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Insulin Regimen Calculation

Getting Down To Basals

Getting Down To Basals

To borrow a phrase from the late, great Rodney Dangerfield, “Basal insulin gets no respect.” Very few people know how to spell it correctly (basil? bazal? I mean, really!), and even fewer know what the heck it’s for. That’s a shame, because basal insulin (no “z”) is the foundation upon which insulin therapy is built. Unlike its more famous little brother bolus, which is the rapid-acting insulin given to cover those delicious carbohydrates in our diet, basal’s job is much more mundane: to match the liver’s secretion of glucose into the bloodstream (and to prevent the liver from oversecreting glucose). Everyone’s liver does it, and a healthy pancreas responds by secreting a small amount of insulin into the bloodstream every few minutes. How would we manage without basal insulin? Not so well. Because the liver is secreting glucose into the bloodstream continuously, a complete lack of insulin, even for just an hour or two, would result in a sharp rise in blood glucose level. Basal insulin also makes sure that the body’s cells are nourished with a steady supply of glucose to burn for energy. Without basal insulin, many of the body’s cells would starve for fuel. Some cells would resort to burning only fat for energy, and that leads to production of acidic waste products called ketones. The combination of dehydration (caused by high blood glucose) and heavy ketone production (from excessive fat metabolism) leads to a life-threatening condition known as diabetic ketoacidosis (DKA). Suffice it to say that basal insulin is necessary for maintaining blood glucose control, not to mention survival. So where does one find basal insulin? How much is needed? And when should it be taken? Basal options Each person’s basal insulin requirement is unique. It’s affe Continue reading >>

Insulin Dosing

Insulin Dosing

Two hour post-prandial Blood Glucose <160 mg/dl Aim for 50% of Blood Glucose s in target range Look for consistent pattern in Blood Sugar s for >3 days Compare Blood Sugar for same time each day Consider eating and activity patterns during day Maintain a 50:50 mix of Basal to Bolus Insulin Insulin dose 10-20 units: Adjust by 2 units Insulin dose >20 units: Adjust by 10% Insulin dose Decrease rapid Insulin ( Lispro ) at dinner One Unit covers each 10-15 grams carbohydrate Add 1-2 units for every 50 mg/dl Glucose >150 Indications to adjust basal Insulin (e.g. Glargine ) All Blood Glucose s high (within 50 mg/dl) Increase basal Insulin per adjustment above Critical to distinguish 3 AM low BG from high BG Indications to adjust Bolus Insulin (e.g. Lispro ) Two hour post-prandial >40-60 mg/dl over premeal Increase rapid acting Insulin before meal Average Insulin doses after titrating from start Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Insulin Dosing." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images Related Studies (from Trip Database) Open in New Window A short-acting form of insulin. Regular insulin is obtained from animal or recombinant sources. The onset of action of regular insulin occurs at 30-90 minutes after injection; its effect lasts for 6 to 8 hours. Endogenous human insulin, a pancreatic hormone composed of two polypeptide chains, is important for the normal metabolism of carbohydrates, proteins and fats; it has anabolic effects on many types of tissues. (NCI04) Insulin (51 aa, ~6 kDa) is encoded by the human INS gene. This protein is involved in the direct regulation of glucose metabolism. protein hormone secrete Continue reading >>

A Review Of Insulin-dosing Formulas For Continuous Subcutaneous Insulin Infusion (csii) For Adults With Type 1 Diabetes

A Review Of Insulin-dosing Formulas For Continuous Subcutaneous Insulin Infusion (csii) For Adults With Type 1 Diabetes

