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Maximum Dose Of Insulin Per Day

2010 Aaha Diabetes Management Guidelines For Dogs And Cats

2010 Aaha Diabetes Management Guidelines For Dogs And Cats

Renee Rucinsky, DVM, ABVP (Feline) (Chair) | Audrey Cook, BVM&:S, MRCVS, Diplomate ACVIM-SAIM, Diplomate ECVIM-CA | Steve Haley, DVM | Richard Nelson, DVM, Diplomate ACVIM | Debra L. Zoran, DVM, PhD, Diplomate ACVIM | Melanie Poundstone, DVM, ABVP - Download PDF - Introduction Diabetes mellitus (DM) is a treatable condition that requires a committed effort by veterinarian and client. This document provides current recommendations for the treatment of diabetes in dogs and cats. Treatment of DM is a combination of art and science, due in part to the many factors that affect the diabetic state and the animal's response. Each animal needs individualized, frequent reassessment, and treatment may be modified based on response. In both dogs and cats, DM is caused by loss or dysfunction of pancreatic beta cells. In the dog, beta cell loss tends to be rapid and progressive, and it is usually due to immune-mediated destruction, vacuolar degeneration, or pancreatitis.1 Intact females may be transiently diabetic due to the insulin-resistant effects of the diestrus phase. In the cat, loss or dysfunction of beta cells is the result of insulin resistance, islet amyloidosis, or chronic lymphoplasmacytic pancreatitis.2 Risk factors for both dogs and cats include insulin resistance caused by obesity, other diseases (e.g., acromegaly in cats, hyperadrenocorticism in dogs), or medications (e.g., steroids, progestins). Genetics is a suspected risk factor, and certain breeds of dogs (Australian terriers, beagles, Samoyeds, keeshonden3) and cats (Burmese4) are more susceptible. Regardless of the underlying etiology, diabetic dogs and cats are hyperglycemic and glycosuric, which leads to the classic clinical signs of polyuria, polydipsia (PU/PD), polyphagia, and weight loss. Increased fat mobi Continue reading >>

Sanofi Receives Fda Approval Of Once-daily Basal Insulin Toujeo®

Sanofi Receives Fda Approval Of Once-daily Basal Insulin Toujeo®

PARIS, Feb. 25, 2015 /PRNewswire-USNewswire/ -- Sanofi announced today that the U.S. Food and Drug Administration (FDA) approved Toujeo® (insulin glargine [rDNA origin] injection, 300 U/mL), a once-daily long-acting basal insulin, to improve glycemic control in adults living with type 1 and type 2 diabetes. Toujeo is expected to be available in the U.S. at the beginning of Q2 2015. "Sanofi is proud of its long heritage in diabetes and insulin therapies, including Lantus® which has supported patients in the management of their diabetes for more than a decade. With the FDA approval of Toujeo, Sanofi builds on its strong legacy and looks forward to bringing a new treatment option to people living with diabetes," said Pierre Chancel, Senior VP, Global Diabetes, Sanofi. The approval of Toujeo was based on FDA review of results from the EDITION clinical trial program, which was comprised of a series of international Phase III studies evaluating the efficacy and safety of Toujeo in more than 3,500 adults from broad and diverse diabetes populations (type 1 and type 2). In the clinical trial program leading to approval, once-daily Toujeo was compared to that of once-daily Lantus (insulin glargine [rDNA origin] injection, 100 U/mL) in open-label, randomized, active-control, parallel, treat-to-target studies of up to 26 weeks of duration with 6 months safety extension. "Nearly 50 percent of people living with diabetes remain uncontrolled," said John Anderson, MD, internal medicine and diabetes specialist, Frist Clinic of Nashville, TN, and Past President of the American Diabetes Association. "Despite the proven efficacy of insulin, ensuring effective titration and maintenance can be a challenge for both patients and healthcare professionals due to hypoglycemia concerns. Toujeo p Continue reading >>

