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Doctors' Answers to "Frequently Asked Questions" - Diabetes


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Diabetes Injections [posted 1/12/99]
Question: I am a Type 2 diabetic aged 55 years. My treatment has recently been modified to using a mixture of Humulin NPH and Humalog, injected before breakfast and dinner. It would often be very inconvenient to mix up both types in a syringe just prior to injection. I wish to know whether there are any known dangers or loss of efficacy if I was to make up my mixed insulin syringes in advance of use. Ideally I'd like to pre-prepare 14 syringes for the week, but if this is "no good" would it be ok to pre-prepare syringes for a shorter number of days? I assume the pre-filled syringes would need to be re-agitated for mixing purposes just prior to injection.

Answer: Usually a week is ok and the syringes are optimized if "mixed" prior to injection.

Diabetic Neuropathy [posted 1/8/99]
Question: Can you give me all the latest information on how to combat Diabetic Neuropathy with various medications. I am asking for my father who has been suffering with type 2 diabetes for a couple of years. Also any neurological opinions you might have or if this field can help would be appreciated. He already goes once a month to have blood drawn due to a high iron count.

Answer: First the high iron count usually means hemochromatosis. Have you been checked, as well as all your siblings? An inherited condition, which causes diabetes in some. Second, the subject of diabetic neuropathy is too long for this column. There are many books available in medical libraries devoted to this subject. There are about 30-50 drugs, which we have tried with varying success in this disease. To date, nothing works well. There are new studies using nerve growth factor. Find a specialist in this area for a second opinion.

Diabetes - changing insulin [posted 1/7/99]
Question: I have had juvenile diabetes for the past 17 years. I have been on the old beef and pork insulin NPH & R. I am going to be switching to Humulin Insulin. What are the differences and will I be taking the same amount? Will I be having Insulin reactions?

Answer: Usually you need to reduce the dosage 5-10%, which is easily done and rarely causes a problem.

Diabetes [posted 1/6/99]
Question: My daughter was recently prescribed the drug Guaifen for her allergies. Can this drug effect her blood sugar level or cause the insulin to work faster or slower? I am asking this question because she had a very low blood sugar level at school today and required the school nurse to administer sugar to raise her level. She has been on this drug for 4 days and her blood sugar levels have been on the low side and her insulin intake has been cut back due to these lower levels.

Answer: Wouldn’t be expected to.

Diabetes & Niacin  [posted 12/09/98]
Question: Is it true that 6 grams of niancin a day for 10 years can bring on diabetes it effects the blood glucose and it will dissappear when niacin is discontinued? Please let me know.

Answer: No obvious cause of diabetes mellitus, but, can cause liver damage if unmonitored.

Diabetic Neuropathy [posted 12/04/98]
Question: I have been taking Vicodin ES, for the last 5 years,for Diabetic Neuropathy. I would like to know if there is a stronger med on the market or new surgical procedure that will stop, or help my pain it is a never ending cycle of pain that at times is total immobilizing.

Answer: All the narcotics work about the same. You will need to increase the dosage as you develop tolerance. If you haven't seen a pain specialist I would.

Insulin Storage [posted 12/04/98]
Question: I am not diabetic, but my toy Poodle Duke is. He is 8 years old. We have him regulated very well with his insulin. He gets 3cc Novolin L Lente twice a day. We have done numerous glucose curves and also fructose test which all are good. My question is: I have been told I should not use a bottle of insulin for more than 6 weeks after opening. Is this good information? In 6 weeks time, I still have half vial remaining. Thanks for your help!

Answer: Doesn't make sense. We usually recommend refrigeration to avoid any bacterial contamination;but, a rare problem.

When Should Blood Sugar Reduction Medications Begin [posted 11/13/98]
Question: If my blood sugar on a fasting diet is 210, do you feel I should start sugar reduction medication?

Answer: Have you given a strong push to diet and exercise? Most can be maintained initially(assuming you are an adult) with the proper diet and regular exercise. If you realistically won't do the exercise, then start the medications while you work on the diet.

Diabetes Medications with an Ileostomy [posted 11/10/98]
Question: I have an ileostomy. (We will celebrate one year of successul operation and being cancer-free in just a couple of weeks.) I recently was diagnosed with Type II diabetes and am currently on Rezulin and Glucophage. Will the ileostomy interfere with the absorption of these meds.?