Go to: Continuous subcutaneous insulin infusion (CSII) is an intensive therapy typically reserved for motivated patients with type 1 diabetes (T1D) who have frequent hypoglycemia, a significant dawn phenomenon (excess hepatic glucose production and non-hepatic insulin resistance in the morning period) or widely fluctuating blood glucose when using multiple daily injections (MDIs) [1•]. If properly managed, CSII may provide patients with improved glucose control compared with MDI therapy [2, 3] and a lower incidence of severe hypoglycemia [4]. As noted in a recent review, the total number of insulin pump users worldwide is unknown but believed to vary greatly across countries [5]. Estimates suggest that there may be as many as 350,000–515,000 insulin pump users in the USA [1•, 6]. A large registry-based study of the more experienced endocrinology centers in the USA indicated that as many as 50 % of their patients with T1D used a pump [7]. Among European nations, in a 2010 report, the proportion of patients with T1D using CSII varies substantially, from ∼1 % in Russia and Portugal to about 20 % in Norway, Austria, the Netherlands, and Switzerland [8]. A 2011 publication estimated that about 10 % of Australian patients were using CSII, with an increasing number of patients initiating CSII sooner after diagnosis than in previous years [9]. Among Asian nations, the proportion of patients with T1D who are using CSII in Japan is estimated to be 7 % (author communication with Medtronic Japan). Precise insulin dosing during CSII is necessary to enable patients with diabetes to adhere to current treatment guidelines [10, 11]. Unfortunately, precise dosing is complicated by the need to calculate two to five different basal rates for a 24-h period to match varying insulin n Continue reading >>

Mysugr Bolus Calculator – Get Help With Your Insulin Dose (currently Available In Eu)

Mysugr Bolus Calculator – Get Help With Your Insulin Dose (currently Available In Eu)

back to Overview It's time for lunch. Your blood sugar is 165 mg/dl (9.2 mmol/L). You have a big slice of pizza, a bag of chips, and a cold Diet Coke waiting for you. How much insulin do you take? I can think of a few ways this goes: There’s not much to think about. You always eat the same thing and always take the same amount of insulin. You define the phrase “creature of habit.” You hate thinking about all of this stuff, so you just guess. You love doing a bunch of math before every meal, so calculating your insulin dose is fun and easy. I can relate to the first two. There’s a lot of value in routine, and I’ve also done my share of guesstimating. That last one? Enjoying all of the diabetes math? I’m sorry. That’s just weird. (I’m teasing. Kind of…) But there’s another option, and it makes thinking about your insulin doses easier and more precise. I’m talking about a bolus calculator. If you wear an insulin pump, you’re probably already using one (they’re often built in). You’re welcome to stay and read, but there’s not much new information for you here. However, if you’re using injections (syringes or pens), like most people with diabetes, then stick around. This article should be helpful. So you don’t have (or want) an insulin pump, but I bet you have a smartphone. What does that mean? It means that you should meet mySugr’s Bolus Calculator. It’s a module integrated into the mySugr app that helps with your insulin doses (note: mySugr Bolus Calculator is currently approved for use in Europe). What the heck is a “bolus,” you ask? Great question. A bolus, in our case, is a single dose of insulin given all at once. In other words, it’s your mealtime shot or a shot to fix a high blood sugar. mySugr’s Bolus Calculator examines Continue reading >>

Insulin Calculation

Insulin Calculation

Ads by Google Insulin calculation formula in this page is the generalized rule for find daily insulin dosage both basal and bolus requirement. However, bear in mind your insulin requirement can be lower if you are newly diagnosed and still making insulin on your own and requirement is higher if you are very resistant to insulin. Monitor your BS; vary your insulin requirement for the best insulin dose to meet your individual needs. How do you do the insulin calculation? The insulin requirements for type 1 diabetes cannot calculate precisely because every individual is different. However, to begin the treatment, there is a simple thumb rule formula exist, which can help you provide just close to your insulin requirement. After by trial and measurement, you can fine-tune your insulin treatment. Before proceed further, you should learn some important term in your insulin calculations, they are: Total daily dose of insulin is the insulin requirement of both basal and bolus insulin. The basal insulin (background insulin) is the insulin requirement; overnight, during fasting and in-between meals. The bolus insulin is the insulin requirement to cover the mealtime carbohydrate and blood sugar correction. Insulin to the carb ratio is the grams of carbohydrate the body can dispose by one unit of insulin. CHO insulin dose is the insulin requirement to cover the total grams of carbohydrate. Insulin sensitivity factor or Blood sugar correction factor is defining, as one unit of insulin (rapid acting) will drop the blood-sugar level Blood sugar insulin correction dosage is the insulin requirement to cover the blood sugar deviation from the target. Total mealtime bolus insulin is the insulin requirement to cover the mealtime carbohydrate and deviation in the blood sugar. Calculate your Continue reading >>