Weight-based Insulin Dosing Safe At Recommended Doses

Weight-based Insulin Dosing Safe At Recommended Doses

Weight-based insulin doses up to 0.6 units per kilogram are associated with a low risk of hypoglycemia, according to a new report…. Dr. Daniel J. Rubin from Temple University School of Medicine in Philadelphia writes that, "Our study provides evidence for the safety of daily insulin doses up to 0.6 units/kg." "I hope this will encourage more physicians to be comfortable using weight-based insulin dosing." Dr. Rubin and colleagues investigated the relationship between insulin dose and hypoglycemia in a retrospective, case-control study of 1,990 diabetic patients admitted to hospital wards. The report appears online June 23 in Diabetes Care. The unadjusted odds of hypoglycemia increased with insulin doses above 0.2 units/kg, and patients who received insulin doses of 0.6 units/kg or more faced increased odds of hypoglycemia. The adjusted odds of hypoglycemia were not higher among patients who received 0.2 to 0.6 units/kg. The adjusted odds of hypoglycemia were 3 times higher among patients who didn’t receive sliding scale insulin than among those who did, and there was a trend toward higher odds among patients who received NPH compared with patients who received glargine or short-acting insulin. Hypoglycemia was not more common among patients given insulin with an oral diabetes medication than among those given insulin alone. "0.6 units/kg seems to be a threshold below which the odds of hypoglycemia are relatively low," the researchers note. "Some patients, however, require more than 0.6 units/kg to treat hyperglycemia and do not experience any hypoglycemia," Dr. Rubin said. "If there is any concern for hypoglycemia, it is reasonable to use doses <0.6 unit/kg. Insulin dosing for individual patients must be done on a case-by-case basis." "Our data are consistent with t Continue reading >>

How Much Insulin Do You Need?

How Much Insulin Do You Need?

Getty ImagesIf you have type 2 diabetes and your doctor thinks it might be a good time to start insulin therapy, there are two important factors to consider: How much insulin do you need to take? When do you need to take it? And both are very personal. "You can't paint everyone with type 2 diabetes with the same brush," says Mark Feinglos, MD, division chief of endocrinology, metabolism, and nutrition at the Duke University School of Medicine, in Durham, N.C. "You need to tailor the regimen to an individual's needs." A person with type 2 diabetes might start off on half a unit of insulin per kilogram of body weight per day, especially if there is not much known about the nature of his or her diabetes. Still, it is not unusual to need more like 1 unit, says Dr. Feinglos. (One unit per kilogram would be 68 units per day for someone who weighs 150 pounds, which is about 68 kilograms.) Testing Each DayI test morning, evening, and before meals Watch videoMore about blood sugar monitoring A lot depends on your specific health situation. People with type 2 diabetes suffer from insulin resistance, a situation in which the body loses its ability to use the hormone properly. Early in the course of the disease, the insulin-producing cells of the pancreas respond to insulin resistance by churning out even more of the hormone. Over time, though, insulin production declines. Taking insulin can help you overcome the body's insulin resistance, though many factors can affect your dosage. If your body is still sensitive to insulin but the pancreas is no longer making much insulin, for example, Dr. Feinglos says that you would require less insulin than someone who is really resistant to insulin. "But the most important issue is not necessarily how much you need to take," he adds. "Rather, Continue reading >>

Levemir® (insulin Detemir [rdna Origin] Injection) Indications And Usage

Levemir® (insulin Detemir [rdna Origin] Injection) Indications And Usage

Levemir® is contraindicated in patients with hypersensitivity to Levemir® or any of its excipients. Never Share a Levemir® FlexTouch® Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens. Dosage adjustment and monitoring: Monitor blood glucose in all patients treated with insulin. Insulin regimens should be modified 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 of concomitant anti-diabetic treatment. Administration: Do not dilute or mix with any other insulin or solution. Do not administer subcutaneously via an insulin pump, intramuscularly, or intravenously because severe hypoglycemia can occur. Levemir® (insulin detemir [rDNA origin] injection) is indicated to improve glycemic control in adults and children with diabetes mellitus. Levemir® is not recommended for the treatment of diabetic ketoacidosis. Intravenous rapid-acting or short-acting insulin is the preferred treatment for this condition. Levemir® is contraindicated in patients with hypersensitivity to Levemir® or any of its excipients. Never Share a Levemir® FlexTouch® Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens. Dosage adjustment and monitoring: Monitor blood glucose in all patients treated with insulin. Insulin regimens should be modified 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 the insulin dose or an adjustment of concomitant anti-diabetic treatment. Administration: Do not dilute or mix with any other insulin Continue reading >>

What Is The Correct Dose Of Insulin To Start With?