Answer: No.

Diabetes or Temporary high Glucose ? [posted 10/13/98]
Question: I have for several months have had a great increase in thirstiness and frequent urination. Also night sweats and tiredness. I went to the Dr. and it showed a blood glucose of 285. I was prescribed Glipizide and am being referred to a dietican. Does just one high level of glucose and those symptoms mean I am diabetic or could this just be a short term temporary showing of high glucose.

Answer: Yes. Technically any over 140(some say 120) fasting if diabetes mellitus. However, that doesn't mean that diet and exercise won't control it for years-regardless of the initial level.

Diabetes & Estrogen Replacement [posted 10/1/98]
Question: I have been on rezulin (600) since october 1997. the drug works fine but i have gained about 25 pounds in that time period. is this a normal side effect? if so what can be done about it? the weight gain counteracts the rezulins glucose regulating.

Answer: Well, the weight gain per se is not related to the drug. However, it may be related to the better control of your diabetes. That is, you are not urinating out several grams of glucose a day and these calories are being utilized.

Diabetes & Estrogen Replacement [posted 10/1/98]
Question: I have frequent headaches "Migraines" and have sugar problems. They have me on Estradiol. The last one was Estrogens conjugated. I was taking the it until It started making me sick. I would take it in the morning by the afternoon I was sick in bed. My feet swell at night and i know my sugar level is will go up and down. I tired of being fat with this medicine.

Answer: You should focus on ensuring that one of your three problems is under control. I would focus on the estrogen replacement first. There are several types of replacement and it may take 6 months or so to find the right one. Keep with it.

Diabetes and Weight Loss [posted 8/14/98]
Question: I've heard that diabetes (I have Type 2) can become so out of control that it can cause weight loss instead of weight gain. True or False?

Answer: Very true.

Diabetes [posted 7/16/98]
Question: I wondering about the use of rezulin in a type I diabetic, who is not getting optimum use. Why would rezulin not work and what are the potential dangers?

Answer: I don't think I understand your question. Is it not working in you? In general, Rezulin will increase the efficiency of insulin 10-30% depending on the patient-and thus allow the dosage of insulin to be decreased by increasing the efficiency of the insulin given. There are dangers of low blood sugar and the dosage of insulin needs to be decreased. There have been recent reports of liver toxicity, so this needs to be checked. One will usually get some GI effects from the medication - gas, etc.

Insulin Availability for Diabetics
Question: I am a diabetic on 75 to 100 units per day. I was laid off work and am without health insurance. The cost for insulin is over $100 per month. Without income, this cost is prohibitive. Is there anywhere I can get low cost or even free insulin. I am using Novolin 70/30 pen fills.

Answer: Some of the drug companies have indigent patient assistance. Have your doctor write to their home office and request indigent assistance. I have several patients who receive assistance in this manner. However, not all companies participate and you may have to switch insulin types to find one that will.

Diabetes
Question: We are a Fifth grade class reading a story about a young man with diabetes. We would like to Know a little more about the disease. Where did the disease originate? What exactly is the disease? Is there a cure for it? Is it life threatening? How many times a week do they have to take their insulin shots? Or is it a certain time a day? How do they know when to take the insulin and how much do they have to take? Are you born with Diabetes or is it inherited?

Answer: There are two kinds of diabetes. Diabetes Mellitus (the kind that involves sugar) and Diabetes Insipidus (which involves the concentrating ability of the kidney). I'll assume that you are interested in Diabetes Mellitus since that is the socially common disease. This has been around as long as there have been humans. Also seen in other animals as well. There are two basic types. Type I, which is insulinopenic(low to absent insulin) and Type II, which has normal to high insulin levels, but difficulty using the insulin efficiently. Usually, Type I is seen with onset in the early teens or occasionally childhood and Type II is seen in adult years. However, either can be seen at any age. The disease is caused by elevated blood sugar levels caused by either a lack of insulin or an inability to utilize one's insulin efficiently. There is no cure for juvenile diabetes. But, Type IIs can often restore normal glucose levels with diet, weight loss and exercise. It does damage organs over time and leads to end organ disease of all the organs with the heart, kidneys, and eyes being the most damaged over time. Not all Diabetics need insulin-only the Type I diabetics. They usually take their shots a minimum of one a day and more commonly 2-4 times a day. The amount of insulin and time varies, but generally is morning and evening and the diabetic can test their own glucose using a home meter to determine the optimum dose or have the dosage preset by their physician. The Type I disease is not inherited, the Type II is inherited in terms of the tendency to develop the disease. Your local Diabetes Association can provide much more information. Lilly Pharmaceutical is also helpful at 800-545-5979.