Insulin Dose Calculation Definitions Ï‚§carbohydrate Ratio

Insulin Dose Calculation Definitions Ï‚§carbohydrate Ratio

Information Needed to Get Started How many grams of carbs the child is eating Blood glucose (BG) taken before eating Important numbers from primary caregiver: – Carbohydrate Ratio – Correction Target – Correction Factor How many grams of carbohydrates will be covered by one unit of insulin Correction Target Target blood glucose value used for insulin dose calculations when the blood glucose is high Correction Factor How many points (mg/dL) one unit of insulin will lower the blood glucose over several hours Bolus Insulin Calculation Worksheet Insulin for carbs Insulin for high blood glucose Add insulin for carbs to insulin for high blood glucose Bolus Insulin Calculation Worksheet Place the example numbers on the worksheet. Carbohydrate Ratio: 15 Correction Target: 120 Correction Factor: 30 15 30120 Bolus Insulin Calculation Worksheet Place the example numbers on the worksheet. Carbohydrate Ratio: 15 Correction Target: 120 Correction Factor: 30 15 30120 Bolus Insulin Calculation Worksheet Place total carbs and blood glucose on the worksheet. Carb Grams: 68 Blood Glucose: 214 15 30120 68 214 Bolus Insulin Calculation Worksheet Calculate carb bolus: 68 ÷ 15 = 4.533 Round answer to nearest tenths 15 30120 68 214 For example: 4.533 rounds to 4.5 4.555 rounds to 4.6 Bolus Insulin Calculation Worksheet Calculate Correction Bolus: 214–120 = 94 ÷ 30 = 3.133 Round answer to nearest tenths 15 30120 68 214 4.5 94 3.1 For example: 3.133 rounds to 3.1 3.155 rounds to 3.2 Bolus Insulin Calculation Worksheet Add the carb bolus to the correction bolus: 4.5 + 3.1 = 7.6 15 30120 68 214 4.5 94 3.1 4.5 3.1 7.6 Bolus Insulin Calculation Worksheet The final Rounded Total Insulin Bolus depends if the child uses half units or Continue reading >>

7. Approaches To Glycemic Treatment

7. Approaches To Glycemic Treatment

Pharmacological Therapy for Type 1 Diabetes Most people with type 1 diabetes should be treated with multiple-dose insulin injections (three to four injections per day of basal and prandial insulin) or continuous subcutaneous insulin infusion. A Consider educating individuals with type 1 diabetes on matching prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity. E Most individuals with type 1 diabetes should use insulin analogs to reduce hypoglycemia risk. A Individuals who have been successfully using continuous subcutaneous insulin infusion should have continued access after they turn 65 years of age. E Insulin Therapy Insulin is the mainstay of therapy for individuals with type 1 diabetes. There are excellent reviews to guide the initiation and management of insulin therapy to achieve desired glycemic goals (1). Although most studies of multiple-dose insulin versus pump therapy have been small and of short duration, a systematic review and meta-analysis concluded that there are minimal differences between the two forms of intensive insulin therapy in A1C (combined mean between-group difference favoring insulin pump therapy −0.30% [95% CI −0.58 to −0.02]) and severe hypoglycemia rates in children and adults (2). A large randomized trial in patients with type 1 diabetes with nocturnal hypoglycemia reported that sensor-augmented insulin pump therapy with the threshold suspend feature reduced nocturnal hypoglycemia, without increasing glycated hemoglobin values (3). Intensive management through pump therapy/continuous glucose monitoring and active patient/family participation should be strongly encouraged (4–6). Selected individuals who have mastered carbohydrate counting should be educated that fat increases glucose concent Continue reading >>

