and Doris’s grandmother had spent time in England, so they sounded very British.  One of the cousins had spent time in Australia, so she sounded very Aussie.  There were two other young cousins who hadn’t been abroad yet, so I really wanted one to go to Boston and another to go to South Africa so the Baumgarteners could have a full compliment of English accents.

 

How you say a word can change how others look at the word.  If you are diabetic, how you test your blood sugar can change how you look at your disease.  For example, if you are diabetic, you know you have to test your blood sugar at home.  But, there is another blood sugar test out there that looks at your diabetes differently.  We have lots and lots of evidence from huge studies that show blood sugar testing at home and with this other test will help diabetics.  These big studies have funny names like DCCT and UKPDS and they say that the closer a diabetic person keeps their blood sugar to normal values the less chance they have of getting the big four problems of diabetes.

 

The big four problems associated with diabetes are heart disease, kidney disease, amputation, and blindness.  So, if you are diabetic you should follow your diet and exercise plan, use your medications appropriately, and test your blood sugar at home.  Home blood sugar testing is one of the best ways for you to see if your diabetic plan that you developed with your health care professional is keeping your blood sugar within normal limits.  And if you keep your blood sugar within normal limits, you are more likely to avoid the diabetes big four.

 

So what is this other blood sugar test?  It is called a hemoglobin A1C or glycosylated hemoglobin test.  It gives an average of how your blood sugar has been doing over the last 3 months.  Most diabetes guidelines say it should be done at least once a year.  Let’s talk about how a hemoglobin A1C test works.

 

Red blood cells carry oxygen in your blood.  Red blood cells look like doughnuts with the hole in the middle not quite all the way through.  Or another way to picture them is they look like a ball that has been pinched together in the middle.  What red blood cells look like is important, because of what they do.  A red blood cell picks up its load of oxygen in the lungs, goes through the heart, and drops off its oxygen at a tissue.  To get to its tissue, the red blood cell must bend and squeeze to get through very narrow tubes called capillaries.

 

Now let’s add diabetes to the mix.  If you have diabetes, you have too much sugar in your blood.  The hemoglobin A1C test checks to see how many of your red blood cells are coated with sugar.  If your blood sugar control over the past 3 months has been good, your hemoglobin A1C will be good.  Why does the hemoglobin A1C test 3 months worth of blood sugar control?  Because red blood cells live about 3 months.

 

What number does your doctor want to see on your hemoglobin A1C test?  The latest guidelines say most Type 1 and Type 2 diabetics should aim to get their hemoglobin A1C to 7% or less.  What if your hemoglobin A1C is higher than 7%?  That just gives you room to improve your diabetes control.  Studies show that for every 1% you can lower you hemoglobin A1C, you reduce your chances of eye, kidney and nerve diseases by 40%.  If you can get your hemoglobin A1C from 10% to 9% even though you aren’t at ideal range yet your eyes, kidneys and nerves will thank you.

 

To get a hemoglobin A1c test your usually have to go see your doctor.  They then have to send your blood to a lab to get your hemoglobin A1C tested.  Not so on Wednesday, November 23!  On Wednesday, November 23 the Dauphin Clinic Pharmacy has a portable hemoglobin A1C tester available from 9 am to 3 pm.  The whole test takes less than 15 minutes.  There are only a limited number of tests available.  Call the pharmacy at 638-4602 to book your appointment today.  Come have a different look at your blood sugar.

 

People in different parts of the world look at English words differently, so they say them differently.  Being biased, I think more people should say words like we do in Dauphin.  I just so happens that we have a German student working at the Dauphin Clinic Pharmacy to improve her English.  Her name is Anna, and although her English is very good already, I think she needs more Dauphinisms in her vocabulary.  Come down to the store to say hi to Anna and maybe some of our expressions can go back across the pond with her.

 

As always if you have any questions or concerns about these or other products, ask your pharmacist.

