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Prevent Exercise-induced Hypoglycemia

Exercise-related Hypoglycemia In Diabetes Mellitus

Exercise-related Hypoglycemia In Diabetes Mellitus

Diabetes is a chronic disease state characterized by absolute or relative insulin deficiency and is a leading cause of death and disability in the USA. In 2008, the CDC reported that approximately 23.6 million people in the USA have diabetes and, of that population, 5.7 million cases are undiagnosed [1]. Approximately 5–10% of individuals with diabetes have Type 1 diabetes mellitus (T1DM), an autoimmune disorder involving pancreatic β-cell destruction and consequent abolition of insulin secretion. Comprising the bulk (90–95%) of diabetes cases [1], Type 2 diabetes mellitus (T2DM) results from a combination of environmental and genetic factors, which lead to insufficient insulin secretion and insulin resistance. Diabetes can lead to an array of microvascular and macrovascular complications. It is the main cause of kidney failure, limb amputation and new-onset blindness in American adults [1]. Rates of both cardiovascular disease mortality and stroke are up to fourfold higher among people with diabetes versus those without. Positively, several historic studies conducted over the past 20 years have established that aggressive blood glucose control can prevent and slow the progression of diabetic complications, including retinopathy, microalbuminuria and neuropathy [2–5]. These findings have informed and redirected patient care strategies with the American Diabetes Association (ADA) setting general target glycosylated hemoglobin (HbA1c) values at less than 7% in 1995 [6]. Unfortunately, at this point in time, the primary negative consequence of intensified glycemic control in T1DM or T2DM is an increased frequency of hypoglycemic episodes [2–5,7,8]. These events chiefly occur in individuals treated with insulin secretagogues (sulfonylureas and meglitinides) and/or Continue reading >>

Preventing Exercise-induced Hypoglycemia In Type 1 Diabetes Using Real-time Continuous Glucose Monitoring And A New Carbohydrate Intake Algorithm: An Observational Field Study

Preventing Exercise-induced Hypoglycemia In Type 1 Diabetes Using Real-time Continuous Glucose Monitoring And A New Carbohydrate Intake Algorithm: An Observational Field Study

Abstract Real-time (RT) continuous glucose monitoring (CGM) offers the possibility to better manage glucose levels during exercise in active individuals with type 1 diabetes mellitus (T1DM). However, studies have yet to determine the appropriate actions to take when glucose levels are trending toward hypoglycemia. The purpose of this observational field study was to test the effectiveness of RT-GCM and a new carbohydrate intake algorithm designed for maintaining euglycemia during sports. During a 2-week sports camp, 25 adolescents (8-17 years old) with T1DM were fitted with a RT-CGM device and instructed to ingest fast-acting carbohydrates (8-20 g, depending on the concentration of glucose at the time of RT-CGM alert and rates of change in glycemia) when glucose levels were trending toward hypoglycemia. Rates of change in glucose were measured before and after algorithm use, and the incidence of hypoglycemia was documented. With RT-CGM and algorithm use, euglycemia was largely maintained with modest amounts of carbohydrate intake, even when glucose levels were initially dropping at an elevated rate (>0.55 mmol/L per 5 min). Mild biochemical hypoglycemia (3.0-3.9 mmol/L) occurred just twice out of 22 uses of the algorithm (9%) when trend arrows alerted the subjects that glucose levels were dropping. When glucose levels were already below target (<5.0 mmol/L), mild hypoglycemia occurred five times out of 13 events (38%), despite 16 g of carbohydrate being ingested. Average glucose levels during sports in the 60 min following algorithm use were 5.8 ± 1.2 mmol/L, 5.3 ± 1.0 mmol/L, and 6.2 ± 0.8 mmol/L in the 20-, 16-, and 8-g carbohydrate intake protocols when glucose levels were initially on target but dropping toward hypoglycemia. When coupled with RT-CGM, a new carboh Continue reading >>

