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Skin Related Complications Of Insulin Therapy Epidemiology And Emerging Management Strategies

Painful Fat Necrosis Resulting From Insulin Injections

Painful Fat Necrosis Resulting From Insulin Injections

Summary The case is a 34-year-old woman with long-standing type 1 diabetes mellitus with existing follow-up in the outpatient clinic at the Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, UHCW. She had maintained good glycaemic control and glycaemic stability with basal bolus regimen for many years. She had not developed any diabetes-related complications and had no other co-morbidities. Six months ago, she presented to A&E with sudden-onset, well-localised and severe pain in the right iliac fossa, just lateral to the para-umbilical area. Her biochemistry was normal. Ultrasound scan, however, revealed a right-sided ovarian cyst, which was thought to have caused pain to her. She was discharged from A&E with simple analgesia. On subsequent gynaecological follow-up 4 weeks later, her pain remained severe and examination revealed an exquisitely tender subcutaneous nodule at the same location measuring 2 cm in diameter. Magnetic resonance imaging (MRI) scan at the time revealed a 1 cm mass in the subcutaneous adipose tissue, which co-localised to her pain. The mass demonstrated a central fat signal surrounded by a peripheral ring: observations consistent with fat necrosis. There were other smaller subcutaneous nodules also observed in the left para-umbilical area. Subsequent surgical resection of the main area of fat necrosis was performed. The patient made an excellent recovery and her pain resolved post-operatively. Histology confirmed the presence of fat necrosis. Fat necrosis is a rare complication of s.c. insulin injection. This case illustrates the importance of considering this diagnosis in patients who inject insulin and develop localised injection-site pain. Fat necrosis is a rare complication of insulin injections that can manifest w Continue reading >>

Prime Pubmed | Prevalence Of Lipohypertrophy In Insulin-treated Diabetic Patients And Predisposing Factor

Prime Pubmed | Prevalence Of Lipohypertrophy In Insulin-treated Diabetic Patients And Predisposing Factor

Exp Clin Endocrinol Diabetes 1996; 104(2):106-10EC In a cross-sectional study the frequency of insulin-induced lipohypertrophy at injection sites was assessed in 223 type 1 and 56 type 2 diabetic patients. 64 (28.7%) of the subjects with type 1 diabetes, but only 2 (3.6%) of those with type 2 diabetes presented clinical evidence of lipohypertrophy. In every second affected type 1 diabetic patient lipohypertrophy developed within 2 years after starting insulin therapy. The occurrence of lipohypertrophy was independent of the insulin source and mode of therapy. In a multivariate logistic regression analysis young age, low body mass index, abdominal injection site and, particularly, missing rotation of injection site were significant independent risk factors for the presence of insulin-induced lipohypertrophy. Avoidance of such areas led to a partial or full remission of tissue swellings in 6 of 11 cases under observation for one year. In conclusion, lipohypertrophy is still a frequent complication of insulin therapy. To prevent such local skin reactions insulin-treated patients should be more intensively trained to regularly change injection sites. Hauner, H, et al. "Prevalence of Lipohypertrophy in Insulin-treated Diabetic Patients and Predisposing Factors." Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association, vol. 104, no. 2, 1996, pp. 106-10. Hauner H, Stockamp B, Haastert B. Prevalence of lipohypertrophy in insulin-treated diabetic patients and predisposing factors. Exp Clin Endocrinol Diabetes. 1996;104(2):106-10. Hauner, H., Stockamp, B., & Haastert, B. (1996). Prevalence of lipohypertrophy in insulin-treated diabetic patients and predisposing factors. Experimental and Clinical End Continue reading >>

Teaching Injection Technique To People With Diabetes American Association Of Diabetes Educators

Teaching Injection Technique To People With Diabetes American Association Of Diabetes Educators