 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

 

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

Are Diabetics Testing Their Blood Sugar Too Much? – Audio

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music 

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

Byetta

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

 

I love the television show Family Guy.  If you have never seen it, it revolves around a foul-mouth obscene New England cartoon family.  Because it is a cartoon, my kids keep trying to watch Family Guy with me.  My wife then gets suitably upset and yells at me that Family Guy is inappropriate for the children.  My five year old Eric loves that.  He loves when I get into trouble.  So Eric has started tattling on me.  He has started with yelling  “Mom!  Dad is watching something inappropriate!” whenever I flip through the channels and simply pause on Family Guy too long.  Lately, Eric has grown older and wiser.  Whenever I start watching anything he doesn’t want to see like the weather, the news, a hockey game or anything that isn’t Spongebob Square Pants he tells me, “Dad, this show is inappropriate!”  I’ve been watching Eric’s shows often enough that I can tell you that Spongebob has a pet snail named Garry.

Eric seems to be leaving his dinosaur phase, but I’m sure he would think a Gila monster would make a good pet.  The Gila monster is a 2 foot long lizard that apparently is the only known venomous lizard native to the United States.  Because of the venom thing, I think my wife would back me in saying a Gila monster is an inappropriate pet.  The venom in the saliva is interesting though.  It has been used to derive a new diabetes treatment.  The new medication is called Byetta or exenatide.  Byetta or exenatide is part of a group of medications called incretins.

Before we talk about how incretins work, let’s do a quick refresher on diabetes.  There are two main types of diabetes, Type 1 and Type 2.  In Type 1 diabetes, the special cells that make insulin stop working.  So Type 1 diabetics must inject insulin or they will die.  Type 1 diabetics only account for about 20% of the diabetics in Canada.  Almost 80% of diabetics out there have type 2 diabetes.  In type 2 diabetes, the person is still producing insulin, but the muscle, fat and other cells don’t listen to the signal from insulin to suck up glucose from the blood stream.

We often treat type 2 diabetes with medication.  They have names like glyburide, metformin, actos and acarbose.  Unfortunately, we aren’t winning the war on type 2 diabetes.  Type 2 diabetes is becoming more common.  The increase is  partially blamed on the fact we are getting less active, eating more poorly and getting more obese.  Diabetes can lead to serious complications.  These include the big four: blindness, heart disease, kidney disease and amputation.  And even in the patients we are treating now, it seems like their blood sugars keep going up despite the fact we are using multiple medications and insulin on them.  It sure would be nice if we had  new tools in the diabetes tool box.

Well, the new tools are called incretins.  Incretins are hormones made in your gut.  They are released when you eat food with carbohydrates in them.  There are several  naturally occurring incretins but we are going to talk about  Glucagon Like Peptide 1 (GLP-1).  GLP-1 does some interesting things.  It delays the emptying of the stomach, it makes beta cells in the pancreas produce more insulin, reduces glucagon secretion and convinces your brain that you are less hungry.

Scientists found if GLP-1 was injected directly into patients it reduced blood sugar levels, had a low risk of making the blood sugar go too low, caused weigh loss, helped the insulin making cells stay healthy, but it caused some nausea and vomiting.  That was good, but the injected GLP-1 was broken down by the body within minutes.  To get any good effects they had to continuously pump it into the test subjects.  That would not be practical for the average type 2 diabetic.

So the drug companies have developed two different types of GLP-1 like products.  The first type of incretin is called a DDP-4.  The DDP-4’s block the enzyme that breaks down GLP-1.  This makes the GLP-1 in the body last longer.  DDP-4’s are oral pills and have names like Januvia (sitagliptin), and Onglyza (saxagliptin).  The second type of incretin is called a GLP-1 analog.  GLP-1 analogues act like GLP-1 in the body, but they aren’t broken down as fast.  The first GLP-1 analogue available in Canada was called Victoza or liraglutide.  The new one is called Byetta or exenatide.  GLP-1 analogues need to be injected.

The injection liraglutide is injected once a day.  It will help a patient lose weight, and will lower their blood sugar.  Liraglutide is likely to cause nausea for the first few weeks and then the nausea should go away.  The new drug byetta or exenatide is injected twice a day.  It will also cause weight loss and a reduction in blood sugar.  Liraglutide reduces blood sugar a little bit better than the new medication exanatide.  Liraglutide is only a once a day injection so it is more convenient that the new medication exenatide which is injected twice a day.  Liraglutide should cause less nausea than the new medication exentide.  So why would someone want try the new medication exenatide?  Exenatide is cheaper.

