[acb-diabetics] USE OF PRAMLITIDE FOR TYPPE 2

Patricia LaFrance-Wolf plawolf at earthlink.net
Tue Nov 23 23:22:20 GMT 2010 





Pramlintide Therapy, Chapter 11 - Part 1

Diagnosis_and_Management_of_Type_2_DiabetesSteve V. Edelman, MD

Robert R. Henry, MD 

The discovery of insulin over 80 years ago is one of the great success
stories in the history of modern medicine.  Although insulin remains the
mainstay of therapy for many patients with diabetes, the greatest deterrents
to the use of intensive insulin regimens are hypoglycemia, the fear of
hypoglycemia, and the need for...


Advertisement 

 



frequent fine-tuning of insulin doses on a day-to-day basis.  Particularly
in patients with Type 2 diabetes, who are often overweight, the weight gain
associated with intensive insulin therapy is also a significant concern.
Additionally, current insulin formulations and methods of delivery fail to
duplicate insulin action of healthy individuals, especially during the
postprandial period when normally there is a rapid surge of insulin into the
portal vein.

Given these concerns, the quest for more physiologic, and thus more
effective, approaches to treatment has prompted investigation of other
glucoregulatory hormones. These include the beta-cell hormone amylin, the
alpha-cell hormone glucagon, and numerous gut-derived hormones, such as the
potent incretins glucagon-like polypeptide-1 (GLP-1) and gastric inhibitory
peptide (GIP). Because the effects of some, if not all, of these hormones
are dysregulated to some extent in people with diabetes, many researchers
now believe that replicating glucose homeostasis requires a multipronged
effort involving more than replacement of insulin and/or enhancement of
peripheral glucose uptake. Along these lines, replacing the function of both
pancreatic beta-cell hormones, amylin and insulin, may afford more complete
restoration of the physiology of glucose control.

The synthetic human amylin analog, pramlintide acetate (Symlin) injection,
which retains the desired biologic activities of human amylin but has
superior stability and solubility, was FDA approved as an adjunct treatment
for patients with Type 2 diabetes who have failed to achieve desired glucose
control despite optimal insulin therapy, with or without a concurrent SFU
agent and/or MET, and also for patients with Type 1 diabetes who use
mealtime insulin therapy and have failed to achieve desired glucose control
despite optimal insulin therapy.

A New Paradigm: Regulating Glucose Appearance and Disappearance

Given the physiology of glycemic regulation, management of patients with
diabetes requires interventions aimed at reestablishing and maintaining
glycemic homeostasis by regulating glucose appearance and disappearance.
Type 2 diabetes is a progressive disease characterized by ongoing beta-cell
failure. The current management paradigm for patients with Type 2 diabetes
starts with diet and exercise, followed as needed with sequential oral
antidiabetic agents. Ultimately, because of progressive beta-cell failure,
these initial steps are not sufficient to maintain adequate glycemic
control, and the patient will require insulin.

Insulin controls PPG by two major mechanisms. First, it promotes the uptake
of glucose into insulin-sensitive peripheral tissues. Second, it inhibits
hepatic glucose output by exerting direct and indirect effects on the liver,
including suppression of glucagon secretion. Amylin is packaged together
with insulin in the beta-cell granules and is co-secreted with insulin. In
healthy individuals, amylin secretion follows the same pattern as insulin,
whereby it surges into the bloodstream in response to nutrient uptake
(Figure 11.1-A). Like insulin, amylin secretion is abnormal in patients with
Type 2 diabetes and is deficient in patients with Type 1 diabetes (Figure
11.1-B).

Whereas insulin primarily stimulates the disappearance of glucose from
plasma, amylin inhibits its appearance through three different mechanisms of
action, all of which are thought to be mediated via the central nervous
system (Figure 11.2):

. Pramlintide slows gastric emptying, i.e., the rate at which food is
released from the stomach to the small intestine.

. Pramlintide suppresses glucagon secretion, which leads to suppression of
endogenous glucose output from the liver.

. Pramlintide regulates food intake due to centrally mediated modulation of
appetite.

 

Edelman11-1

 

 

FIGURE 11.2 - Proposed Model of Amylin and Insulin Action in Postprandial
Glucose Homeostasis

Edelman11-2

Insulin is the major hormonal regulator of glucose disposal. Preclinical and
clinical studies indicate that amylin complements the effects of insulin by
regulating the rate of glucose inflow to the bloodstream.

* Reported in rodents.

Edelman SV, Weyer C. Diabetes Technol Ther. 2002;4:180.

Thus amylin is a neuroendocrine hormone that regulates glucose appearance
and works in concert with insulin, which primarily promotes glucose
disappearance. In patients with diabetes, glucose regulation is disrupted.
With the development of pramlintide, a more comprehensive approach to
glucose homeostasis is possible. 