What Is The Correct Dose Of Insulin To Start With?

Q: I am 65 years old suffering from type II diabetes. I have been on medication but am not able to control the sugar levels. I was advised Insulin by two different doctors. There are two opinions on which insulin to start with. The first doctor prescribed Human Mixtard 30-70 (18 units AM and 8 units PM). The second doctor prescribed Lantus Optiset 16 units after dinner in combination with Diamicron MR-60 AM and Tigomet SR1 gm AM and PM before meals. I am inclined to go with Lantus Optiset only because it is once daily and seems to be a smaller dose. Would it limit my options in the future to change to another type of insulin? Is 16 units the right dose to start with? A:Most patients need insulin at some stage when oral anti-diabetic agent are not effective. Irrespective of the formulation, the insulin units are equivalent. In other words, 18 + 8 units (total 26 units) of Mixtard are not equal to 16 units of Lantus; they are 10 units more. One has to titrate the dose of insulin in individual patients because one does not know the amount of insulin that a particular patient will require. One of the doctors apparently feels that the patient is likely to need 26 units or near about per day while the other feels that 16 units are likely to suffice. Maybe both are wrong and the patient may need 20 units! In transferring patients from oral tablets to insulin there is now adequate scientific evidence that Mixtard is better than Lantus. I doubt that in addition to insulin the patient will also require other oral medicines like gliclazide (Diamicron). Assuming that it is required, one should prescribe a fair-priced brand such as Lycazid (Rs. 31 for 10 tablets against Diamicrons Rs. 59), particularly when it is to be taken for life. The patient may or may not require metformin. Me Continue reading >>

Ask D'mine: New Basal Insulin Toujeo, New Dosing Math

Ask D'mine: New Basal Insulin Toujeo, New Dosing Math

Welcome back to our weekly diabetes advice column, Ask D’Mine — with your host veteran type 1, diabetes author and educator Wil Dubois. This week, Wil looks at the newest basal insulin to hit the market: Sanofi's Toujeo (aka the Son of Lantus). It was newly approved by FDA early this year and launched in early April, and it can be a little confusing since the unit-dosing is a bit different from what we're used to. Don't worry, Wil's got this... {Have your own questions? Email us at [email protected]} Matthew, type 2 from Oregon, asks: I’m confused about the new basal insulin Toujeo, I understand that it is U-300 and therefore should be more “concentrated,” but when I went to the webpage for this product, it talked about how Toujeo is a 1:1 dosing and conversion from Lantus. I thought that the dose would actually be less as it’s more concentrated. I also read about how people actually required a higher dose of Toujeo to allow the same blood sugar control as with Lantus. How on earth does this all work?! [email protected] D’Mine answers: It’s fuzzy math, Mathew, but you chose the right person to ask. However, a warning: It’s impossible to give a concentrated answer about concentrated insulin! So OK, let’s concentrate (get it?!)… Most modern insulins are what we call U-100, which means that there are 100 units of insulin per milliliter of fluid. That’s what they mean by its concentration. Back in the day we also had U-20, U-40, and U-80 insulins. I also had it in my head that there was a U-60 at one time, but I may be wrong about that, as a quick Google search only turns up articles about the German Sub U-60, which apparently had one of the least distinctive war records of the Nazi fleet -- and no discussions of insulin. Anyway, back in the many-conce Continue reading >>