June 2013 For people with diabetes who use insulin or other injectable medication(s), the diabetes educator can enhance and improve patient engagement to maximize clinical outcomes by mitigating injection concerns and teaching methods to maximize insulin absorption and action while reducing discomfort. So while the discussion about algorithms for the use of regular insulin, rapid-acting insulin and other injectable medications for management of hyperglycemia is ongoing, the aim of this advisory is to outline the topics that should be covered by diabetes educators when teaching patients proper injection technique. State law regulates which healthcare professionals are authorized by license to provide hands on instruction for injection administration, and it behooves diabetes educators to be aware of the level of practice for which they are covered. As with any type of patient education, it is critical to assess and make accommodations for patient literacy and numeracy level, learning and visual disabilities, or other impairment issues. Recommended topics ï‚· Information about the drug(s) to be administered (beyond the scope of this document) ï‚· Injection sites, site rotation and sterile technique ï‚· Choice of injection device o Proper storage of injectable medications, including expiration date awareness ï‚· Injection technique ï‚· Injection discomfort and complications ï‚· Disposal of used sharps Injection site, site rotation and sterile technique The most common injection site is the abdomen (or stomach) while avoiding the area within two inches of the umbilicus. The back of the upper arms, the upper buttocks or hips, and the outer side of the thighs are also used. Individuals self-injecting medications should be taught to inspect the intended Continue reading >>

Cutaneous Complications Of Insulin Therapy In Patients With Type1 Diabetes Mellitus

Cutaneous Complications Of Insulin Therapy In Patients With Type1 Diabetes Mellitus

Cutaneous complications of insulin therapy in patients with type1 diabetes mellitus Munib A. Alzubaidi J Fac Med Baghdad Vol.51, No.4, 2009 353 Munib A. Alzubaidi* DCH, FICMS . Summary: Background: Common complications of subcutaneous insulin injection include lipoatrophy and lipohypertrophy which may lead to erratic absorption of the insulin with the potential for poor glycemic control and unpredictable hypoglycemia. Other cutaneous complications are local and systemic insulin allergy. Patients and methods: The study included 150 patients with type1 diabetes mellitus attending thediabetic clinic of Children Welfare Teaching Hospital who were assessed for cutaneous omplications of insulin therapy especially at the sites of the injections. Data collected evaluated using chi square and Pvalue. Results: Out of 150 patients, the male to female ratio was 1:1.3, with mean age of 11.34 years ± 4.461SD.The cutaneous complications of insulin therapy present in (56.7%) of patients, (94.1%) of them had lipohypertrophy and (5.9%) had allergy to insulin while lipoatrophy and other cutaneous complications were not reported.The cutaneous complications were associated with increase in the incidence of other complications of diabetes mellitus (72.9%).Most of cutaneous complications developed in the upper arms (69.4%) especially in those who did not change the sites and those with wrong technique of injections. Conclusions: The cutaneous complications developed because of poor education about the proper use of insulin or failure to follow the instructions, as the school achievement of the person who injects the insulin for the patient had no role. So I recommend proper education about the sites and the technique of insulin injection and the maintenance of this education. Key words: Ty Continue reading >>

Skin-related Complications Of Insulin Therapy

Skin-related Complications Of Insulin Therapy

, Volume 4, Issue10 , pp 661667 | Cite as Skin-Related Complications of Insulin Therapy Epidemiology and Emerging Management Strategies The incidence and prevalence of all types of diabetes mellitus is increasing at an alarming rate. Modern therapy involves greater and earlier use of intensive insulin regimens in order to achieve better control of blood glucose levels and reduce the long-term risks associated with the condition. Insulin therapy is associated with important cutaneous adverse effects, which can affect insulin absorption kinetics causing glycemic excursions above and below target levels for blood glucose. Common complications of subcutaneous insulin injection include lipoatrophy and lipohypertrophy. The development of lipoatrophy may have an immunological basis, predisposed by lipolytic components of certain insulins. Repeated use of the same injection site increases the risk of lipoatrophy with time, patients learn that these areas are relatively pain free and continue to use them. However, the absorption of insulin from lipoatrophic areas is erratic leading to frequent difficulties in achieving ideal blood glucose control. With the increasing use of modified, rapidly absorbed analog insulins (e.g. insulin lispro, insulin aspart) the incidence of lipoatrophy occurring has decreased over recent years. The likelihood of lipoatrophy can be reduced by regular rotation of injection sites but once developed, practical benefits may be obtained by insulin injection into the edge of the area, co-administration of dexamethasone with insulin, or changing the mode of insulin delivery. Lipohypertrophy is the most common cutaneous complication of insulin therapy. Newer insulins have also reduced its prevalence considerably, although its adverse effect on diabetic cont Continue reading >>