Interactive Dosing Calculator

Interactive Dosing Calculator

Lantus® is a long-acting insulin analog indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Lantus® should be administered once a day at the same time every day. Limitations of Use: Lantus® is not recommended for the treatment of diabetic ketoacidosis. Contraindications Lantus® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or one of its excipients. Warnings and Precautions Insulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimen cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Do not dilute or mix Lantus® with any other insulin or solution. If mixed or diluted, the solution may become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable manner. Do not administer Lantus® via an insulin pump or intravenously because severe hypoglycemia can occur. Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus®, and may be life-threatening. Medication errors, such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label before each injection. Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue Lantus®, treat and monitor until symptoms resolve. A reduction in the Lantus® dose may be re Continue reading >>

Tips For Calculating A Total Daily Dose Of Insulin

Tips For Calculating A Total Daily Dose Of Insulin

You can use one of several methods to determine a safe, initial dose Published in the August 2007 issue of Today’s Hospitalist. Evidence keeps mounting that high blood sugars lead to worse outcomes in hospitalized patients “and that sliding scale regimens produce both more hyperglycemia and hypoglycemia. But as hospitalists switch from sliding scale to basal and bolus dosing, how do they calculate a safe total daily dose to start with? Experts say that physicians can use any of three different strategies, depending on whether patients have been using insulin as either an outpatient or in the ICU. ~ Deepak Asudani, MD Baystate Medical Center Any one of these approaches will produce a safe, conservative initial dose, but experts warn that none of the strategies by itself is a slam dunk. You still have to bring art to each approach, adjusting doses according to such factors as illness severity and eating status. Related article: Keeping it simple with insulin regimens, July 2013 Here’s a look at how two hospitalists use these strategies in their day-to-day practice. 1. Base total sub-Q dose on insulin infusion rates. When Deepak Asudani, MD, a hospitalist at Baystate Medical Center in Springfield, Mass., transitions patients from IV insulin in the ICU to sub-Q insulin on the wards, he uses the following formula: Take the average hourly insulin infusion rate over the past six hours and multiply that rate by 20. That gives you a number that should equal 80% of the daily infusion dose. “It’s a little correction to prevent any hypoglycemia,” says Dr. Asudani. Because patients’ insulin needs are tapering down a bit as they exit the ICU, he adds, you don’t need to supply the same daily dose. For patients eating substantial amounts of food, you can use that calcul Continue reading >>

New Apps Calculate Your Insulin Doses

New Apps Calculate Your Insulin Doses

Trying to calculate your insulin doses for injections, without the help of an insulin pump "wizard"? There's an app for that! (of course) First came basic insulin dose calculators like RapidCalc. But providing more personalized recommendations in a so-called "insulin titration app" was something of a challenge, because these provide real medical treatment decision support and therefore require FDA approval -- as opposed to so many diabetes logging apps that do not. The first regulatory breakthrough for a "mobile prescription therapy aid" that analyzes users' past data trends to deliver personalized recommendations came with WellDoc's BlueStar app in 2013. That was followed in 2015 by the Accu-Chek Connect app, that also calculates and recommends insulin amounts. WellDoc just recently snagged an expanded label for its BlueStar app that allows patients to use it without a doctor's prescription -- adding to the accessibility of this mobile tech tool. The FDA's decision last year to allow a dosing claim for the Dexcom G5 CGM system seems to have helped pave the way for even more smartphone-based decision therapy tools. And now, two new apps have snagged FDA clearance and are almost ready for prime time: Lilly's Go Dose In December, Eli Lilly got FDA clearance on its new mobile app called Go Dose, which can be used for the Lilly-branded Humalog insulin to titrate doses. This is the company's first class II ("moderate-risk") mobile app approved by the FDA. This one is designed for adults with type 2 diabetes, and is focused on meal-time insulin use for Humalog U-100 only. There is a Go Dose version for patients to use at home, and the Go Dose Pro clinical version for use by healthcare professionals. As of now, it's only compatible with iOS devices (iPads and iPhones), but hop Continue reading >>