Diabetes and Vasotec
Question: I am a Type II diabetic on 6 mg of glynase (since May 1996). I have a new physician who has prescribed 5 mg of Vasotec daily. My blood pressure is 110/70. He says this will help long-term with renal concerns. I like that idea but have never heard of this drug (large family history of Type I and Type II). Can't tell much from the pharmacological descriptions of Vasotec. Is this something which will help me? Are there any contraindications for long-term use?

Answer: Vasotec is in the class of drugs called Angiotension Converting Enzyme Inhibitors(ACE). Some people have shown dramatic improvement in renal decline in diabetics. Most physicians will proscribe these medications for any diabetic to achieve this long term benefit. There are no major side effects except cough in 10%(this is better with Cozaar, a cousin drug). This class works by inhibiting conversion of rennin(made in the kidney) to angiotension(a potent vascular pressor). This is very helpful in hypertension, heart failure, diabetic renal disease and some other conditions. It is an excellent class of drugs.

Diabetes Neuropathy
Question: Are there any medications besides trental and carbamazepine?

Answer: For prevention or treatment? There are experimental drugs which are almost released to prevent neuropathy or minimize neuropathy. Currently, drugs to treat neuropathy are a real hodge podge. Many drugs will help the pain but in an unpredictable manner. That is, you need to try them for several weeks to see if they'll help. They include Dilantin, Depakote, anti-depressants(especially Elavil and Doxepin), and a host of others. Your doctor should be able to do this.

Lupus and Type 1 Diabetes
Question: What interaction, if any, is there between these two conditions and/or the medications Humalog and Humulin NPH insulin and hydroxyquinone? I seem to be having greater difficulty in controlling my diabetes since the lupus was diagnosed and I was started on the hydroxyquinone. I have asked two doctors and a pharmacist, and they all indicated that there is no known interaction. However, in the past I have found that my own observations are often later confirmed by research results.

Answer: I am not aware of any problem. However, you were started on hydroxyquinone due to increased activity of your disease. I suspect it is the activity of the lupus which is effecting the diabetes mellitus, rather than the medications you are using to treat it. Either this or your activity level (or appetite) is changed due to the medications or basic disease process.

Diabetics and food
Question: What dietary information should diabetics know about their illness in order to minimize any further risk to their health when they travel a long distance?

Answer: Diabetes Mellitus can be a difficult condition to manage, both for the patient as well as for the health care provider. The disease becomes all the more difficult to control, and complications more difficult to avoid, during travel. However, a few basic dietary principles can help you manage your diabetes when your are away from home. Firstly, know that although diabetes is a problem of excessively high blood sugar, there is also the possibility, if you take either pills or insulin, that your sugars can go dangerously low if you do not eat enough. Therefore, regardless of how you control your diabetes, always carry non-perishable food with you on your person. Crackers or other dry snacks are a good idea. Having some hard candy with you is another good safeguard. In addition, know in advance when you will be taking your medication, be it pill or insulin, and plan out your trip in advance around your medication schedule. Meeting with your physician well in advance of an anticipated trip can aid greatly in this regard. Perhaps your medication regimen can be altered to make the trip more enjoyable and the medication administration less cumbersome. Always bring insulin administration (if needed) and sugar monitoring equipment with you, taking at least 7 extra days worth of equipment just in case. Finally, seeing a dietitian trained in dealing with Diabetes is a good idea, and your health care provider can refer you to one. Both your provider and dietitian can help you review the potential dietary pitfalls during your travels, as well as discuss with you the types of foods you will encounter and what changes, if any, you need to make in your medications while on your trip. Knowing the location or phone number to call in case of an emergency will also give you piece of mind on your trip and allow you to enjoy yourself and get the most out of your trip.