Maybe Family Guy is inappropriate for children to watch.  Maybe a Gila monster is an inappropriate for a pet for a five year old.  But the medication exenatide or Byetta may be an appropriate add on medication for some type 2 diabetics.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We are always looking for new ideas for these articles.  If you have any topic suggestions, please email us at dcp@mymts.net.

 

As always if you have any questions or concerns about these products, ask your pharmacist.

Byetta – Audio

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

Diabetes Basics

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

 

I had a really good time at the Diabetes Expo held at the Senior’s Center on Feb 26/11.  The turn out for the Parkland Chapter of the Canadian Diabetes Association’s Education event was close to 150 people!  That is the largest audience in its 16 year history!  Kudo’s to all the organizers.  I got to be one of the experts on a panel with Dr. Scott Kish, Dietician Janice Brackman and Optometrist Dr. Randy Ashcroft.  The panel tried our best to answer diabetes questions from the audience.  When I was talking to people after the panel around the Dauphin Clinic Pharmacy display, I also got asked a lot of interesting questions.   There were people who had diabetes for 30 years and knew far more about the disease than I did.  There were also a lot of people who didn’t know very much about diabetes.  So I thought I’d do a diabetes primer today.

What is diabetes?  Diabetes is when your body has trouble using sugar.  There are 3 main types of diabetes: type 1, type 2, and gestational diabetes.  Type 1 diabetes is when your pancreas doesn’t produce insulin.  You must inject insulin or you will die.  Type 1 accounts for about 10% of diabetics.  In Type 2 diabetes, your body may produce normal, or even above normal amounts of insulin.  However, other parts of the body like your muscle and fat cells aren’t listening to the insulin signal.  Type 2 diabetes can be treated with diet, exercise, pills or insulin.  Type 2 accounts for about 90% of diabetics.  Gestational diabetes is a temporary condition that occurs during pregnancy. It affects approximately 2 to 4 per cent of all pregnancies.  Gestational diabetes increases the risk of developing diabetes for both mother and child.

Let’s start with a person without diabetes.  They eat something.  The carbohydrates in their food get broken down into sugar.  That sugar goes into the blood.  The pancreas produces insulin in response to the sugar.  The insulin is a signal to all the cells in the body.  I think of insulin like a key.  It goes into locks in the cells.  When the insulin key goes into the lock, little doors open in the cell.  These open doors let the sugar leave the blood and get into the cell.  The cell then burns the sugar to produce energy. 

What is happening in diabetes?  In Type 1 diabetes, the body can’t produce any insulin keys.  So there is no way to open the doors in the cells.  The sugar stays in the blood stream.  That means the blood sugar level stays high, but the cells have no energy to use.  Type 2 diabetes is a little different.  The pancreas produces insulin.  It may even produce higher than normal amounts of insulin.  The problem seems to be with the little locks on the sugar doors in the cells.  The little locks seem to have gotten rusty.  Even if insulin keys go into the locks, the keys can’t turn and the doors won’t open.  We call this insulin resistance, and we think this is the main problem in Type 2 diabetes.

Now it should make sense why we inject insulin for Type 1 diabetics.  The pancreas doesn’t produce any insulin so we inject it.  In Type 2 diabetes it is not as straight forward.  We can inject insulin.  With enough insulin keys, we can force those rusty lock open.  We can give pills that force the pancreas to produce more insulin.  They have names like glyburide.  They work well, but eventually the pancreas will get tired an stop producing insulin.  Or we can give medications like metformin which act like WD-40.  This makes the locks easier to turn. 

Diabetes is a complicated condition.  Diet and exercise should always be part of any diabetes treatment plan.  My little stories about locks and keys are a very overly simplified sketch of diabetes.  But I hope they shed a little more light on a disease that effects around 9 million of us Canadians.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Diabetes Basics – Audio

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

BLOOD GLUCOSE METERS-No More Pokes?

 

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio?  Listen to 730 CKDM Tuesday Mornings at 8:35 am!  We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional. 