Designing An Insulin Regimen

Designing An Insulin Regimen

Intensive Insulin Therapy is the standard method of insulin replacement. This page includes a list of what your medical provider should prescribe when designing an insulin regimen for you. The main goal in designing an insulin regimen is to mimic how the body normally releases insulin. When you have type 1 diabetes, Intensive Insulin Therapy most closely mimics natural insulin production and is the standard method of insulin replacement. For Intensive Regimens: When you are intensively managed with insulin your medical provider will prescribe an insulin regimen for you, but these are the general principles: Your medical provider should prescribe: A basal or background insulin dose This will be prescribed as one or two injections of long acting insulin, or, if you are using an insulin pump, a daily infusion rate of continuous, small amounts of rapid acting insulin. The background/basal insulin dose is usually the same day to day. With an insulin pump you do have the option of temporarily changing the background rate for a few hours – up or down as needed! A bolus insulin dose to cover the sugar or carbohydrate in your food This will be presented as an insulin to carbohydrate ratio( I:CHO). The I:CHO ratio tells you how many grams of carbohydrate can be covered by one unit of rapid acting insulin. You will need to calculate how much carbohydrate you will eat, and take a dose of insulin that matches the food. A bolus insulin dose to bring your blood sugar back to the normal range A high blood sugar correction bolus insulin dose to bring your blood sugar back into the target range. This will be presented as a correction factor. This correction factor refers to how much your blood sugar will drop after 1 unit of insulin rapid acting insulin. When your blood sugar is too hi Continue reading >>

Insulin Management Of Type 2 Diabetes Mellitus

Insulin Management Of Type 2 Diabetes Mellitus

Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner. Augmentation therapy can include basal or bolus insulin. Replacement therapy includes basal-bolus insulin and correction or premixed insulin. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications. Insulin is secreted continuously by beta cells in a glucose-dependent manner throughout the day. It is also secreted in response to oral carbohydrate loads, including a large first-phase insulin release that suppresses hepatic glucose production followed by a slower second-phase insulin release that covers ingested carbohydrates 1 (Figure 12). Clinical recommendation Evidence rating References Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia. A 17–19 Fasting glucose readings should be used to titrate basal insul Continue reading >>

Insulin Dosing

Insulin Dosing

OTHER HELPFUL PAGES ACRONYMS AND DEFINITIONS ADA - American Diabetes Association Basal Insulin - Long- and Intermediate-acting insulins used to supply constant blood levels of insulin activity Carb- carbohydrate DM1 - Type 1 diabetes DM2 - Type 2 diabetes FDA - U.S. Food and Drug Administration Hypoglycemia - low blood sugar Multidose insulin regimen - Insulin regimens that involve a basal insulin and a premeal insulin given at meals Premeal Insulin - also called “prandial” insulin. Rapid and short-acting insulins given at mealtime for short burst of insulin. Total daily dose of insulin - Sum of premeal and basal insulin given in a day Units/kg/day - units of insulin per kilogram of body weight per day USDA - United States Department of Agriculture 1 kilogram = 2.2 pounds IMPORTANT POINTS ABOUT DOSING INSULIN Overview There are a number of different ways to dose insulin No detailed guidelines for dosing insulin have been issued by professional associations The appropriate method for individual patients will depend on a number of factors including patient education, patient motivation, diabetes control, and resources Low blood sugar (Hypoglycemia) The main concern in most patients when initiating an insulin regimen is the occurrence of low blood sugars Patients need to understand that when they are starting and adjusting insulin, there is an increased risk for low blood sugars A number of things can affect this risk including variations in eating patterns, sensitivity to insulin, and variations in activity level Measures to help prevent low blood sugars Start low and go slow - patients naïve to insulin should start at the lower end of dosing ranges When using a multidose regimen, adjust only one of the regimens every 3 days and alternate between the two (see below f Continue reading >>