How To Prevent Workout Hypoglycemia

How To Prevent Workout Hypoglycemia

Back to October 2017 Newsletter They say laughter is the best medicine. If that is true, then physical activity must be a very close second. Physical activity has been shown to reduce risks for everything from heart disease and stroke to depression and Type 2 diabetes! The unfortunate irony is that for people with diabetes using insulin, physical activity can also lead to one of our most dangerous short term risks, hypoglycemia. Hypoglycemia, or low blood sugar, can cause physical symptoms including; anxiety, loss of coordination and mental clarity, rapid heartbeat, shaking, loss of consciousness, and seizure. In a non diabetic person blood sugar is regulated by insulin and glucagon from the pancreas. Glucagon is a hormone produced in the pancreas that signals the liver to release stored glucose in times of low blood sugar or when intense mental or physical activity increases glucose demands of the body. Insulin lowers blood sugar and the presence of insulin inhibits the glucagon release to the liver to release additional sugar into the blood stream (after all, why would your body send out insulin to lower blood sugar, and glucagon to raise it at the same time?). Unfortunately, in a person with diabetes, the presence of insulin taken by infusion, injection or inhalation means that even though our blood sugar may be low, and demands for glucose are high, glucagon is not released, and the liver does nothing about the situation. (Come ON Glucagon, you had ONE job! But remember, glucagon is not stimulated by low blood sugar, but by the absence of insulin, and we are putting insulin into our bodies. So our glucagon just sits there watching the insulin lower the blood sugar.) During exercise, insulin keeps driving us lower, as our bodies are burning up what little glucose the Continue reading >>

Limiting Low And High Blood Sugars During And After Exercise

Limiting Low And High Blood Sugars During And After Exercise

Exercise can be amazing, empowering, and uplifting, but it can also sometimes be a frustrating experience. If you live with diabetes and your blood sugars just won’t cooperate when working out, you know what I’m talking about. Not cool! But can you imagine a world where you felt comfortable exercising, knowing that your exercise, food, and insulin choices lead to a limited risk of low or high blood sugar during and after your workout? I’ve been living with type 1 diabetes since 1997, and I believe that we can achieve that if we have the right tools and the right knowledge and information. In this post, I’ll share some of the methods I use myself and with my clients to achieve optimal blood sugar control during and after exercise. The Basics of Exercise and Blood Sugars Knowing the basics of how different types of exercise affect your blood sugars is the first step to successfully mastering blood sugars and exercise. If you have already started seeing patterns, and have a good idea about which types of exercise make your blood sugar drop and which make them soar, that’s great! That knowledge will set you up for success. But maybe you are new to it all or haven’t seen any patterns yet, and need some pointers on where to start and what to be aware of. That’s what I will try to provide in this post. In its most basic form, there are two types of exercise, aerobic and anaerobic. Aerobic exercise is characterized by a steady elevated heartbeat that you’ll see from jogging, dancing, flat terrain biking and walking. Most people will see a drop in their blood sugar when engaging in this kind of activity. Anaerobic exercise is characterized by bouts of intense movement that will have your heart rate fluctuating. Types of exercise that are labeled anaerobic are wei Continue reading >>

Dealing With Exercise-induced Hypoglycemia

Dealing With Exercise-induced Hypoglycemia

Too often our patients who are very active start to decrease their participation in sports and other physical endeavors. Frequently, this is because they are experiencing hypoglycemia and have no idea how to prevent this from happening. Sheri Colberg, Ph.D., FACSM, helps you to understand what is going on and what to do in Dealing with Exercise-Induced Hypoglycemia. Dealing with Exercise-Induced Hypoglycemia By Sheri Colberg, Ph.D., FACSM Experiencing bad low blood sugar reactions is one of the main factors that lowers the quality of life of those with diabetes. Even the fear of such lows is enough to increase your anxiety levels. You can do several things, however, to lower your risk, including becoming more aware of the possible symptoms of hypoglycemia. Recognizing the Symptoms of Hypoglycemia You really need to know all the possible symptoms of lows, both at rest and during exercise, to detect and treat it early. As you know, normal fasting blood sugars range from 70 to 99 mg/dl (3.9 to 5.5 mmol/L). Although hypoglycemia is technically any blood sugar below 70 (3.9 mmol/L), how low it has to go to cause symptoms of hypoglycemia varies. For instance, if you have been in poorer control, sometimes you will get symptoms while your blood sugars are still normal if they drop rapidly, without ever getting as low as 70 (3.9 mmol/L). If you’re in really tight control, your symptoms may not start until you reach 55 mg/dl (3.1 mmol/L) or lower. Some people have hypoglycemic unawareness, which means that they either don’t have or fail to recognize the usual symptoms. This condition appears to be more common in people with tight control or frequent lows (more on this later). The hormones that your body releases during exercise result in some of the same symptoms as hypoglyce Continue reading >>