Terry O’Reilly is an ad producer and also comments on advertising in a radio show called The Age of Persuasion.  In one episode he talked about some unwritten rules of advertising such as women in beer ads are impossibly good looking and beer is always to be served in glasses that are dripping with condensation.  I’d like to add one of my own.  When you see an ad on TV for blood sugar testing machines, you never see anyone poking their finger.  

At least a couple of times a month, I get a diabetic in the pharmacy asking for that machine that can check their sugars without a finger poke.  I get the pleasure of telling them it doesn’t exist.  The customer is never very happy with that answer and I understand why.  Poking your finger several times a day to check your blood sugar is annoying and painful.  Isn’t there a better way? 

Checking you blood sugar without getting your finger poked is possible, but not simple.  A decade ago, I was playing pool with another pharmacist and a friend of his.  The friend was a graduate student in biochemistry, so I asked what he was working on.  He said they had developed a piece of equipment that could test someone’s blood sugar without the diabetic person having to poke their finger!  I was immediately interested and asked him more.  He said it worked by firing infra-red light through the skin and figuring out the blood sugar from that.  I was floored!  This was definitely something that every diabetic would want!  The researcher said the piece of equipment was about the size of a VCR and wasn’t commercially available.  Oh well. 

Jumping back to the present, there is one poke free machine available in Canada.  It is called the Guardian REAL-Time Continuous Glucose Monitoring System made by Medtronic.  Before you get too excited, it is not really the finger poking replacement I was hoping for.  On the positive side it has a small wireless transmitter that sends blood sugar readings to a machine without a finger poke.  On the negative side, the transmitter itself is has needle that must go under the skin and you have to poke your finger up to three times a day to calibrate the meter.  The Guardian wasn’t really designed to replace finger pokes.  It was designed to continuously monitor your blood sugar and be used with an insulin pump.  One of the problems with leaving a needle in the skin to continuously monitor the blood sugar is it may cause local inflammation which can effect the blood sugar readings.  That is why you still need to finger poke to calibrate the machine. 

Other interesting technology involves lasers.  I just like saying lasers.  A hole is still poked in the skin, but it is supposed to be painless, about the width of a human hair and drilled into just the outer layer of the skin with lasers.  The fluid that comes out is called interstitial fluid and can be tested for sugar.  Again this is really more for continuous sugar monitoring.  You need to poke the finger once a day to calibrate the machine and you have to measure the temperature of the skin to keep the readings accurate. 

There was a cool sounding product in the US called the Glucowatch G2 Biographer.  It generated a small electrical current the sucked sodium ions out of the skin which pulled water and glucose along.  The process is called reverse iontophoresis.  So the good news is it actually got a blood glucose reading without poking a hole in the skin.  The problems were it often required a finger poke to calibrate it, it took 2 hours to warm up before it would work and it was very expensive.  It never was marketed in Canada, and to the best of my knowledge they have stopped selling it in the US. 

Then there is my favorite, infrared light.  The machines to measure blood sugar with infrared light have shrunk down from the size of a VCR.  And we can successfully measure other things in the blood with infrared.  For a long time now we put little infrared clips on people’s fingers to measure the oxygen saturation of their blood.  Unfortunately, it isn’t so easy for glucose.  Things like dehydration, body temperature, hemoglobin level and even medications effect how well the infrared light can measure the glucose level.  So, again there are many finger pokes to calibrate the machines.  

Recently, there was a new device developed by the company GlySens.  It is an implantable device that is put under the skin.  It has been in pigs for more than a year and seems to be working well.  The best news is it doesn’t seem to need calibration with finger pokes.  But it has not been tested in people yet. 

So maybe art really does imitate life.  The women in Dauphin are impossibly good looking.  The beer is always so cold it forms condensation on the glass.  But as for blood sugar tests without finger pokes?  Not just yet. 

Link to Juvenile Diabetes Research Foundation – artificial pancreas project: www.artificialpancreasproject.com

Link to Candian Journal of Diabetes article on less invasive home blood sugar monitoring: www.diabetes.ca/files/HomeGlucoseGabbaySept03.pdf

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Diabetic Feet – Audio

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

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