Next Week, Part 2: Mechanisms of Action of Pramlintide

You can purchase this textalt at Amazon.com, just click on this link:
Diagnosis and Management of Type 2 Diabetes 10E
<http://www.amazon.com/gp/product/1932610677?ie=UTF8&tag=rx4betterhealt04&li
nkCode=as2&camp=1789&creative=9325&creativeASIN=1932610677> 

 


 
<http://www.diabetesincontrol.com/articles/diabetes-news/10086-editors-note-
paying-now-or-later> 

 
<http://www.diabetesincontrol.com/articles/diabetes-news/10086-editors-note-
paying-now-or-later> Editor's Note: Paying Now or Later

 

 <http://www.diabetesincontrol.com/> 

 
<http://www.diabetesincontrol.com/articles/diabetes-news/10078-diabetes-disa
ster-averted-7-double-checking-calculations-catches-> 

 
<http://www.diabetesincontrol.com/articles/diabetes-news/10078-diabetes-disa
ster-averted-7-double-checking-calculations-catches-> Diabetes Disaster
Averted #7: Double-Checking Calculations Saves Patient from Multiple
Problems

 

 






 <http://www.addthis.com/bookmark.php?v=250&pub=diabetesincontrol> Bookmark
and Share| Print
<http://www.diabetesincontrol.com/articles/diabetes-news/10085-diagnosis-and
-management-of-type-2-diabetes-10th-edition-ch-11-pt-1&action=1>  | Category
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&id=85>  | Home <http://www.diabetesincontrol.com/index.php>  

This article originally posted 12 October, 2010 and appeared in 

Past five issues: Issue
<http://www.diabetesincontrol.com/index.php?option=com_labels&view=label&lab
el=548&Itemid=12>  548 | Issue
<http://www.diabetesincontrol.com/index.php?option=com_labels&view=label&lab
el=547&Itemid=12>  547 | Diabetes
<http://www.diabetesincontrol.com/index.php?option=com_labels&view=label&lab
el=dcms6&Itemid=12>  Clinical Mastery Series Issue 6 | Issue
<http://www.diabetesincontrol.com/index.php?option=com_labels&view=label&lab
el=546&Itemid=12>  546 | Diabetes
<http://www.diabetesincontrol.com/index.php?option=com_labels&view=label&lab
el=dcms5&Itemid=12>  Clinical Mastery Series Issue 5 | 

 


Recent Most Read Articles:

 
<http://www.diabetesincontrol.com/articles/diabetes-news/6594-obesity-reduce
s-survival-by-2-years> Obesity Reduces Survival By 2 Years 
Posted March 31, 2009
 
<http://www.diabetesincontrol.com/articles/diabetes-news/6675-not-enough-sle
ep-causes-more-eating-and-diabetes-risk> Not Enough Sleep Causes More Eating
and Diabetes Risk 
Posted May 01, 2009
 
<http://www.diabetesincontrol.com/tools/test-your-knowledge/6729-test-your-k
nowledge-issue-469-test-your-knowledge-issue-469> Test Your Knowledge Issue
469 
Posted May 19, 2009
 
<http://www.diabetesincontrol.com/articles/newproduct/6568-generex-biotechno
logy-announces-successful-phase-iii-study-data-for-generex-oral-lyn(tm)>
Generex Biotechnology Announces Successful Phase III Study Data for Generex
Oral-lyn(tm) 
Posted March 17, 2009
 
<http://www.diabetesincontrol.com/tools/test-your-knowledge/6515-test-your-k
nowledge-issue-457-test-your-knowledge-issue-457> Test Your Knowledge Issue
457 
Posted February 24, 2009
 
<http://www.diabetesincontrol.com/articles/diabetes-news/6621-discovery-of-a
-new-receptor-antagonist-predicts-diabetes-2-onset> Discovery of a New
Receptor Antagonist Predicts Diabetes 2 Onset 
Posted April 18, 2009
 
<http://www.diabetesincontrol.com/articles/diabetes-news/2475-a-spoonful-of-
vinegar-helps-the-sugar-go-down> A Spoonful of Vinegar Helps the Sugar Go
Down 
Posted February 08, 2005
 
<http://www.diabetesincontrol.com/articles/diabetes-news/8043-letter-from-th
e-editor-june-29-2009-issue-475-> Letter From The Editor. June 29, 2009
Issue #475 
Posted June 29, 2009
 
<http://www.diabetesincontrol.com/articles/diabetes-news/8010-artificial-swe
eteners-linked-to-two-fold-increase-in-diabetes-> Artificial Sweeteners
Linked to Two-Fold Increase in Diabetes 
Posted June 23, 2009
 
<http://www.diabetesincontrol.com/articles/diabetes-news/746-supplementation
-with-chromium-picolinate--therapeutic-for-diabetes-and-pre-diabe>
Supplementation with Chromium Picolinate: Therapeutic for Diabetes and
Pre-Diabe 
Posted May 05, 2002
 <http://www.diabetesincontrol.com/mostreads.php> 
See more most read... 