Dosing Overview

Dosing Overview

Go to site For Pet Owners Vetsulin® (porcine insulin zinc suspension) 10 mL vials and 2.7 mL cartridges should be shaken thoroughly until a homogeneous, uniformly milky suspension is obtained. Foam on the surface of the suspension formed during shaking should be allowed to disperse before the product is used and, if required, the product should be gently mixed to maintain a homogeneous, uniformly milky suspension before use. Clumps or white particles can form in insulin suspensions: do not use an insulin vial or cartridge if visible clumps or white particles persist after mixing thoroughly. Taking the proper steps to prepare VetPen® is critically important and must be done before each injection. It is essential to ensure that the VetPen is ready to use and helps ensure that a new needle is being used, the insulin is mixed properly, and VetPen and the needle are working properly. See VetPen Instructions for Use leaflet or administration video for information on preparing VetPen. Using a U-40 insulin syringe or VetPen, administer the injection subcutaneously, 3/4 to 2 in (2–5 cm) from the dorsal midline, varying from behind the scapulae to the mid-lumbar region and alternating sides. To help your clients prepare and administer Vetsulin to their dogs, there are resources available that guide them step-by-step through the process: Starting dose In dogs, the initial recommended Vetsulin dose is 0.5 IU insulin/kg of body weight. This dose should be given once daily concurrently with or right after a meal. Veterinarians should reevaluate canine patients at appropriate intervals and adjust the dose based on clinical signs, urinalysis results, and glucose curve values until adequate glycemic control has been attained. Achieving effective glycemic control The goals of managin Continue reading >>

Type 2 Diabetes And Insulin

Type 2 Diabetes And Insulin

Getting Started When most people find out they have Type 2 diabetes, they are first instructed to make changes in their diet and lifestyle. These changes, which are likely to include routine exercise, more nutritious food choices, and often a lower calorie intake, are crucial to managing diabetes and may successfully lower blood glucose levels to an acceptable level. If they do not, a drug such as glyburide, glipizide, or metformin is often prescribed. But lifestyle changes and oral drugs for Type 2 diabetes are unlikely to be permanent solutions. This is because over time, the pancreas tends to produce less and less insulin until eventually it cannot meet the body’s needs. Ultimately, insulin (injected or infused) is the most effective treatment for Type 2 diabetes. There are many barriers to starting insulin therapy: Often they are psychological; sometimes they are physical or financial. But if insulin is begun early enough and is used appropriately, people who use it have a marked decrease in complications related to diabetes such as retinopathy (a diabetic eye disease), nephropathy (diabetic kidney disease), and neuropathy (nerve damage). The need for insulin should not be viewed as a personal failure, but rather as a largely inevitable part of the treatment of Type 2 diabetes. This article offers some practical guidance on starting insulin for people with Type 2 diabetes. When to start insulin Insulin is usually started when oral medicines (usually no more than two) and lifestyle changes (which should be maintained for life even if oral pills or insulin are later prescribed) have failed to lower a person’s HbA1c level to less than 7%. (HbA1c stands for glycosylated hemoglobin and is a measure of blood glucose control.) However, a recent consensus statement from Continue reading >>

Adjustable Dosing

Adjustable Dosing

Adjustable Dosing NovoLog® stays in step with your activities and mealtimes. Your health care provider will teach you how to adjust your NovoLog® dose to your eating, activity, and blood sugar levels. NovoLog® is designed to closely mimic your body's insulin patterns at mealtime. It is changed slightly so that it acts more quickly than regular human insulin. That is why it is called analog insulin. Keep in mind, you will need to eat a meal within 5 to 10 minutes after taking NovoLog®. For information on food labels and carb counting, click here. You and your diabetes care team will also have to see how your physical activity affects your insulin dosage and adjust it as needed. For example, when you are very physically active, you have to decide whether to eat more or take less insulin, since both physical activity and insulin decrease the amount of sugar in the blood. Checking your blood sugar often when you are physically active will help you figure out how each type of physical activity you do affects your blood sugar. NovoLog® Dosing Tool Your diabetes care team can help you learn how to fine-tune your NovoLog® doses throughout the day. While you are figuring out how to adjust your insulin dose, you will want to stay in close touch with your diabetes care team. If you are using NovoLog® FlexPen®, you can select doses from 1 to 60 units in 1-unit steps. NovoPen Echo® provides precise half-unit dosing from 0.5 units up to 30 units. It also records the insulin dose and time passed since the last injection. If you have type 2 diabetes, ask your diabetes care team if the NovoLog® Dosing Tool might be right for you. This tool was created to help with adding and adjusting your mealtime insulin dose. If you’ve been taking NovoLog® for a while and your A1C is not Continue reading >>