The Use Of Mini-dose Glucagon To Prevent Exercise-induced Hypoglycemia In Type 1 Diabetes

The Use Of Mini-dose Glucagon To Prevent Exercise-induced Hypoglycemia In Type 1 Diabetes

Overview This trial has been completed. Condition diabetes mellitus, type 1 Treatments g-pen mini™ (glucagon injection), glucose tabs, basal insulin reduction Phase phase 2 Sponsor Jaeb Center for Health Research Collaborator Xeris Pharmaceuticals Start date January 2016 End date February 2017 Trial size 15 participants Trial identifier NCT02660242, T1DX Mini-dose Exercise Summary This project focuses on development of new strategy for the prevention of exercise-associated hypoglycemia using mini-dose glucagon. Location Institution Status Boston, MA Joslin Diabetes Center completed Philadelphia, PA University of Pennsylvania completed Study Design Allocation randomized Intervention model crossover assignment Primary purpose prevention Masking participant Arm Control (No Intervention) No basal insulin adjustment, no carbohydrate intake (until glucose drops <70 mg/dL). Basal insulin reduction (Active Comparator) Basal insulin reduction to 50% one hour before the start of exercise. basal insulin reduction Basal insulin reduction to 50% one hour before the start of exercise. Glucose Tabs (Active Comparator) Dextrose tabs orally (20 grams) 15 minutes before the start of exercise and at 30 minutes of exercise (total 40 grams). glucose tabs over-the-counter oral glucose tablets Dextrose tabs orally (20 grams) 15 minutes before the start of exercise and at 30 minutes of exercise (total 40 grams). G-Pen Mini™ (glucagon injection) (Experimental) Glucagon (150 µg) 15 minutes before the start of exercise (SQ-abdomen). g-pen mini™ (glucagon injection) mini-dose glucagon Glucagon (150 µg) 15 minutes before the start of exercise (SQ-abdomen). Primary Outcomes Measure Glycemic response time frame: 0 to 75 minutes following exercise initiation Secondary Outcomes Measure Occurren Continue reading >>

Get In The Zone: My Tips For Avoiding Hypoglycemia During Exercise

Get In The Zone: My Tips For Avoiding Hypoglycemia During Exercise

Twitter summary: Diagnosing & solving hypoglycemia (lows) & hyperglycemia (highs) during exercise w/ #diabetes. It’s all about personal experimentation. Exercise has been one of four complete gamechangers for managing my type 1 diabetes, but it can frequently be a source of confusion, frustration, exhaustion, and blood sugar unpredictability. I think this is partially why I get so many reader questions on this topic – managing blood sugars during exercise is challenging. Fortunately, it’s not impossible! This article shares what I’ve learned from athletes, healthcare providers, and 14 years of experimenting with blood sugars during exercise. I strongly believe that anyone with diabetes can master exercise, and it all starts with becoming a good driver – maintaining the right speed (100-180 mg/dl) while applying the proper amount of gas and brake (food and insulin) at the right times. The big challenge is that universal driving recommendations aren’t possible, since everyone’s car model (i.e., body), car engine (i.e., diabetes, physiology), and road conditions (type of exercise) are different. The key is not to give up, as it can take a while to climb the learning curve and figure out what works for you. This article offers a toolkit to help you on that path. Part I shares a diagnostic checklist, followed by some potential tactics to avoid lows and highs (Part II). Part III shares what I specifically do, in case it’s useful. I’m a pretty active person (much of my exercise is vigorous) and have figured out what works for me over time, so your adjustments could (and probably will) differ dramatically. You should absolutely talk to your healthcare provider before making any changes to your medications or routine. If you find this article useful, check out Continue reading >>