 


Browse by Feature Writer & Article Category. 
A.
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=65-a-lee-dellon-md-&limit=20>  Lee
Dellon, MD | Beverly
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=77-beverly-price-rd-ma-ryt-&limit=2
0>  Price | Charles
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=83-charles-w-martin-dds&limit=20>
W Martin, DD | Derek
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=90-derek-lowe-phd&limit=20>  Lowe,
PhD | Dr.
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=63-richard-k-bernstein-md-face-facn
-fccws-&limit=20>  Bernstein | Dr.
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=82-dr-brian-p-jakes-&limit=20>
Brian Jakes, Jr. | Dr.
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=66-fred-pescatore-md&limit=20>
Fred Pescatore | Dr.
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=67-dr-tom-burke-phd&limit=20>  Tom
Burke, Ph.D | Eric
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=73-eric-s-freedland-md-&limit=20>
S. Freedland | Evan
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=64-evan-d-rosen-md-phd-&limit=20>
D. Rosen | Ginger
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=76-ginger-kanzer-lewis&limit=20>
Kanzer-Lewis | Greg
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=92-greg-milliger-cpc-cpc-h-cpc-p-ce
c-cemc-cpc-i&limit=20>  Milliger | Kristina
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=70-kristina-sandstedt-ms-&limit=20>
Sandstedt | Laura
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=80-laura-plunkett-ba-psychology&lim
it=20>  Plunkett | Leonard
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=68-leonard-lipson-ma-psychology-&li
mit=20>  Lipson, M.A. | Louis
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=94-philipson-louis&limit=20>  H.
Philipson | Marilyn
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=72-marilyn-porter-rd-cde-&limit=20>
Porter, RD, CDE | Melissa
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=69-melissa-diane-smith-&limit=20>
Diane Smith | Paul
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=74-paul-chous-ma-od-&limit=20>
Chous, M.A., OD | Philip
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=79-philip-a-wood-dvm-phd&limit=20>
A. Wood PhD | Sheri
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=81-dr-sheri-colberg-phd-facsm&limit
=20>  R. Colberg PhD | Sherri
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=71-sherri-shafer-rd-cde-&limit=20>
Shafer | Steve
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=78-steve-pohlit-cpa-mba&limit=20>
Pohlit | Steven
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=84-steven-v-edelman-md&limit=20>
V. Edelman, M.D. | Timothy
<http://www.diabetesincontrol.com/index.php?option=com_content&view=category
&layout=feature_writer_article&id=64&wid=75-timothy-s-hollingshead-&limit=20
>  S. Hollingshead | 

Diabetes In Control Advertisers 




 



 
<http://openx.diabetesincontrol.com/www/delivery/ck.php?oaparams=2__bannerid
=22__zoneid=22__cb=d1e51d5fd7__oadest=http%3A%2F%2Fwww.niprodiagnostics.com%
2F> 




 
<http://openx.diabetesincontrol.com/www/delivery/ck.php?oaparams=2__bannerid
=119__zoneid=20__cb=c7d296b65d__oadest=http%3A%2F%2Fwww.bd.com%2Fus%2Fdiabet
es%2Fhcp%2Fmain.aspx%3Fcat%3D3067%26id%3D32557> BD Medical Supplies



 
<http://openx.diabetesincontrol.com/www/delivery/ck.php?oaparams=2__bannerid
=140__zoneid=23__cb=3daeb4ae66__oadest=http%3A%2F%2Fwww.diabetesincontrol.co
m%2Fannodyne%2Findex.php> Don&amp;#039;t just help your patients live with
pain. Help them live.




 
<http://openx.diabetesincontrol.com/www/delivery/ck.php?oaparams=2__bannerid
=41__zoneid=21__cb=fd0d2945ef__oadest=http%3A%2F%2Fwww.a1ctest.com> 



 
<http://openx.diabetesincontrol.com/www/delivery/ck.php?oaparams=2__bannerid
=26__zoneid=24__cb=1a48851b9c__oadest=http%3A%2F%2Fwww.lifeforachild.idf.org
%2F> Life for a Child




 


Cast Your Vote

Would you consider Shared Office Visits with your patients if you had the
training and the opportunity was available?

165 Yes  166 No  167 Not Sure  



Processing .... 



