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This is the third in a weekly series of diaries that deal with healthy positive approaches to the process of ageing. They all carry a tag of [ageing gracefully] and can be found by searching on that tag.  

Archive to All Aging Gracefully Diaries

Diabetes is certainly not a condition that is exclusive to later life. The term is actually an umbrella for a group of related conditions that all have the common feature of a problem of elevated blood sugar. However, there are several factors that are inherent to the ageing process that increase the risk of diabetes as one grows older. The longer you live the greater the likelihood of developing some problems with it.

Medical classifications break it into type I and type II diabetes. Type I usually has its onset in adolescence and results in a more or less complete loss of the ability of the pancreas to produce insulin. Type 1 usually appears in childhood or adolescence, but can appear in adults. Only about 5% of people diagnosed with diabetes have type I. The basic cause is still not fully determined. Treatment usually involves injecting insulin.

Type II is by far the more common form and its incidence has seen sufficient increase in recent years for people to talk about a diabetes epidemic. This term represents a cluster of problems. The two major factors involved are a decreased ability to produce insulin and an increased resistance on the part of the bodily process that use insulin in carbohydrate metabolism. There are a number of characteristics that have been identified as representing risk factors of type II diabetes. Some of the common ones are:

Are over 45

Are obese or overweight

Have family members who have type 2 diabetes

Don't exercise

Have low HDL cholesterol or high triglycerides

Have high blood pressure

Some of these factors are things over which a person can exercise some control. That forms an important part of the treatment and management.

Elevated blood sugar is not usually an immediate danger. It can be at extremely high levels. This is usually only seen in people who are insulin dependent. For most people with type II the damage occurs when moderate levels of high blood sugar are allowed to persist over time. The excess sugar can cause irreversible damage to the tissue of nerves and small blood vessels. This damage can result in some serious medical problems such as diseases of the eyes, kidneys and circulatory system. It generally accelerates the ageing process.

Here is a link to the American Diabetes Association and an overview of information on type II. There is a huge amount of online resources on the subject.

At this point I want to move into my personal testimonial about living with diabetes. I was first diagnosed with type II and high blood pressure at the age of 29. That was a long time ago and I am still kicking. There is a history of the condition on both sides of my family which means that I likely have a predisposition to the problem. The exact mechanism of that is not yet well understood. The reason that it caught up with me at such an early age was because I was leading a very high stress and unhealthy lifestyle. I wasn't then nor have I ever been overweight, but I was doing lots of things wrong. With medication the problem was fairly quickly brought under control. I slowly and grudgingly began to make some changes in my behavior. After about a year I no longer needed the medication. It took me 10 years to fully clean up my act and adopt a fundamentally healthy lifestyle. I now look back on that with a certain amount of gratitude.

Age begins to take some toll on almost everybody in middle age, say late 40s to 50s. Having a healthy and productive life beyond that point requires making accommodations in one's habits and lifestyle. The older one gets the more difficult it is for most of us to make changes in the way we do things. Having a persuasive reason to make healthy choices when you are still fairly young has definite benefits to it. The kind of diet and exercise routines that I have learned to practice would stand anybody of my present age (71) in good stead, diabetes or not.

The basic mechanisms for managing diabetes are:




For people who are considered to be pre or borderline diabetic a good consistent program of diet and exercise may be sufficient for successful management without the need for medication. For those who do require medication, D & E can greatly reduce the amount required.

We covered the basics of exercise in last week's diary on arthritis. It is the aerobic part that is important for diabetic control. Not only does it help to speed the utilization of blood sugar, but it also contributes to decreasing the insulin resistance. An hour a day of steady aerobic exercise is a good target to aim for.

A healthy diet for a person with diabetes is not appreciably different from what any adult from middle age onward should be eating. There is likely some extra focus on balancing the carbohydrate load, but there is not some kind of separate special diet for diabetics. I am going to save the topic of diet for another diary, since there is lots to talk about there.

In the 41 years that I have been dealing with diabetes there has been a huge change in the medications that are available. Some of them at times have been controversial because of side effects. I am not going to get into a major technical discussion of them, since that would get well beyond my competence. Here's a link from the ADA.  Type II is usually treated with medications that can be taken orally as long as the pancreas has the capacity to produce insulin. Should that fall below a usable level then insulin injections could be required. They have not yet produced oral insulin.