Insulin Lipohypertrophy: A Non-fatal Dermatological Complication Of Diabetes Mellitus Reflecting Poor Glycemic Control

Insulin Lipohypertrophy: A Non-fatal Dermatological Complication Of Diabetes Mellitus Reflecting Poor Glycemic Control

Lipohypertrophy has been a recognized complication of insulin therapy. Despite improvements in insulin purity and the introduction of recombinant human insulin, its prevalence has remained high particularly in those with a poor glycemic control. Injection of insulin into a site of lipohypertrophy, although painless, may lead to erratic absorption of insulin, with the potential for poor glycemic control and unpredictable hypoglycemia. Rotation of injection sites can reduce the frequency of the problem but does not abolish it. The importance of this complication is not only cosmetic but also in its impact on insulin absorption, and hence glycemic control. Lipohypertrophy is characterized by a benign "tumor-like" swelling of fatty tissue secondary to subcutaneous insulin injections. A strong association of lipoatrophy and lipohypertrophy with insulin antibodies might suggest that autoimmune phenomena with insulin play a role in the development of both. Presented here is a young type 1 diabetic on human insulin with poor glycemic control who developed lipohypertrophy at the injection sites around the umbilicus. Continue reading >>

Article: Answer To Photo Quiz: A 65-year-old Female With Poorly Controlled Type 2 Diabetes Mellitus (full Text) - December 2015 - Njm

Article: Answer To Photo Quiz: A 65-year-old Female With Poorly Controlled Type 2 Diabetes Mellitus (full Text) - December 2015 - Njm

Although the patient did not allow us to perform a skin biopsy, the findings were consistent with severe necrotic insulin-induced lipoatrophy. We told her that it is mandatory to rotate injection sites and the dose of premixed insulin was decreased to 68 units daily. Four months later, her glycated haemoglobin level had decreased to 7.1%, along with marked improvement in the lipoatrophic area (figure 2). Some patients tend to use the same injection site, since it leads to reduction of pain sensation. However, this increases the risk of dermatological complications of insulin therapy: insulin-induced lipohypertrophy and lipoatrophy.1 Lipohypertrophy is far more common, but both conditions may lead to poor glycaemic control. Insulin-induced lipoatrophy is considered to be an immune complex-mediated inflammatory lesion.1 Any insulin formulation can in principle cause lipoatrophy. The prevalence of this condition was 2.5% in patients who used older bovine and porcine insulins.2 But its prevalence has tremendously decreased with the use of newer insulin analogues.3 Only 13 cases associated with the use of lispro, aspart, glargine or detemir insulin have been reported so far.3 There are no strict guidelines for the treatment of lipoatrophy. Topical disodium cromoglycate, topical and systemic glucocorticoids have been occasionally used for the treatment of insulin-induced lipoatrophy.4 However, randomised clinical trials have not been performed to assess their true efficacy. Rotation of injection sites has the most important role in lipoatrophy treatment, as seen in our case. In conclusion, it is important for clinicians to recognise lipoatrophy as a potential complication of therapy with insulin analogues, since it may lead to impaired insulin absorption and poor glycaemic c Continue reading >>

[full Text] Degarelix Treatment Is Compatible With Diabetes And Antithrombotic The | Rru

[full Text] Degarelix Treatment Is Compatible With Diabetes And Antithrombotic The | Rru