Insulin Dependent Diabetes Mellitus
Question: I'm a pharmacist looking for current information concerning the treatment of IDDM (Insulin Dependent Diabetes Mellitus) during stressful periods such as surgery, infection, ketoacidosis, etc., when the patient is NPO. Current recommendations are use of IV Insulin with Dextrose containing solutions. Can you recommend some references or a way to rephrase my search?

Answer: Some of the better studies have been done by Goldman and can be found in "Medical Evaluation of the Surgical Patient" by Lee Goldman.

Diabetes
Question: I have diabetes. The doctor has prescribed diabines 250 mg started with one half increased to one and a half. My numbers are around 185 in the AM before breakfast and around 240-300 at night 2 hours after dinner. When do I start to worry about damage from high numbers and are these numbers really high? I have been able to keep the numbers down with diet until about a month ago. I was on another type of med. about a year ago and my numbers dropped too low.

Answer: In general, we feel that damage to organs begins whenever the sugar level is above 140- 160. A better way of following your diabetes is to know the hemoglobin A1C. This is a measure of "control" averaged over 90 days and is a much better reflection of your control and the possibility of long term damage than daily glucose levels. I'd recommend keeping the HgAlC as low as possible. Levels of 240 will not accomplish this.

Synthroid and Diabetics
Question: My mother has been taking Synthroid for approximately 11 years now. 2.5 years ago she was diagnosed as being diabetic also. She takes a daily shot of Humulin along with her 200 mcg of synthroid. The problem is that in the last two months she has been in the hospital twice due to fast heart rate (140), lack of appetite, dehydration, and some other things. All of the symptoms that she has are accurate with those of having an extremely low thyroid condition yet she is taking her synthroid pill everyday. What I am wondering could there be a conflict between the synthroid and the humulin? Her doctor is beyond answers so we are waiting to take her to the Mayo Clinic if need be. She is going to a specialist in the next couple of days.

Answer: I know of no interaction with Humulin or any insulin. The symptoms you describe, if anything, would represent an over-active thyroid . What was her last TSH? If low, I'd try to lower her dosage somewhat and see if her symptoms improve.

Insulin Dependent Diabetes Mellitus
Question: I'm a pharmacist looking for current information concerning the treatment of IDDM (Insulin Dependent Diabetes Mellitus) during stressful periods such as surgery, infection, ketoacidosis, etc., when the patient is NPO. Current recommendations recommend use of IV Insulin with Dextrose containing solutions.

Answer: These are long, complex and completely different. That is, the treatment of DKA and pre/post op patients for example. A good source would be Harrisons Principles and Practices of Medicine. Also, the Merck Manual or Washington Manual both give practical advice on treatment in each of these situations. These are available in any medical bookstore or medical library.

Saccharine versus Aspertame
Question: There seems to be a high risk in using either Saccharine (Cancer prone) or Aspertame (brain damage) for a food sweetener. Which is more safe, or is there an alternative sweetener to either one of these?

Answer: For a diabetic it is much better to use fructose as a sweetener.

Diabetes medication
Question: My 28 year old boyfriend was diagnosed with type II diabetes two years ago. He takes three 10 mg tablets of Glucotrol XL a day, monitors his blood sugar and tries to watch his diet although he sometimes falters in this last area. Recently his blood sugar has become uncontrollable and his original symptoms of extreme lethargy, indifference, irritability and an increased need for sleep have returned. He has noticed the Glucotrol undigested in his stool several times, but he is reluctant to bring this to the attention of his doctor. I am very concerned for his health and I would appreciate any guidance you could provide us as to why this might be happening.

Answer: The pill casing for glucotrol XL does not dissolve and will always be expelled in the stool. Although it looks intact, the medication has been released in the body. It sounds like his diabetes is out of control and additional agents will be necessary if he is to regain his former health.

Diabetic Kidney Disease
Question: I am diabetic, and in a sick quest to lose weight I stopped taking my insulin and lost 50 pounds as a result. I also began using a lot of illegal drugs (heroin and cocaine) and was smoking about a pack of cigarettes a day. I found out the other day that I have the early signs of diabetic kidney disease, and that I was spilling lots of ketones in my urine. I need to know how to get my life back on track and the best way to do it.