Oral hypoglycemic agents are medications that stimulate the pancreas to produce more insulin. That can speed up the metabolism of blood sugar, but it can also create the condition of hypoglycemia or low blood sugar. Unlike moderately elevated blood sugar or hyperglycemia, hypoglycemia can be immediately dangerous. People taking OHAs have to be alert to this risk and monitor their blood sugar levels and diet.

Metformin is the leading drug for treatment of type II. It is what I take. I have been on an OHA in the past and dealing with hypoglycemia wasn't a lot of fun. Metformin acts on the liver and also works to reduce insulin resistance. For most people it doesn't have major serious side effects. Some of the newer drugs on the market have some issues about side effects. They are generally used as second line treatments when the older types of drugs are insufficient.

The reality about diabetes is that if its management is neglected it can lead to very serious problems. However, for most people effective management that doesn't disrupt your life is entirely possible. I have not incurred any of the complications that can arise from it. I am able to keep my blood sugar level in the pre-diabetic level. Other than the medication I take specifically for it, everything else that I do to manage it contributes directly to my health as an ageing adult.


Originally posted to Richard Lyon on Tue Apr 29, 2014 at 03:00 PM PDT.

Also republished by KosAbility and Community Spotlight.

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Comment Preferences

  •  My dad is 69 and has Type II (10+ / 0-)

    It runs in the family. He is not obese. He takes pills for his diabetes but I have had to catch him falling down from a sugar low.

    I'll probably have it too, and I am 45.


    by commonmass on Tue Apr 29, 2014 at 03:07:32 PM PDT

  •  Richard, you say that: (11+ / 0-)
    Only about 5% of people diagnosed with diabetes have type II.
    That's very incorrect and should be changed.  In fact, more than 90% of diabetics are Type 2 diabetics.  See .

    I say this as a Type 2 diabetic who so far has almost miraculously been able to control blood sugar with diet and exercise.  My first A1C test (which measures average blood sugar over a period of about four months) was 11, about two years ago.  My most recent such test was 6.8, which is actually in the normal range.  But this tends to get worse over time, even with good discipline.

  •  My father is in his 80s. He's a former Marine (10+ / 0-)

    and tough as nails.  He's always been disciplined about keeping himself in shape.  But Type 2 diabetes has almost killed him.  He went into a coma not long ago from super low blood sugar, and it nearly killed him.  One has to be very careful about taking diabetes medications, especially more than one at the same time as he had been prescribed (metformin plus glipizide).

  •  One of the things I did was to quit drinking (9+ / 0-)

    and my doctor told me that was a good start to avoiding diabetes. I have quit smoking about a dozen times and am still working on it.

    My boyfriend is 28 years old, so I have to make sure that I can, you know, keep everything in order. ;)


    by commonmass on Tue Apr 29, 2014 at 03:22:51 PM PDT

  •  Big topic. Oceans of information are available. (13+ / 0-)

    Two quick comments:

    1. Buy the books of Richard Berstein, M.D., a Type 1 diabetic who invented the concept of personal home blood sugar monitoring.  He is the great genius of the field.  And in his 80s, I believe, he's still practicing medicine and available for consult.

    Of course, he's hardcore.  He says there is only one fruit that diabetics can ever eat--avocados.  I allow myself just a little of banana or apple, etc.

    But the most absolutely forbidden substance is fruit juice, unless one needs to quickly elevate blood sugar.  In my last months before diagnosis, I had some nights with the classic symptom of very great thirst and very frequent urination--where I groggily got up many times in the middle of the night to drink orange juice!  That's insane!  That's pouring gasoline on a fire!  I must have had some blood sugar readings of 500 or even much higher!  Thank goodness it didn't damage my eyes.

    2. Be very wary of the American Diabetic Association.  Many of their recommendations are outdated, unscientific, and dangerously wrong.  In particular, they generally advocate carbohydrate consumption for Type 2 diabetics that is insanely high!!  

    I could tell many stories to prove that.  When I was recently in the hospital, they kept insisting I had to order fruit juice and even ICE CREAM, because they followed ADA guidelines and demanded a high level of carbohydrates.  That is seriously insane.