Editor who approved publication: Dr Jan Colli Suguru Tokiwa,1 Hiroaki Shimmura,1 Shuhei Nomura,24 Ryota Watanabe,1 Minoru Kurita,1 Naoto Yoshida,1 Kaori Yamashita,1 Yoshitaka Nishikawa,5 Alexander Kouzmenko,6 Shigeaki Kato4 1Department of Urology, Jyoban Hospital, Tokiwa Foundation, Iwaki, Fukushima, Japan; 2Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; 3Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, 4Research Institute of Innovative Medicine, Tokiwa Foundation, Iwaki, 5Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan; 6Department of Life Sciences, Alfaisal University, Riyadh, Kingdom of Saudi Arabia Introduction: Therapeutically induced androgen deficiency (AD) is a standard treatment for patients with prostate cancer, but it is often associated with various adverse effects (AEs) that may lead to discontinuation. Some AEs may depend on the patients health condition, while others may be due to complications of the drug delivery method. Degarelix is a gonadotropin-releasing hormone (GnRH) antagonist widely used for the treatment of androgen-dependent prostate cancer. This study aimed to ascertain the following: 1) the compatibility of degarelix treatment with diabetes and 2) any specific causal associations of degarelix injections with increased blood clotting and antithrombotic therapy requirements. Patients and methods: The medical records of 162 patients with prostate cancer who had undergone degarelix treatment were retrospectively examined. The association of a medical history of diabetes and anticoagulant co-treatment with degarelix treatment discontinuation was analyzed statistically. Results: Rapid and significa Continue reading >>

Prevalence And Risk Factors Of Lipohypertrophy In Insulin-injecting Patients With Diabetes

Prevalence And Risk Factors Of Lipohypertrophy In Insulin-injecting Patients With Diabetes

Our objective was to assess the frequency of lipohypertrophy (LH) and its relationship to site rotation, needle reuse, glucose variability, hypoglycaemia and use of insulin. The study included 430 outpatients injecting insulin who filled out a wide-ranging questionnaire regarding their injection technique. Then, a diabetes nurse examined their injection sites for the presence of LH. Nearly two-thirds (64.4%) of patients had LH. There was a strong relationship between the presence of LH and non-rotation of sites, with correct rotation technique having the strongest protective value against LH. Of the patients who correctly rotated sites, only 5% had LH while, of the patients with LH, 98% either did not rotate sites or rotated incorrectly. Also, 39.1% of patients with LH had unexplained hypoglycaemia and 49.1% had glycaemic variability compared with only 5.9% and 6.5%, respectively, in those without LH. LH was also related to needle reuse, with risk increasing significantly when needles were used>5 times. Total daily insulin doses for patients with and without LH averaged 56 and 41IU/day, respectively. This 15 IU difference equates to a total annual cost to the Spanish healthcare system of>€122 million. This was also the first study in which the use of ultrasound allowed the description of an “echo signature” for LH. Correct injection site rotation appears to be the critical factor in preventing LH, which is associated with reduced glucose variability, hypoglycaemia, insulin consumption and costs. The full text of this article is available in PDF format. Notre objectif était d’évaluer la fréquence des lipodystrophies (LH) et sa relation avec la rotation des sites d’injection, la réutilisation des aiguilles, la variabilité de glycémie, l’hypoglycémie et Continue reading >>

Insulin Injection Site Dystrophic Calcification With Fat Necrosis: A Case Report Of An Uncommon Adverse Effect Ramdas S, Ramdas A, Ambroise M - J Fam Med Primary Care

Insulin Injection Site Dystrophic Calcification With Fat Necrosis: A Case Report Of An Uncommon Adverse Effect Ramdas S, Ramdas A, Ambroise M - J Fam Med Primary Care

We report a case of an uncommon adverse effect of insulin injection resulting in hard subcutaneous swelling in the lower abdomen of a 47-year-oldfemale with type 1 diabetes. Extensive dystrophic calcification and fat necrosis was revealed on histopathological examination. Keywords:Calcification, cutaneous, dystrophic, injection, insulin Ramdas S, Ramdas A, Ambroise M. Insulin injection site dystrophic calcification with fat necrosis: A case report of an uncommon adverse effect. J Family Med Prim Care 2014;3:269-71 Ramdas S, Ramdas A, Ambroise M. Insulin injection site dystrophic calcification with fat necrosis: A case report of an uncommon adverse effect. J Family Med Prim Care [serial online] 2014 [cited2018 Apr 28];3:269-71. Available from: Cutaneous adverse effects of insulin injections can cause inadvertent fluctuation in the glucose levels by possibly causing interference with absorption at the site. In spite of improvements in the insulin therapy these adverse effects are still common particularly in type 1 diabetics and in patients who do not rotate the injection site. We report one such case with poor glycemic control in which the injection site was cosmetically unsightly and histopathology revealed rare complication of dystrophic calcification. A 47-year-old woman diagnosed with type 1 diabetes at the age of 15 years and on subcutaneous insulin injections (insulin analog aspart) was admitted to the hospital with complaint of unsightly painless swelling in the lower abdomen at the injection site, which she noticed to be gradually increasing in size over the past 10 years. She also gave past history of recurrent abscesses at the same site. On examination, the patient was of lean build with a body weight of 69 kg and a height of 167 cm with a body mass index of 2 Continue reading >>