Answer: Diabetes Mellitus is a common, but serious disorder that is due to either a lack of insulin production by the pancreas, and/or resistance to ones own insulin by the body’s tissues. When this occurs, the body’s usable form of sugar, or glucose, cannot enter the cells of the body where it is needed, and as a result glucose levels in the bloodstream build up to high levels. Diabetes, if left untreated, can lead to complications that include kidney disease, stroke, heart attack, as well as altered sensation in the hands and feet, balance problems, blood pressure problems, and increased susceptibility to infection. There is an abundance of information about this disease, which you can obtain either directly from your physician, or from sources to which he or she directs you.

Consistent use of medications, be they insulin, or pills, to treat your diabetes is the key to maintaining good blood glucose levels, at either preventing or slowing the rate of the many complications the disease can produce. Unfortunately, with our busy schedules, and day to day stressors, taking many medications over the course of each and every day is very time consuming and difficult. However, the cost of not doing so is a decline in health, and other illnesses than can be quite severe. Speak to your physician. He or she can discuss with you strategies to help you adhere to your medication regimen and schedule, and help you cope with a chronic illness that thousands of patients suffer from. There are, in addition, many support groups for individuals with diabetes, and your physician can provide the resources for you to get involved with one of these groups. Coping with a long term illness is not an easy task, but with help, and practice, you can gain control over the disease, rather than have it control over you.

Diabetic Kidney Disease
Question: I am diabetic, and in a sick quest to lose weight I stopped taking my insulin and lost 50 pounds as a result. I also began using a lot of illegal drugs (heroin and cocaine) and was smoking about a pack of cigarettes a day. I found out the other day that I have the early signs of diabetic kidney disease, and that I was spilling lots of ketones in my urine. I need to know how to get my life back on track and the best way to do it.

Answer: Diabetes Mellitus is a common, but serious disorder that is due to either a lack of insulin production by the pancreas, and/or resistance to ones own insulin by the body’s tissues. When this occurs, the body’s usable form of sugar, or glucose, cannot enter the cells of the body where it is needed, and as a result glucose levels in the bloodstream build up to high levels. Diabetes, if left untreated, can lead to complications that include kidney disease, stroke, heart attack, as well as altered sensation in the hands and feet, balance problems, blood pressure problems, and increased susceptibility to infection. There is an abundance of information about this disease, which you can obtain either directly from your physician, or from sources to which he or she directs you.

Consistent use of medications, be they insulin, or pills, to treat your diabetes is the key to maintaining good blood glucose levels, at either preventing or slowing the rate of the many complications the disease can produce. Unfortunately, with our busy schedules, and day to day stressors, taking many medications over the course of each and every day is very time consuming and difficult. However, the cost of not doing so is a decline in health, and other illnesses than can be quite severe. Speak to your physician. He or she can discuss with you strategies to help you adhere to your medication regimen and schedule, and help you cope with a chronic illness that thousands of patients suffer from. There are, in addition, many support groups for individuals with diabetes, and your physician can provide the resources for you to get involved with one of these groups. Coping with a long term illness is not an easy task, but with help, and practice, you can gain control over the disease, rather than have it control over you.

Diabetes- Exercise
Question: What are the immediate effects of exercise on a diabetic who is exhibiting acute hyperglycemia? (levels of 200 or above?)

Answer: Exercise has several effects on improving both glucose levels and general diabetic control. Given two identical diabetic patients-one who exercises and one who does not exercise-the exerciser will always have better control and lower glucose levels. Curiously, this is not just the effect of burning calories with exercise which lowers glucose levels. Exercise appears to improve the efficiency of insulin at the cellular level so that the same amount of insulin has a far larger effect with exercise than without. This may be due to changing so called "counteregulatory hormones";that is, other hormone levels in your body that also control glucose control like growth hormone, cortisol and others. Another possibility is that it improves the intracellular efficiency of insulin.
The three main controls of glucose levels are exercise levels, insulin levels, and calorie intake. Like most other aspects of diabetes, it is best to keep one's exercise about the same each day. However, depending on how high one's sugar is, additional exercise will lower glucose levels within two or three hours. The effect of exercise also lasts for about 12-24 hours in improving diabetic control.
One additional note, if a diabetic takes insulin and then runs, the absorption of insulin will be increased over normal, so the site of injection may effect the type of exercise one does.