 
<http://www.diabetesincontrol.com/component/apoll/apoll/42-would-you-conside
r-shared-office-visits-with-your-patients-if-you-had-the-training-and-the-op
portunity-was-available> 


 




Featured Jobs

 <http://www.diabetesincontrol.com/jobs?oc=11459> Infectious Disease
Physician - Seaboard Health Care Search 
Sebring, Florida

 <http://www.diabetesincontrol.com/jobs?oc=11379> Endocrinologist -
Christiana Care Health System 
Newark, Delaware

 <http://www.diabetesincontrol.com/jobs?oc=586> Pediatric Clinical Nurse
Specialist - Intermountain Healthcare 
Salt Lake City, Utah

 <http://www.diabetesincontrol.com/jobs?oc=11378> RN - Bilingual, Diabetes
Patient Educator - Outpatient - Hoag Hospital
Newport Beach, California

 <http://www.diabetesincontrol.com/jobs?oc=3101> Clinical Pharmacist
Specialist/Diabetes MI- STAAR Prog - Detroit Med Ctr 
Detroit, Michigan 

 <http://www.diabetesincontrol.com/jobs?oc=13786> Sr. Clinical Dietitian -
Rush University Medical Ctr
Chicago, Illinois 



CME/CE of the Week

 <http://www.diabetesincontrol.com/cme> Advances in the Treatment of
Childhood Diabetes 
William Tamborlane, MD, FAAP, FACE

Category: General Diabetes
CE Credits: .75 

 


 



 



 

 


Free Weekly Newsletter 
 <http://www.diabetesincontrol.com/articles/uncategorized/9177-Subscribe>
Sign up here. 


Free CE Available 
 
<http://www.diabetesincontrol.com/index.php?option=com_content&view=article&
id=6761> CE Programs on diabetes 


Sponsored Link 
 
<http://openx.diabetesincontrol.com/www/delivery/ck.php?oaparams=2__bannerid
=9__zoneid=7__cb=a0e4e599fe__oadest=http%3A%2F%2Fwww.diabetesproductsource.c
om> Compare diabetes products for your practice here. 

 


 

 


 



 	 

 



 

Advertisement

For appropriate patients with type 2 diabetes uncontrolled
<http://openx.diabetesincontrol.com/www/delivery/ck.php?oaparams=2__bannerid
=173__zoneid=26__cb=cbfc55d77a__oadest=http%3A%2F%2Fad.doubleclick.net%2Fclk
%3B227477425%3B44466057%3Bp>  on metformin alone. Get them started by adding
the power of an antihyperglycemic agent. Learn more about getting them to
goal. 

 


 


Advertisement

Test HbA1c in any clinical setting in every room. NGSP
<http://openx.diabetesincontrol.com/www/delivery/ck.php?oaparams=2__bannerid
=105__zoneid=33__cb=1802dad735__oadest=http%3A%2F%2Fwww.a1ctest.com>
certified, lab accurate, and portable. Results in 5 minutes. 
Find out how point of care testing shifts patient behavior for the better. 

 

 

 



Search Articles On Diabetes In Control 

 





 

	

 <http://alltop.com/> alltop

 	 



 





 

Sign up for our complimentary
weekly e-journal 






 <http://www.diabetesincontrol.com/privacy.php> Privacy /
<http://www.diabetesincontrol.com/advertising.php> Advertising With Us /
<http://www.diabetesincontrol.com/contactus.php> Contact Us 

 <http://www.diabetesincontrol.com/newsfeed.php> Entries (RSS News) 

Add us to your favorite news reader
<http://fusion.google.com/add?feedurl=http://www.diabetesincontrol.com/newsf
eed.php>
<http://my.msn.com/addtomymsn.armx?id=rss&ut=http://www.diabetesincontrol.co
m/newsfeed.php&tt=CENTRALDIRECTORY&ru=http://rss.msn.com>
<http://add.my.yahoo.com/rss?url=http://www.diabetesincontrol.com/newsfeed.p
hp> 


DISCLAIMER: The content of this Website is independent of the views of our
advertisers and sponsors. The site is designed primarily for use by
qualified physicians and other medical professionals. The information
contained herein should NOT be used as a substitute for the advice of an
appropriately qualified and licensed physician or other health care
provider. The information provided here is for educational and informational
purposes only. In no way should it be considered as offering medical advice.
Please check with a physician if you suspect you are ill. 


 

Copyright @ 1999-2010 Diabetes In Control, Inc.. All rights reserved. 

 

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0001.htm>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 9650 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0023.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 3072 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0024.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 41774 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0025.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 22080 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0026.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 42 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0027.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 2469 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0028.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 605 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0029.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 3072 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0030.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 5303 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0031.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 43 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0032.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 39619 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0033.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 18688 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0034.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 20693 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0035.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 20579 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0036.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 1337 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0037.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 3072 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0038.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 3072 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0039.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 14609 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0040.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 3072 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0041.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 1087 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0042.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 1162 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0043.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 1302 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0044.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/octet-stream
Size: 691 bytes
Desc: not available
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101123/ee44a16f/attachment-0045.obj>

More information about the acb-diabetics mailing list