Skin-related Complications Of Insulin Therapy: Epidemiology And Emerging Management Strategies

Skin-related Complications Of Insulin Therapy: Epidemiology And Emerging Management Strategies

The incidence and prevalence of all types of diabetes mellitus is increasing at an alarming rate. Modern therapy involves greater and earlier use of intensive insulin regimens in order to achieve better control of blood glucose levels and reduce the long-term risks associated with the condition. Insulin therapy is associated with important cutaneous adverse effects, which can affect insulin absorption kinetics causing glycemic excursions above and below target levels for blood glucose. Common complications of subcutaneous insulin injection include lipoatrophy and lipohypertrophy. The development of lipoatrophy may have an immunological basis, predisposed by lipolytic components of certain insulins. Repeated use of the same injection site increases the risk of lipoatrophy--with time, patients learn that these areas are relatively pain free and continue to use them. However, the absorption of insulin from lipoatrophic areas is erratic leading to frequent difficulties in achieving ideal blood glucose control. With the increasing use of modified, rapidly absorbed analog insulins (e.g. insulin lispro, insulin aspart) the incidence of lipoatrophy occurring has decreased over recent years. The likelihood of lipoatrophy can be reduced by regular rotation of injection sites but once developed, practical benefits may be obtained by insulin injection into the edge of the area, co-administration of dexamethasone with insulin, or changing the mode of insulin delivery. Lipohypertrophy is the most common cutaneous complication of insulin therapy. Newer insulins have also reduced its prevalence considerably, although its adverse effect on diabetic control is similar to lipoatrophy through impaired absorption of insulin into the systemic circulation. Experience with liposuction at thes Continue reading >>

Skin-related Complications Of Insulin Therapy Epidemiology And Emerging Management Strategies

Skin-related Complications Of Insulin Therapy Epidemiology And Emerging Management Strategies

Skin-related Complications Of Insulin Therapy Epidemiology And Emerging Management Strategies Diabetes Skin-related Complications Of Insulin Therapy Epidemiology And Emerging Management Strategies is a particularly serious cause of foot pain infection and ulcers and without proper foot care can result in amputation. Skin-related Complications Of Insulin Therapy Epidemiology And Emerging Management Strategies wed all be happy if that is the case however extraordinary foot care advice diabetic patients claims require extraordinary evidence. In response to the growing health burden of diabetes mellitus (diabetes) the diabetes community has three choices: prevent diabetes; cure diabetes; and take better care of people with diabetes to prevent devastating complications. low carb recipes for type 2 diabetes bitter melon juice zwangerschapsdiabetes klachten and diabetes (#1) You know after the sugar diabetes spike. diabetes dietary supplements Eventually this clogging destroys the glomeruli the filtration units of the kidney. diabetic diet kcal painful diabetic neuropathy treatment guidelines Insulin aspart [NovoLog] insulin lispro. For type 2 diabetes Xanthelasma; SITE SECTIONS: Eye Problems+Symptoms Eye Diseases+onditions diabetes treatment and management intensive blood pressure control in type 2 diabetes Diet didnt help so I ended up on insulin injections. Tips for Healthy Living Frequently Asked Questions Publications Diabetes Websites. Agave does not give me that feeling so I know it is not affecting my blood sugar level. Diabetes Mellitus Type 2. Finally the scale requires 4 AAA batteries. You mentioned this girl. diabetes foundation of ms bacchus ball american diabetes association diabetes myths Thats another excellent point. TC Skin-related Complications Of Insulin T Continue reading >>