5 Ways To Prevent Exercise-induced Hypoglycemia

5 Ways To Prevent Exercise-induced Hypoglycemia

Although beneficial for people with diabetes, exercise can cause your blood glucose levels to drop too much, especially if you take insulin or any glucose-lowering medications. Symptoms of hypoglycemia (low blood sugar) tend to happen suddenly and include feeling shaky, light-headed, weak, confused, anxious, fatigued, irritable, or hungry; headache; breaking out into a clammy sweat; or even fainting. This can occur during exercise, right after exercise, or even up to 24 hours after you finish a workout. In rare cases, individuals may not experience any symptoms at all. By paying close attention to how you're feeling, and by knowing how to treat low blood sugar symptoms correctly, you can prevent problems before they put you at risk of injury. To prevent exercise-related hypoglycemia: If you take insulin, do not inject insulin near the primary muscles that will be used during exercise (typically the thighs or back of the arms), because it will be absorbed too quickly. Check your blood glucose level before you exercise and make any necessary adjustments based on your glucose reading before you start exercising. Do not skip planned meals before exercise or go too long without eating. Carry an easy-to-consume glucose source (such as juice, hard candy, or glucose tablets) when you exercise. Drink plenty of water before and during exercise as dehydration can affect glucose levels. Continue reading >>

The University Of Western Australia

The University Of Western Australia

Mary B. Abraham, MD,1,2 Raymond Davey, PhD,2,3 Michael J. O'Grady, MBBCh,1,3 Trang T. Ly, PhD,1,2,3 Nirubasini Paramalingam, BSc,1,3Paul A. Fournier, PhD,4 Anirban Roy, PhD,5 Benyamin Grosman, PhD,5 Natalie Kurtz, DrMedVet,5 Janice M. Fairchild, FRACP,6 Bruce R. King, PhD,7 Geoffrey R. Ambler, MD,8 Fergus Cameron, MD,9 Timothy W. Jones, MD,1,2,3 and Elizabeth A. Davis, PhD1,2,3 Background: Sensor-augmented pump therapy (SAPT) with a predictive algorithm to suspend insulin delivery has the potential to reduce hypoglycemia, a known obstacle in improving physical activity in patients with type 1 diabetes. The predictive low glucose management (PLGM) system employs a predictive algorithm that suspends basal insulin when hypoglycemia is predicted. The aim of this study was to determine the efficacy of this algorithm in the prevention of exercise-induced hypoglycemia under in-clinic conditions. Methods: This was a randomized, controlled cross-over study in which 25 participants performed 2 consecutive sessions of 30 min of moderate-intensity exercise while on basal continuous subcutaneous insulin infusion on 2 study days: a control day with SAPT alone and an intervention day with SAPT and PLGM. The predictive algorithm suspended basal insulin when sensor glucose was predicted to be below the preset hypoglycemic threshold in 30 min. We tested preset hypoglycemic thresholds of 70 and 80 mg/dL. The primary outcome was the requirement for hypoglycemia treatment (symptomatic hypoglycemia with plasma glucose <63 mg/dL or plasma glucose <50 mg/dL) and was compared in both control and intervention arms. Results: Results were analyzed in 19 participants. In the intervention arm with both thresholds, only 6 participants (32%) required treatment for hypoglycemia compared with 17 partici Continue reading >>

Evaluation Of The Efficacy Of The External Artificial Pancreas To Prevent Exercise-induced Hypoglycemia

Evaluation Of The Efficacy Of The External Artificial Pancreas To Prevent Exercise-induced Hypoglycemia

We are looking for volunteers to participate in a the following research projet: Evaluation of the efficacy of the external artificial pancreas to prevent exercise-induced hypoglycemia in adults with type 1 diabetes. Inclusion criteria: Have type 1 diabetes Be over 18 years old Use insulin pump therapy for more than three months This study involves five to nine visits that can be undertaken over four months. A first visit of approximately two hours to determine your eligibility to participate in the study will take place at the research center. There will be then four intervention visits to test different stratégies to control glucose levels during exercise: Single-hormone artificial pancreas (insulin) with exercise announcement to the artificial pancreas Single-hormone artificial pancreas (insulin) without exercise announcement to the artificial pancreas Dual-hormone artificial pancreas (insulin and glucagon) with exercise announcement to the artificial pancreas Dual-hormone artificial pancreas (insulin and glucagon) without exercise announcement to the artificial pancreas Continue reading >>

Why Is My Blood Glucose Sometimes Low After Physical Activity?

Why Is My Blood Glucose Sometimes Low After Physical Activity?