Inhaled Insulin Dosing Information

Inhaled Insulin Dosing Information

AFREZZA is used at the beginning of the meal using the supplied oral inhaler and one or more single-use cartridges (single inhalation per cartridge). Dosage adjustment may be needed when converting from injected insulin to AFREZZA. How to start: Insulin-Naïve Individuals: Start on 4 units of AFREZZA at each meal. Individuals Using Subcutaneous Mealtime Insulin: Determine the appropriate AFREZZA dose for each meal by converting from the injected dose using chart below. Individuals Using Subcutaneous Pre-mixed Insulin: Estimate the mealtime injected dose by dividing half of the total daily injected pre-mixed insulin dose equally among the three meals of the day. Convert each estimated injected mealtime dose to an appropriate AFREZZA dose (see chart below). Administer half the total daily injected pre-mixed dose as an injected basal insulin dose. How to convert from injected mealtime insulin: How to adjust the injected mealtime insulin dose: Adjust the dosage of AFREZZA based on your individual metabolic needs, blood glucose monitoring results, and glycemic control goal. Dosage adjustments may be needed with changes in physical activity, changes in meal patterns (i.e., macronutrient content or timing of food intake), changes in renal or hepatic function, or during acute illness. Dosage adjustment may be needed when AFREZZA is co-administered with certain drugs. Please refer to the Drug Interactions section of the Prescribing Information. For doses exceeding 12 units For AFREZZA doses exceeding 12 units, inhalations from multiple cartridges are necessary. To achieve the required total mealtime dose, you should use a combination of 4-, 8- and 12-unit cartridges. Please see additional Important Safety Information for AFREZZA and full Prescribing Information, including Boxed Continue reading >>

Insulin (medication)

Insulin (medication)

"Insulin therapy" redirects here. For the psychiatric treatment, see Insulin shock therapy. Insulin is used as a medication to treat high blood sugar.[3] This includes in diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states.[3] It is also used along with glucose to treat high blood potassium levels.[4] Typically it is given by injection under the skin, but some forms may also be used by injection into a vein or muscle.[3] The common side effect is low blood sugar.[3] Other side effects may include pain or skin changes at the sites of injection, low blood potassium, and allergic reactions.[3] Use during pregnancy is relatively safe for the baby.[3] Insulin can be made from the pancreas of pigs or cows.[5] Human versions can be made either by modifying pig versions or recombinant technology.[5] It comes in three main types short–acting (such as regular insulin), intermediate–acting (such as NPH insulin), and longer-acting (such as insulin glargine).[5] Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922.[6] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[7] The wholesale cost in the developing world is about US$2.39 to $10.61 per 1,000 iu of regular insulin and $2.23 to $10.35 per 1,000 iu of NPH insulin.[8][9] In the United Kingdom 1,000 iu of regular or NPH insulin costs the NHS 7.48 pounds, while this amount of insulin glargine costs 30.68 pounds.[5] Medical uses[edit] Giving insulin with an insulin pen. Insulin is used to treat a number of diseases including diabetes and its acute complications such as diabetic ketoacid Continue reading >>

Insulin Dosing: How High Can You Go?

Insulin Dosing: How High Can You Go?

What is the highest dose of insulin that can be used in a patient whose diabetes remains uncontrolled on a regimen of insulin plus an oral antidiabetic agent? —— MD When it comes to using insulin to treat hyperglycemia, “the sky’s the limit.” Extremely high doses are occasionally required; that is the reason U-500 insulin is available. A colleague once reported using 35,000 units of insulin a day in a patient with a genetic receptor defect. In patients with glucotoxicity, hyperglycemia, and down-regulation of the beta cells, very high doses of insulin are needed to reverse the clinical situation; after this has been accomplished, the insulin dose can be gradually lowered to a maintenance level. Ironically, hyperglycemia may either stimulate the beta cells to correct the clinical problem or have a toxic effect on the beta cells (ie, induce apoptosis) and thus worsen the situation. In patients with type 2 diabetes, marked obesity, and insulin resistance, total daily insulin doses of 200 to 300 units are often required. In this setting, management for most patients includes a total of 1.0 to 2.0 units of insulin per kilogram per day; thus, in very obese patients, a larger total dose is required. In these patients—provided they have no contraindication—metformin therapy is continued by most clinicians to treat insulin resistance, improve glucose control, and minimize further weight gain. —— Russell D. White, MD Professor of Medicine Director, Sports Medicine Fellowship Program University of Missouri–Kansas City School of Medicine Continue reading >>