Weight Problem
Question: I am a 16 year old diabetic. I am very diligent in my diabetes care, and maintain normal blood sugar levels. However I am about 51-20 pounds overweight(about 152lbs and I am 5’6”). I am on a very strict diet and do lots of exercise. For several years I swam regularly. Now I walk long distances and bike. Why am I not losing any weight? I can’t understand it. I am taking approximately 20 units of humulin insulin a day...a small dose indeed and my blood sugar levels are well within normal ranges. By the way my doctor took a blood test to check my thyroid, everything was normal.

Answer: Sounds like you're pretty healthy-why do you need to lose weight? Your weight has a lot to do with the build of your parents at each decade of life-check their pictures, I'll bet there is a high correlation.

Menstruation Problems
Question: . I am a 16 year old diabetic who has not yet menstruated yet without the aid of “chlomid.” My doctor put me on the chlomid for three consecutive months in which I did menstruate. However now I am entering the first month in which I am not taking any medication and thus far(almost seven weeks) nothing has happened. Please note I was sent for a sonogram and it was determined that all was in order, “eggs” and all. Please be further advised that I am very diligent about my diet and my diabetes. I also exercise regularly.

Answer: What is your weight? Most women will stop menstruating below a certain weight-usually about 10% below ideal weight. Has your thyroid and pituitary been checked? Do you have normal levels of FSH and LH. Do your body core temperatures cycle? Try some of these.

Propulsid & Erythromyacine
Question:. Hi, I’m a diabetic and have had nerve damage in my stomach my doctor started me on propulsid and erythromyacine. It has healed my stomach problems but now I am tired all the time and don’t feel like doing anything. My hair has also started coming out by the comb full. I am also taking zoloft, accupril and a multi vitamin. I have quit taking the propulsid and the erythromyacine. I was just wondering if these could cause hair loss.

Answer: Propulsid is a brand name of a medication known as cisapride, and is used to increase the “pumping” function of the intestines, including the stomach. You are probably taking this medication because your physician feels that you have stomach problems from your diabetes. The diabetes has the effect of deceasing the function of your stomach, so that it does not digest and push the food into the small intestines as well as it should. Erythromycin, although useful for certain infections in the stomach, also has the effect of increasing stomach pumping, thereby increasing its ability to push the food you eat into your small intestines. Although the Physician’s Desk Reference does mention rash as a possible side effect of both of these medications, it does not mention hair loss. However, the other symptom you mentioned, namely fatigue, may be a sign of another condition, or perhaps indicate a problem with your diabetes. Do you have any other conditions that can cause fatigue or hair loss? You report taking Zoloft, a commonly prescribed anti-depressant medication. Your fatigue may reflect that your depression is acting up. A visit to your health care provider would be beneficial. He or she can take a thorough history, perform a physical exam, and determine what further testing, if any, is needed to determine the cause of your hair loss, and fatigue.

Pancreatitis
Question:. My 33-year-old brother has recently been diagnosed with diabetes. Since his mid-20s he has been hospitalized for pancreatitis and has had recurrent problems with gout in his toes and recently arm. While he was a heavy drinker in his early 20s, this still seems quite unusually young for these problems, especially in a family with no history of any of this. When my mother was pregnant with him she was on some prescription drugs to prevent bleeding and miscarriage -- could this have damaged my brother's pancreas?

Answer: Most likely it relates to his alcoholism and recurrent pancreatitis. Pancreatitis has the ability to permanently damage the pancreas so that it will not perform its normal job of releasing insulin and digestive enzymes(into the small intestine). Many patients with pancreatitis(regardless of the cause) will develop diabetes mellitus. I would focus on his alcohol and pancreatitis-not drugs taken while in utero.

Glucotrol
Question:. My dad was diagnosed with diabetes at the age of 45. He began taking oral glucotrol. After seeing an endocrinologist, he is now taking insulin injections 2x/ day. What causes this change and what can be done to avoid having to take the injections? He was told he may only need them for 3-4 months to get regulated. Do you have any tips that he can follow to keep him off insulin?

Answer: Lose weight, exercise and limit daily calories. Many adult diabetics can successfully avoid all medications if they follow these steps.

Nicotinamid Acid
Question: Can nicotinamid acid prevent patients with pre-diabetes of becoming diabetics for a few years, and if so, how does it work ?

Answer: Not that I am aware of.



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