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Rdained a minister by the Unitarian Church in Westport, Connecticut, last May, Participating Scholar Debra Haffner will be joining the Consultation's Board of Directors this coming January. Debra is currently Co-director of the Religious Institute on Sexual Morality, Justice and Healing whose full-page declaration appeared in the New York Times and many other publications. The declaration challenges the religious and political Right's views on reproductive health. Debra received a Master of Public Health degree at Yale University School of Medicine in 1979. She has also worked as a research fellow at Yale's Divinity School. Her work experience includes offices related to public health issues.

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Depressives have prozac, wellbutrin ziloft trileptal remeron celexa lexapro. Blood glucose levels 29, 66, 67 ; . Bedtime snacks may be needed to avoid nocturnal hypoglycemia.The addition of protein to carbohydrate at bedtime has not demonstrated a reduction in hypoglycemia 69 ; . Prepared snack bars with cornstarch have demonstrated some effectiveness in reducing overnight hypoglycemia 70, 71 ; . High protein content vs. high fat content ; of an evening meal has also demonstrated some protection against nocturnal hypoglycemia 72 ; . Knowledge of the acute effects of exercise is mandatory for any person treated with insulin. Unless considerable hyperglycemia i.e. more than 15 mmol L ; and ketosis is present, low- to moderate-intensity exercise lowers glucose levels both during and after the activity, increasing the risk of a hypoglycemic episode.These effects on glucose levels can be modified by altering diet, insulin and the type and timing of exercise. In contrast, high-intensity exercise raises glycemia during and immediately after the bout. Self-monitoring of glucose level before, during, and especially for many hours after exercise is important for establishing the patient's response to exercise and guiding the appropriate management of exercise. In patients with type 1 diabetes, the use of intensive diabetes management regimens with either multiple daily injections or CSII provides additional flexibility in appropriately modifying the insulin dose for exercise 73, 74 ; . v ; Hypoglycemia unawareness and glucose counterregulation Severe hypoglycemic reactions are the main barrier to achieving optimal glucose control in people with type 1 diabetes 75 ; . The major risk factors for severe hypoglycemia include a prior episode of severe hypoglycemia 23, 29, 76, ; , a current low HbA1c less than 6% ; 23, 29, 78 ; , hypoglycemia unawareness 79 ; , long duration of diabetes 78, 80 ; and autonomic neuropathy 81 ; . Severe hypoglycemic episodes occur mostly at night 29, 82 ; or in the absence of hypoglycemia awareness that alerts patients to take actions to correct their glucose levels. Adolescents were found to be even at greater risk 85.7 episodes per 100 patient-years ; 24 ; . Glucagon responses to hypoglycemia are lost within the first few years after diagnosis of type 1 diabetes 83 ; , and patients become dependent on sympathoadrenal responses for appropriate glucose counterregulation and for hypoglycemia awareness. It is therefore not surprising that autonomic neuropathy defined as defects in both heart rate and systolic blood pressure changes with standing ; has been shown to be an independent risk factor for severe hypoglycemia in people with type 1 diabetes 84 ; , and those with autonomic neuropathy have further reduced epinephrine and norepinephrine responses to hypoglycemia 81 ; . However, autonomic neuropathy is not required for hypoglycemia unawareness to be present. The incidence of prior hypoglycemic episodes has been shown to be a crucial factor leading to hypoglycemia unawareness. Hypoglycemia has been reported to occur on average in people with type 1 diabetes at a frequency of approximately 2 and achromycin.

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From 1Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana; the 2Isle of Wight Healthcare, National Health Service Trust, St. Mary's Hospital, Newport, Isle of Wight, U.K.; the 3Second Department of Internal Medicine, Faculty Hospital, Comenius University, Mickiewiczona, Bratislava, Slovak Republic; the 4NZOZ GCP Dobra Pratyka Lebarska, ul che-mi-ska, Grudzi-dz, Poland; the 5Medyczyne Centrum, Diabetologiczno-Endokrynologia, Diabetologia Rusznikarska, Krakow, Poland; and the 6Takeda Europe Research and Development Centre, London, U.K. Address correspondence and reprint requests to Dr. Meng H. Tan, Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN 46285. E-mail: tan meng lilly . Received for publication 30 August 2004 and accepted in revised form 12 December 2004. Abbreviations: FPG, fasting plasma glucose; FSI, fasting serum insulin; HOMA, homeostasis model of assessment; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; OAM, oral antihyperglycemic medication. A.B. has received grant research support from Quintiles. A table elsewhere in this issue shows conventional and Systeme International SI ; units and conversion ` factors for many substances. 2005 by the American Diabetes Association and acomplia.

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