Case Report J Endocrinol Metab. 2014;4(1-2):36-38 Presselmer

Case Report J Endocrinol Metab. 2014;4(1-2):36-38 Presselmer

Articles © The authors | Journal compilation © J Endocrinol Metab and Elmer Press Inc™ | www.jofem.org This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited A Rare Cutaneous Complication of Insulin in a Patient With Type 2 Diabetes That Developed Foot Necrosis at the Injection Site: A Result of Inadequate Patient Education Tosun Haci Bayrama, c, Gumustas Seyitalia, Agir Ismaila, Uludag Abuzera, Serbest Sancarb Abstract Cutaneous complications of insulin became rare due to the intro- duction of highly purified recombinant human insulin preparations. We reported a case of a 63-year-old Anatolian man with type 2 diabetes mellitus that developed foot necrosis at the injection sites after local administration of analog recombinant mixed insulin to dorsal aspect of the foot due to foot pain. This case is rare and very interesting. The education of patients who use insulin is crucial to prevent skin-related complications of insulin therapy. So education is a part of treatment for patient with diabetes. Keywords: Diabetic foot; Diabetes; Insulin therapy; Patient educa- tion Introduction A large number of patients with diabetes are being treated with subcutaneous insulin injection [1]. Insulin allergy in patient with diabetes is a rare condition [2]. Insulin allergies range from localized skin reactions to systemic anaphylaxis. While insulin allergies were very common which were rated as 50-60% in the past, it is estimated to be less than 1-3% now [3]. This condition dramatically decreased due to im- provement of the purification techniques and recombinant human insulin analogs [3, 4]. Foot infect Continue reading >>

Insulin Infusion Device Complication

Insulin Infusion Device Complication

Commonly used by patients with type 1 diabetes in the US External device connected by flexible tubing to a subcutaneous catheter Delivers continuous basal insulin and (by manually activating) bolus insulin (prandial or correction doses) Patient switches subcutaneous site every 3 days, refills insulin reservoir as needed every few days accidental (or iatrogenic) disconnection, kinked tubing, empty reservoir, uncharged batteries, poorly positioned needle, lipohypertrophy, patient not rotating sites DKA can occur very rapidly if pump fails, since pumps only use rapid-acting insulin Cellulitis [1] , usually due to strep or staph Local reactions to adhesives or insulin preparation Subcutaneous granulation tissue due to local insulin action Infusing through such sites erratic insulin absorption labile blood glucose, hyperglycemia Patients most often know how to operate and perform basic diagnostics on their pump Many devices have a log of bolus histories and changes to basal rates, alarms, etc. All major pump manufacturers have a 24/7 technical support hotline Awake, alert patients without diabetes-related complaints should be allowed to operate their pump while in the ED If pump needs to be disconnected for >1hr, give a dose of subcutaneous insulin Continue reading >>

Insulin Pumps: Understanding Them And Their Complications

Insulin Pumps: Understanding Them And Their Complications

While the rate of diabetes climbs, the number of patients who are using insulin pumps grows apace. Pumps appeal to physicians because they mimic normal insulin physiology with a consistent basal rate and appropriate bolus doses for meals. This leads to tighter glucose control and smaller variations. For patients, the pumps can be liberating, requiring far fewer injections than a typical multi-dose regimen. Regardless of why your patient has an insulin pump, it helps to know about how they work… for when they don’t. Background on insulin pumps Pumps are not a replacement for a fully-functioning pancreas. In technical terms, insulin pumps are an open system – they deliver a constant rate of insulin, but it is still up to patients to determine where their blood sugar is and where it may trend. Thus, patients with pumps still need to count carbs, and check their glucose frequently (often more frequently than those on multi-dose regimens). [1] Anatomy of the insulin pump Generally, insulin pumps consist of a reservoir, a microcontroller with battery, flexible catheter tubing, and a subcutaneous needle. When the first insulin pumps were created in the 1970-80’s, they were quite bulky (think 1980’s cell phone). In contrast, most pumps today are a little smaller than a pager. The controller and reservoir are usually housed together. Patients often will wear the pump on a belt clip or place it in a pocket. A basic interface lets the patient adjust the rate of insulin or select a pre-set. The insulins used are rapid acting, and the reservoir typically holds 200-300 units of insulin. The catheter is similar to most IV tubing (often smaller in diameter), and connects directly to the needle. Patients insert the needle into their abdominal wall, although the upper arm or th Continue reading >>

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