    My wife and I took some diabetes management courses at Kaiser Permanente, an HMO for which I generally have great respect, but they also follow ADA guidelines and advocate outrageously high levels of carbohydrate consumption.

    Veer toward Bernstein, not the ADA!

  •  I have literally had to catch my dad falling down (7+ / 0-)

    when he was hypoglycemic.


    by commonmass on Tue Apr 29, 2014 at 03:56:01 PM PDT

  •  Thank You for This (13+ / 0-)

    I am caregiver for my brother whose diabetes has gone out of control out of neglect on his part. We have appointments almost every day trying to get him better. I have had to literally save his life six times since he came out here in September. We now have a glucagon injector after his blood sugar dropped to 30 and he went into grand mal seizures.

    I would urge everybody who might be at risk for diabetes to get checked out and do what your doctor tells you. Reid is now in a wheelchair. This is a man who was an EMT for 28 years.

    "A dreamer is one who can only find his way by moonlight, and his punishment is that he sees the dawn before the rest of the world." Oscar Wilde

    by michelewln on Tue Apr 29, 2014 at 03:57:08 PM PDT

  •  The unfortunate thing about diabetes medications (2+ / 0-)
    Recommended by:
    Richard Lyon, mettle fatigue

    is that the patient can't drink any alcohol, at least that's true in my family, or they'll have a fainting episode and end up in the ER unnecessarily, with ambulances called by well-meaning bystanders. (Or maybe the non-drinking is fortunate.)

    The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

    by ybruti on Tue Apr 29, 2014 at 05:47:31 PM PDT

  •  Three out of (4+ / 0-)

    my five closest friends have been diagnosed with Type II in the past year or two. One is in her fifties and it runs in her family, the others in their sixties.

    One of them was hospitalized with a cardiac incident last year and found out while there that he was diabetic through an A1C test. He claims he's had regular checkups and had no sign of it in routine glucose testing. Maybe his checkups weren't as regular as he thinks they were, but it was scary that this could happen.

  •  In my 50th year of type I (10+ / 0-)

    I was diagnosed with type I diabetes at 14. I immediately needed to inject insulin on a daily basis. That was in the fall of 1964. I am in my 50th year of living with diabetes. I was given the gift of very competent care from day one. Diabetic specialists were not the norm in 1964 but my parents found one in our city. He really helped me be in charge of my health and that has stuck with me for the last 50 years. The only way to do well with diabetes is to take charge of your exercise, diet and medication. You are a walking science experiment. The more you monitor yourself using blood glucose monitors and regular checkups with a1c's (crudely stated an average of your blood sugars for the past 6 weeks) the less likely you are to develop complications due to diabetes. These are many! Heart difficulties, glaucoma and extremities nerve damage to name just a few. I have virtually no complications due to diabetes. My doctor says having monitored my diet and exercise and monitoring my blood sugar values regularly as well as maintaining an active lifestyle has lead to this.

    I was very sick when I was diagnosed, throwing up, tired, not eating. Within 3 days of taking insulin I started to feel good again. For me there was no choice, take insulin and eat properly or feel like that again. No way was I going down that road. A very defined diet was necessary. It turns out it is a weight watchers diet in design. I have maintained a very good weight because of this. Anyone diagnosed with diabetes should follow the diet regimen prescribed and get reasonable exercise. Use the blood sugar monitoring devices available regularly. Be in charge of your health care regimen by working with your physician. But it is you who must monitor yourself and adjust your diet and exercise in concert with his/her advice. Only you know how you are doing. You cannot just go to the doctor and not be in charge when you leave. You must be in charge of you health!!!

    For those with type II diabetes it is a little different. Most type II diabetics have the Isles of Langerhans (the insulin producing part of the Pancreas) still producing some insulin. As a result they do not get sick the way I did and do not have the stark contrast of getting so much better with medication and diet so quickly. However they have higher than normal blood sugars for extended periods of time. This is what brings on the complications. It is absolutely necessary to make sure your blood sugar values stay below a certain number as much as possible. It will not necessarily make a difference today but if you do not control your blood sugars you will develop complications later. It is inevitable if you do not take care of yourself but clearly avoidable. I am proof of that.

    I have lived a full and very active life. I bike, hike, backpack, golf, play basketball and generally do anything any other person my age does and more. Take charge of your diabetic life and enjoy the lifestyle that will help you be healthy!