Insulin Therapy In Type 2 Diabetes Mellitus

Insulin Therapy In Type 2 Diabetes Mellitus

INTRODUCTION Type 2 diabetes is by far the most common type of diabetes in adults and is characterized by hyperglycemia and variable degrees of insulin deficiency and resistance. It is a common disorder whose prevalence rises markedly with increasing degrees of obesity. Treatment of patients with type 2 diabetes mellitus includes education, evaluation for microvascular and macrovascular complications, normalization of glycemia, minimization of cardiovascular and other long-term risk factors, and avoidance of drugs that can aggravate abnormalities of insulin or lipid metabolism. Weight reduction, diet, and oral medication (typically metformin) can all be used to improve glycemic control, although the majority of patients with type 2 diabetes fail to maintain glycemic targets after a successful initial response to therapy. The therapeutic options for such patients include adding a second or third oral agent or an injectable agent, including insulin, or switching to insulin. The role of insulin in achieving optimal glycemic control in patients with type 2 diabetes will be reviewed here. Options for initial therapy, options for the management of persistent hyperglycemia, and other therapeutic issues in diabetes management, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately. Continue reading >>

Insulin Regimens

Insulin Regimens

1. Monday, July 16, 2012 1 2. Objectives1. Discuss the different types of insulin preparations available to manage types 1 and 2 diabetes2. Review the various insulin protocols and address appropriate patient selection for each3. Address how to design and adjust insulin regimensMonday, July 16, 2012 2 3. What Type of Insulins Are Available?Monday, July 16, 2012 3 4. Normal Pancreas ‘Bolus’ Insulin (Meal Associated)Insulin Effect Basal Insulin (~0.5-1.0 U/hr.) Insulin is released in response to varying blood glucose levelsMonday, July 16, 2012 and hypoglycemia does not occur 4 5. Basal vs Bolus InsulinBASAL INSULIN BOLUS INSULIN• Suppress hepatic glucose • Meal-associated CHO production (overnight and disposal intermeal) • Storage of nutrients• Prevent catabolism (lipid • Help suppress inter-meal and protein) hepatic glucose – Ketosis production – Unregulated amino acid release• Reduce glucolipotoxicityMonday, July 16, 2012 5 6. Insulin Profiles Regular (6–10 hr) NPH (10–20 hr)Plasma Insulin Levels Ultralente (~16–20 hr ) 0 2 4 6 8 10 12 14 16 18 20 22 24 Monday, July 16, 2012 Time (hr) 6 Rosenstock J. Clin Cornerstone. 2001;4:50-61. 7. The Diffusion Of InsulinMonday, July 16, 2012 Holleman F. NEJM 1997;337(3):176-83 7 8. Insulin Self Association SitesMonday, July 16, 2012 8 9. Newer Insulins ONSET PEAK DURATION MODIFCATION (hr) (hr) (hr) LISPRO β-chain Pro →Lys28 0.25-0.5 1-2 3-5 (Humalog) β-chain Lys →Pro29 ASPART β-chain Pro →Asp28 0.25-0.5 1-2 2-4 (NovoLog) GLULISINE β-chain Lys → 3 Asn Similar Simil ar Similar (Apidra) β-chain Lys → 29 Glu GLARGINE β-chain Asp → 21Gly 1 None 24 (Lantus) β-chain Arg31 /Arg32 DETEMIR β-chain Lys29 (Nε- 2 6-8 18 (Levemir) tetradecanoyl)des( β- 30 ) thrMonday,NPH 2012 Native July 16, insul Continue reading >>

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