Low blood glucose is defined as a blood glucose level below 70 mg/dl if your meter measures whole blood, or 80 mg/dl or below if it measures plasma glucose (a plasma blood glucose of 90 mg/dl or below with symptoms is also a sign of hypoglycemia). One of the most common causes of low blood glucose is too much physical activity. In fact, moderate to intense exercise may cause your blood glucose to drop for the next 24 hours following exercise. This post-exercise hypoglycemia is often referred to as the "lag effect" of exercise. Basically, when you exercise, the body uses two sources of fuel, sugar and free fatty acids (that is, fat) to generate energy. The sugar comes from the blood, the liver and the muscles. The sugar is stored in the liver and muscle in a form called glycogen. During the first 15 minutes of exercise, most of the sugar for fuel comes from either the blood stream or the muscle glycogen, which is converted back to sugar. After 15 minutes of exercise, however, the fuel starts to come more from the glycogen stored in the liver. After 30 minutes of exercise, the body begins to get more of its energy from the free fatty acids. As a result, exercise can deplete sugar levels and glycogen stores. The body will replace these glycogen stores but this process may take 4 to 6 hours, even 12 to 24 hours with more intense activity. During this rebuilding of glycogen stores, a person with diabetes can be at higher risk for hypoglycemia. Here are tips for safe exercising. Guidelines for preventing exercise related hypoglycemia Check your blood glucose before exercising to make sure your blood glucose is sufficient and/or consume an appropriate snack. Avoid exercise at the peak of your insulin action. Avoid late evening exercise. Exercise should be completed 2 hours bef Continue reading >>

Type 1 Diabetes: Preventing Exercise-induced Hypoglycemia With Nutrition

Type 1 Diabetes: Preventing Exercise-induced Hypoglycemia With Nutrition

There have been very few studies on nutritional strategies to help prevent exercise-induced hypoglycemia in adolescents who have type 1 diabetes. To examine this relationship more closely, Canadian researchers compared the impact of various food strategies on blood glucose (BG) levels both during and after 60 minutes of moderately intense exercise. Their study was published online in late February 2012 in the article “Nutritional strategies to prevent hypoglycemia at exercise in diabetic adolescents.” The article will appear in an issue of the journal Medicine & Science in Sports & Exercise. Study participants exercised 120 minutes after breakfast under 1 of the following 3 conditions: standardized breakfast + pre-exercise placebo beverage (PL) standardized breakfast + pre-exercise carbohydrate beverage (CHO) (8 mg of CHO per kg of body weight per minute of exercise) protein supplemented breakfast (PROT) (8 mg of protein per kg of body weight per minute of exercise added to a standardized breakfast) + pre-exercise placebo beverage Ten participants were involved in each condition. The average age of the participants was 14.0 ± 1.5 years old. As soon as BG levels fell below 4 mmol/L or if symptomatic hypoglycemia was present during exercise, the exercise session was stopped, and CHO tablets were given to correct hypoglycemia. Researchers found that BG levels decreased by 6.0 ± 1.9 mmol/L in PL conditions, 1.0 ± 3.1 mmol/l in CHO conditions, and 4.6 ± 1.9 mmol/L in PROT conditions (p<0.05). It was noted that the proportion of participants who reached hypoglycemic values or hypoglycemic sensations was significantly different between the various conditions: 4/10 in the PL conditions, 1/10 in the CHO conditions, and 0/10 in the PROT conditions (p<0.05). The research t Continue reading >>

Low Blood Sugar Levels During Exercise: Is Non-diabetic Hypoglycemia Threatening?

Low Blood Sugar Levels During Exercise: Is Non-diabetic Hypoglycemia Threatening?