  •  thank you for this diary (4+ / 0-)

    I don't spend a lot of time on dKos, so I miss a lot & especially do NOT see many (any) diaries about being diabetic. I was 1st diagnosed with gestational diabetes 27yrs ago. No one at the time or in the years between my pregnancy & my official diagnosis 3yrs ago ever discussed it or mentioned that I had a problem. I was told continuously to lose weight & exericse..Finally when I got my diagnosis I had to take charge of my health.

    No one in family is diabetic (except a great grandmother I never met, died in the 50's) and none of my friends or workers are diabetic. I've had to learn to come to terms with this "special" condition! Insert sarcasm. It's been like a grieving person ...letting go of the things I used to do especially with diet. Two significant things that changed for me this past year have put me on track. Last April I found a physician that is very proactive with diet & exercise. Even though my A1C has been 5.5- 5.8, my daily numbers were not good. I've lost weight this past year, I'm exercising regularly and my diet has improved.

    I know a lot of people hate facebook, but I found a group page for t2 diabetics & that has also been significant for me.
    My siblings, all normal weight etc are very supportive. Most of my time is spent at work & by myself, so as my dr. said, "it is up to me."

  •  It is my understanding that it is very, very (1+ / 0-)
    Recommended by:
    Richard Lyon

    difficult to lose weight when you are on insulin. Does anybody know if this is true?

    •  Not true (0+ / 0-)

      I am on continuous insulin (via a pump). As long as you maintain a healthy diet and exercise weight control is not an issue.

      The opposite of "good" is "good intention" - Kurt Tucholsky

      by DowneastDem on Wed Apr 30, 2014 at 04:43:20 AM PDT

      [ Parent ]

    •  I haven't been on insulin (1+ / 0-)
      Recommended by:
      Nisi Prius

      but I was on an oral hypoglycemic agent for a long time. As long as I kept diet and exercise in balance my weight was stable. However, if I had a slight gain, then cutting back to get it off increased the risk of hypoglycemia. That was a major incentive to keep it under control.

    •  You are correct (1+ / 0-)
      Recommended by:
      Nisi Prius

      avoid insulin at all costs.  If you can afford it try Victoza.

      I also agree that "Be very wary of the American Diabetic Association."  is the best advice here.  They are making a small fortune off the disease.  Also avoid diabetes educators and read Bernstein's book.  

      Cut out most carbs and lose weight.  That's the ONLY way to maintain with diabetes.   Since low carbs works very well for losing weight it's a win win.  

      Really with medication you can eat damned hear anything and maintain blood sugar levels.  Medication however is expensive and the amount of insulin required to offset eating carbs will make you gain weight, a lose lose and not a pound lost.

  •  As a nurse in a high-acuity nursing facility …. (3+ / 0-)

    I see a lot of people who have lost a lot, often everything, because of the toll uncontrolled diabetes has taken.  Hideous wounds and infections that won't go away, people with strokes and dementia who will spend the rest of their bodies' physical "life" in a hospital bed with a vent/trach and gtube, or maybe a downward spiral in which each new health problem never quite gets managed and the hospitalizations/nursing home stays get longer and longer ….

    What I like about this diary is that it's really about life.  
    It's about the possibility of living a full life.

    I like that.

  •  Saw a documentary on people over 100 (0+ / 0-)

    and some of them smoked, ate bacon, drank, etc.. But the four things they had in common were:

    1. Active mind
    2. Active body
    3. Optimistic
    4. Dealt well with loss

  •  "Treatment usually involves injecting insulin." (1+ / 0-)
    Recommended by:
    Richard Lyon

    I'm 32 years into my involuntary hobby - Type 1 - and have yet to hear of a Type I diabetic who successfully treats themselves without injecting insulin.

    As to weight loss while taking insulin:  A few years ago I read Dr. Bernstein's book, became religiously low carb and otherwise closely monitored my diet and exercise, and dropped 15 pounds in a matter of a couple of weeks.

    As with so many things linked to behavior, though, it's hard to be sure how much different factors accounted for the weight loss.  Mindfulness (vs. the autopilot of routines giving way to some backsliding) has a lot to do with good control.