Ï‚§ Carbohydrates Are Broken Down Quickly And Are In The Blood Stream Within 30 Minutes, Food Nutrients Are Absorbed Within 2 -3 Hours

Ï‚§ Carbohydrates Are Broken Down Quickly And Are In The Blood Stream Within 30 Minutes, Food Nutrients Are Absorbed Within 2 -3 Hours

Insulin Dose Adjustments As children grow, their bodies will need more insulin. Children going through growth spurts or coming out of honeymoon may need more frequent changes in their dose. However, when talking about adjusting insulin doses many things have to be considered before the adjustment can be made. These are important as they may affect how a decision is made and whether dose adjustment is warranted.  Timing of injections or missed  Expired or exposed insulin  Injection sites  Carb counting accuracy  Illness  Stress  Change in activity level  Change in season Pre vs Post meal dosing:  Carbohydrates are broken down quickly and are in the blood stream within 30 minutes, food nutrients are absorbed within 2 -3 hours  Fast acting insulins Novolog or Humalog  Begin working in 5 minutes  Work hardest in 1- 1 ½ hours  Done working in 2 ½ to 3 hours  To prevent high or low blood sugars after a meal, pre-meal dosing allows the insulin and carbohydrate to be in the bloodstream at the same time & work together Insulin can go bad:  Change insulin vials and cartridges at least every 28-30 days  Lantus/Levemir and Novolog/Humalog should be clear-free from specks and floaters  Insulin should not be exposed to extreme temperatures  Less than 40˚F  Greater than 87˚F Review and develop a site rotation plan/Injecting into lumpy areas:  Insulin not absorbed  Insulin may be increased unnecessarily  Can lead to severe highs and lows  Can lead to poor overall control Carb counting is important:  Have carb counting book available  Pull out measuring cups regularly  Calculate carb content of n Continue reading >>

How To Interpret Blood Glucose Monitoring Charts And Adjust Insulin Doses

How To Interpret Blood Glucose Monitoring Charts And Adjust Insulin Doses

Interpreting blood glucose results and being able to adjust insulin doses are useful skills for pharmacists to possess.The key to acquiring these skills is in understanding: The insulin regimen and the onset, peak and duration of action for the insulins used The glucose levels to aim for How to titrate insulin doses How all of the above relates to patients’ lifestyles and eating habits Understanding the regimen Insulin may be given alone or, for those with type 2 diabetes, with oral antidiabetic drugs (OADs), often metformin. Although this article focuses on adjusting insulin doses, readers should bear in mind that oral doses may also need to be adjusted. The three most commonly used insulin regimens are: Once daily intermediate-acting or long-acting insulin — normally given at bedtime or during the day, usually with an OAD Twice-daily pre-mixed insulin — one injection before breakfast, one before the evening meal (pre-mixed insulins contain fixed ratios of short- and long-acting insulins) Basal-bolus insulin — three daily injections of rapid- or short-acting insulin with meals and one or two injections of intermediate- or long-acting (basal) insulin The onset, peak and duration profiles of insulin products currentlyavailable in the UK are in the table. These should be used wheninterpreting a blood glucose result, to determine which insulin wasexerting its effect at the time of glucose measurement. Insulin preparations and their onset, peak and duration of action Preparation Onset (hr) Peak (hr) Duration (hr) Soluble insulin Human Actrapid 0.5 2–5 8 Humulin S 0.5 1–3 5–7 Hypurin Bovine Neutral 0.5/1 2–5 6–8 Apidra (Insulin glulisine) 0.25 1 3–4 Humalog (Insulin lispro) 0.25 1–1.5 2–5 Novorapid (Insulin aspart) 0.25 1–3 3–5 Hypurin Porcine Neu Continue reading >>

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