Hypoglycemia is the term used for defining low blood sugar levels, and when we’re talking about non-diabetic hypoglycemia, we refer to below normal values of blood sugar that occur in people who aren’t affected by diabetes. The symptoms of hypoglycemia can vary from one person to another, and can be accentuated by certain factors such as the lack of sleep, fasting or dehydration. Triggers of hypoglycemia in non-diabetic people can be very different, but today we’ll only discuss about exercise-induced low blood sugar levels, and we’ll try to understand why this symptom occurs, how threatening it is and how it can be prevented and managed. Exercise can decrease one’s blood sugar levels, but in healthy people the hypoglycemic episode is only temporary. If you constantly experience low blood sugar levels after or during exercise, it may be wise to schedule an appointment with your doctor and get tested for diabetes. Problems with the adrenal and pituitary glands, as well as liver problems, may also trigger hypoglycemic episodes, so it’s important to exclude any potential health issue from the list. Back to exercise-induced hypoglycemia: you probably experienced it several times after strenuous exercise, so the symptoms may sound very familiar. Hypoglycemia manifests through dizziness, headaches, inability to focus, shaking, sweating, blurred vision, irregular heartbeats, and even loss of coordination, anxiety and seizures if you don’t restore the glycogen reservoirs fast after the first symptoms occur. Why do these manifestations appear when exercising? Your body relies on glucose as its main fuel, so this form of sugar is the first one used by the organism for producing energy during exercise. The muscles and brain require glucose to function properly, and gl Continue reading >>

How To Treat Exercise-related Hypoglycemia

How To Treat Exercise-related Hypoglycemia

Did you know, according to diabetes experts, muscles are responsible for about 90 percent of the body’s use of glucose as fuel? Exercise also affects various hormones which have a direct impact on blood sugar levels. It’s not surprising then, that non-diabetic hypoglycemia (or low blood sugar) is common in frequent exercisers and athletes. If you’ve ever worked out on an empty stomach, you’ve probably experienced the dizziness, muscle weakness and exhaustion of a blood-sugar crash. Understanding how your blood-sugar levels are controlled, and what you can do to prevent these crashes, can help you avoid these symptoms. 1. Understand What Hypoglycemia Is And How Blood Sugar Works The sugar called glucose, which is stored in the muscles and liver, is the primary fuel your muscles use during strenuous activities. As part of a careful balancing act, two hormones are released to try to maintain healthy levels of glucose in the blood, where it can be used readily. Insulin is released into the blood by the pancreas when blood sugar levels are too high, where it bonds with specialized receptors on the cells. Insulin stimulates the cells at these receptors and tells them to absorb glucose. Once these cells respond to insulin, blood sugar levels drop. When blood sugar is too low, however, the pancreas releases glucagon instead. This hormone tells the liver to releases some of its stored glucose into the blood so that can be used as fuel. Exercise puts much higher demands on your muscles, forcing them to utilize more fuel — in much the same way as making your car go faster, or pull a heavy load, will increase how much gas it burns. Overtraining can even cause a permanent shift in this balance by increasing insulin sensitivity, which will make it much more difficult for yo Continue reading >>

Carbohydrate-based Strategies To Prevent Exercise-induced Hypoglycemia

Carbohydrate-based Strategies To Prevent Exercise-induced Hypoglycemia

To prevent hypoglycemia during prolonged exercise (>30 minutes), additional carbohydrate intake is frequently required. Carbohydrate intake required will vary with insulin regimens, timing and type of exercise as well as starting blood glucose level. In addition to the amount of carbohydrate ingested, the timing of carbohydrate intake could also have an impact on glucose control during exercise. Therefore, the objective of this study will be to compare the efficacy of two snacking strategies to maintain glucose levels in the target range during an exercise period in adults with type 1 diabetes: 1) a snack containing ~0.5g of carbohydrates per kilogram of body weight - rounded to the nearest 5g - given 5 minutes before exercise; 2) a snack containing ~0.5g of carbohydrates per kilogram of body weight - rounded to the nearest 5g - distributed this way: ~40% given 5 minutes before exercise, ~30% after 20 minutes of exercise and the last ~30% after 40 minutes of exercise. Study Type : Interventional (Clinical Trial) Estimated Enrollment : 37 participants Allocation: Randomized Intervention Model: Crossover Assignment Masking: None (Open Label) Primary Purpose: Treatment Official Title: Comparison of Two Carbohydrate Intake Strategies to Improve Glucose Control During Exercise in Adults With Type 1 Diabetes Actual Study Start Date : August 3, 2017 Estimated Primary Completion Date : December 2018 Estimated Study Completion Date : December 2018 Arm Intervention/treatment Active Comparator: Full snack given before exercise A snack containing ~0.5g of carbohydrates per kilogram of body weight will be given 5 minutes before exercise Other: Exercise Participants will be admitted at IRCM at 14:00. At 15:30, participants will performed a 60-minute exercise on the ergocycle at 60% o Continue reading >>

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