    A different "best practice" may be for all of us to become aerobic instructors or personal trainers - higher metabolism, better blood sugar control, and ability to eat more of what you like - but bear in mind that IANAD!

  •  I am just processing this one: (1+ / 0-)
    Recommended by:
    Richard Lyon
    Age begins to take some toll on almost everybody in middle age, say late 40s to 50s. Having a healthy and productive life beyond that point requires making accommodations in one's habits and lifestyle.
    When I was younger, I was an eating machine. I scarfed down whatever the hell I wanted, when I wanted, and didn't look back. And I looked like a rail! Nowadays, I no longer look like a rail. And I eat much more cautiously. I bet I take in 1/3 of the average daily calories I used to. And when I "splurge" on pizza or a cookie these days, I'm actively thinking about what corners I'll cut to make up for it.

    Generally, I'm noticing other kinds of slowing-up, too. But what you don't ever hear in this youth-happy culture is that maturity confers a lot of advantages...

    It's here they got the range/ and the machinery for change/ and it's here they got the spiritual thirst. --Leonard Cohen

    by karmsy on Wed Apr 30, 2014 at 01:57:10 PM PDT

  •  Some people can get off of meds for diabetes (0+ / 0-)

    I was just diagnosed with high blood sugar, and found the book "The End of Diabetes" by Dr. Furhman very helpful in describing the cause, and suggesting diet changes that make it possible to get off the meds.  It's a NYT bestseller.

    He claims diabetes is a weight issue, the extra fat gums up our body.  

    Diabetes is when our bodies can no longer process glucose from the carbohydrates we eat.  In a healthy body, the carbs we eat are digested into glucose.  The pancreas responds by producing insulin.  Insulin is a key to the cell walls, it unlocks the cell walls so allow the glucose to enter, where it will be used as energy.

    In an body that is overweight, and research shows even 5lbs can make a difference, the fat interferes with the insulin uptake.  The fat coats the cells, so that insulin no longer fits the cell and the cell cannot be opened to allow the glucose to enter.  The fat also clings to the insulin and changes it's shape so that, again, it can't open the cell.

    The glucose continues to circulate in the blood, as it cannot enter the cells.  So, the pancreas produces more and more insulin.  Over time, the pancreas burns out and stops functioning.

    The way to reverse this, according to Dr. Furhman and many other research sources, is to lose weight so that insulin can work with the cells again.  

    He proposes a diet based on tons of research that studies how food actually is digested and metabolized by our bodies.  The focus is to eat food that is high in nutrients and low in calories.  The focus is to eat foods that aid in nutrient metabolization.   For example, his diet is based on lots of veggies that are very high in nutrients.  It uses lots of beans that provide tons of proteins, and the carbohydrates are not metabolized into glucose.  Instead, bean carbs are fermented in the lower intestine by bacteria which digest the carbs for their energy, and then produce other nutrients that are good for us. So, in the past, we have been told to watch beans because of the carbs, but with a new understanding of the biology, that isn't wasn't the full picture, beans are good.

    Another example of the researched based diet suggestions is nuts.  Past diets have warned away from nuts as fatty.  Now, to the contrary, nuts (as opposed to oils) digest so that the fat isn't digested, but the good nutrients are.  In fact, research shows that eating nuts with greens and veggies works in concert to help the body metabolize even more of the nutrients from veggies.  This is a higher amount than would be metabolized from eating veggies with oils.  Walnuts in particular have a super effect on nutrient uptake.

    Greens, cruciferous veggies like Kale, broccoli, brussel sprouts, etc. are super high in good nutrients that our body can use.

    Fruits are good too.

    Furhman proposes a diet for diabetics that is based on veggies, beans, nuts and fruits with limited grains.  He says that hunger is nutrient based, not calorie based.  By eating foods that are high in nutrients, and low in calories, we can eat more food, feel more satisfied, and lose weight.

    It is a huge dietary change, it's vegan, but focusses on the food high in nutrients, potatoes etc, are not included.  He recommends making the changes slowly.

    I've been on the diet for a week.  More often than not, I have a hard time eating all the food recommended.   The up side is that I have more energy, I don't get tired after a meal, I feel full, I feel clean, I've lost my craving for coffee, chocolate, and carbs.

    Time will tell if it lowers my sugar.  He claims to have gotten thousands of people off of meds with this diet.

    "Whenever you have truth it must be given with love, or the message and the messenger will be rejected" ~Mahatma Gandhi

    by Kiku on Wed Apr 30, 2014 at 05:50:33 PM PDT

  •  Drugs are not the only effective option (0+ / 0-)

    The most encouraging new preventative for Type 2 Diabetes is Transmax-resveratrol, a concentrated plant extract which has been shown in several recent human trials to be more effective than the new Diabetes drugs. Transmax can also be used as a treatment taken with drugs such as Metformin to greatly improve their effectiveness. In four recently published human clinical trials done by respected medical schools, not drug companies that publish rigged tests of their own products designed to cover up their risks or lack of efficacy, it was shown that transmax had the effect of reducing blood glucose, improving insulin sensitivity, lowering blood pressure and LDL cholesterol, and even lowering body weight, at least as well as the Diabetes drugs, but without the adverse effects. The scientist who did the latest transmax study stated, "Resveratrol can be an effective adjunct therapy for type 2 Diabetics currently using one of the Metformin like drugs, or who are controlling their Diabetes without drugs.

  •  Recently diagnosed as pre-diabetic (2+ / 0-)
    Recommended by:
    Mxwll, Richard Lyon

    I was diagnosed with HBP in 2009, and have been taking medication to keep it under good control since.  I hit all the triggers:  over age 45, overweight, HBP, and a generally sedentary lifestyle.

    Since being told I was pre-diabetic, I have tried to make some real changes.  I have changed my diet in several ways, such as switching from regular (white) pasta to whole wheat, whole grain or the like.  Same with any bread I eat - I choose a whole wheat, high fiber bread.  I started buying sugar free sweets - since I do have a sweet tooth and long for something in the evenings.  I make a big pot of broth-based, vegetarian soup every week and have that at least twice a week for dinner and throughout the week for lunches.  These are the baby steps I've been making, and will continue to work in improving my diet.  Next is achieving at least 4 servings of fruits/veggies per day.

    However, I am falling down on the exercise portion.  I have improved slightly - now I walk at least 5 minutes per day.  That's not much, but it's more than nothing.  That too is my next goal - increasing my daily activity to 20-30 minutes.

    The good news is that since the first of the year, I've lost 8 pounds.  That's the most I've been able to lose and keep off in years.  So I believe my methods are effective, and would be even more effective if and when I amped them up.

    Great diary - much appreciated.  I am really hoping I can control my pre-diabetes with changes to my diet and increased activity.

    •  Keep it up. (0+ / 0-)

      You are on the right Track, one. Keep it up.  "Diets" are a losing bet. It is lifestyle that makes the lasting changes.  Choose your foods carefully and work slow and steady. Do not be discouraged by setbacks and what the scale tells you. I would also recommend some weight training (ask your doctor first). Even very light weight training can increase weight loss remarkably.
      Keep it up!

      "Religion is regarded by the common people as true, by the wise as false, and by the rulers as useful." Edward Gibbon

      by Mxwll on Thu May 01, 2014 at 11:19:08 AM PDT

      [ Parent ]

  •  Both my parents have diabetes. (1+ / 0-)
    Recommended by:
    Richard Lyon

    I am 46 and diligent about diet and exercise. I am a vegetarian (I did that more for ethical and environmental reasons than health, but it has paid off) and I gave up processed sugar. If is says "sugar" or "corn syrup" in the ingredients I do not eat it.
    As for my parents, my father is on insulin injections and makes very little effort with diet and exercises. My mother has was diagnosed over ten years ago and still has not needed insulin. She exercises and eats very well. Two sides of the coin. They got divorced when I was seven, by the way.
    The last doctor I saw thought I was in my early thirties until he looked at my paperwork.  I am a father of two young children. My health is not just about me, it is about them. I cared for my dad when he suffered a heart attack in my kitchen that resulted in two weeks in an ICU. He then he came to stay with us for 3 months while he recovered. I do not want to put my kids through that.
    My brother and sister think I am an extremist.
    That may be, but I a damn healthy one.

    "Religion is regarded by the common people as true, by the wise as false, and by the rulers as useful." Edward Gibbon

    by Mxwll on Thu May 01, 2014 at 11:11:37 AM PDT

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