Take Charge: of Your
Take Charge: of Your
Take Charge: of Your
of Your
DIABETES
TM
Diabetes
Take Charge of
Your Diabetes
4th Edition
2007
Suggested citation:
iii
iv
Contents
Some Words of Thanks . . . . . . . . . . . . . . . . . . . . . . vii
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
10 Dental Disease . . . . . . . . . . . . . . . . . . . . . . . . . 65
11 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
12 Pregnancy and Womens Health . . . . . . . . . . . 73
RECORDS
Records for Sick Days . . . . . . . . . . . . . . . . . . . 79
Tests and Goals for Each Visit . . . . . . . . . . . . 89
Tests and Goals for Each Year . . . . . . . . . . . . . 99
Glucose Log Sheets . . . . . . . . . . . . . . . . . . . . 105
Your Health Care Team . . . . . . . . . . . . . . . . . 109
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
vi
vii
viii
1 Introduction
Diabetes touches almost
every part of your life.
Its a serious, lifelong
condition, but theres a
lot you can do to protect
your health. You can
take charge of your
healthnot only
for today, but for the
coming years.
problems.
Why it is important to get your blood glucose
Keeping Records
You can use this book to keep some records about
your health. The forms to write down details about
your health begin on page 79. You can cut out these
pages to take with you on your diabetes care visits.
You may also want to make extra copies to use in the
future. Go over these records often with your health
care team. Keeping track of your health is one of the
ways you can work together to control your diabetes.
On page 109, write down the names and telephone
numbers of your health care team. Theres enough
room on these pages to write questions and other
points you want to remember when you go to your
visits every 4 to 6 months. On page 116, you may
want to write down some contacts for community
groups that deal with diabetes.
Telephone
number: ________________________________
222-222-2222
Your
questions: ___________________________________
_________________________________________________
What was my last A1C result?
_________________________________________________
When is my next eye exam due?
Important points: __________________________________
_________________________________________________
Aim for glucose 90-130 before eating.
_________________________________________________
Less 180 1-2 hours after beginning to eat.
_________________________________________________
Check my feet every day.
What Is Diabetes?
Most of the food we eat is turned into glucose
(sugar) for our bodies to use for energy. The
pancreas, an organ near the stomach, makes a
hormone called insulin to help glucose get into
our body cells. When you have diabetes, your body
either doesnt make enough insulin or cant use its
own insulin very well. This problem causes glucose
to build up in your blood.
Diabetes means that a persons blood sugar is too
high. Your blood always has some sugar in it because the body needs sugar for energy to keep you
going. But too much sugar in the blood can cause
serious damage to the eyes, kidneys, nerves, and
heart.
the feet.
Vomiting.
Types of Diabetes
There are two main types of diabetes:
Type 1.
Type 2.
10
You
Youcan
canhelp
helpmanage
manageyour
yourdiabetes
diabetesby
bycontrolling
controlling
your weight, making healthy food choices, and
getting regular physical activity. Ask for help from
your health care team. Some people with type 2
diabetes may also need to take diabetes pills or
insulin shots to help control their diabetes.
Some
people
with
diabetes
are
concerned
about
Some
people
with
diabetes
are
concerned
about
their family members getting diabetes. A national
study shows that people may be able to prevent or
delay the onset of type 2 diabetes. To find out more,
talk to your health care provider, visit the CDC
Diabetes Web site at www.cdc.gov/diabetes, or
or call
call
1-877-CDC-INFO.
1-800-CDC-INFO.
11
12
13
Keeping a Balance
Ask your
market to carry
more hearthealthy foods.
17
18
19
20
21
Checking your
own blood glucose
levels is a key to
taking charge of
your diabetes.
22
Having Problems
with Low Blood Glucose
In general, a blood glucose reading lower than 70
mg/dL is too low. If you take insulin or diabetes
pills, you can have low blood glucose (also called
hypoglycemia). Low blood glucose is usually
caused by eating less or later than usual, being
more active than usual, or taking too much diabetes
medicine. Drinking beer, wine, or liquor may also
cause low blood glucose or make it worse.
24
Food Item
Sugar packets
Amount
3 to 4
Fruit juice
1/
cup (4 ounces)
1/
cup (4 ounces)
Hard candy
3 to 5 pieces
Sugar or honey
4 teaspoons
Glucose tablets
3 to 4
26
27
28
Be prepared
Always carry some
type of carbohydrate
sugar food or drink with
you so youll be ready at
any time to treat a low
glucose level. See the list
on page 26 for snacks
that have 15 grams of
carbohydrate.
Always carry along some food
with carbohydrates in it.
29
Having Problems
with High Blood Glucose
For most people, blood glucose levels that stay
higher than 140 mg/dL (before meals) are too high.
Talk with your health care team about the glucose
range that is best for you.
Eating too much food, being less active than
usual, or taking too little diabetes medicine are
some common reasons for high blood glucose (or
hyperglycemia). Your blood glucose can also go up
when youre sick or under stress.
Over time, high blood glucose can damage body
organs. For this reason, many people with diabetes
try to keep their blood glucose in balance as much as
they can.
30
32
Keep Eating
Try to eat the same amount of fruits and breads
as usual. If you can, eat your regular diet. If youre
having trouble doing this, use carbohydrate
choices or servings: eat enough soft foods or drink
enough liquids to take the place of the fruits and
breads you usually eat.
33
1/
cup
1/
cup
1/
cup
1/
twin
Sherbet
1/
cup
Saltine crackers
6 squares
Bread
1 slice
Milk
1 cup
Soup
1 cup
1/
cup
Apple sauce
1/
cup
Pudding (regular)
1/
cup
1/
cup (cooked)
1/
cup (cooked)
34
Drink Liquids
Drink extra liquids. Try to drink
at least 1/2 cup (4 ounces) to 3/4 cup
(6 ounces) every half-hour to hour,
even if you have to do this in small
sips. These liquids should not have
calories. Water, diet soda pop, or tea
without sugar are good choices.
Be sure to drink
extra fluids when
youre sick.
Keep Records
Use the Records for Sick Days, starting on page
79. Ask a family member or friend to help if you
need it.
35
36
38
During Travel
When you plan
a trip, think about
your day-to-day
schedule and try
Trips can hold surprises. Plan ahead
to stay as close to
for delays and changes.
it as you can. For
example, if you
usually check your blood glucose at noon and then
eat lunch, plan to do this on your trip, as well. Trips
can hold surprisesin delays and changes. Even the
types of food and supplies you can buy on your trip
may not be the same as those you get at home.
Before you travel, work with your health care
provider to plan your timing for medicine, food, and
activity. Talk about what to do if you find changes in
your glucose readings.
Plan ahead for trips:
Keep snacks with you that could be used to
41
Support Groups
It helps to talk with other people who have
problems like your own. You may want to think
about joining a diabetes support group. In support
groups, people who have just found out they have
diabetes can learn from people who have lived with
it for a long time. People can talk about and share
how they deal with their diabetes. They can also talk
about how they take care of their health, how they
prepare food, and how they get physical activity.
Family members who do not have diabetes may want
to join a support group, too. Ask your health care
team about support groups for people with diabetes
and their families and friends.
If there is
not a support
group in
your area,
you may
want to call
a diabetes
organization
(see the list
on pages
127129)
It can help to talk with other people who
about starthave problems like your own.
ing a group.
Counseling
One-on-one and family counseling sessions may
also help. Be sure to see a counselor who knows
about diabetes and its care. Ask your health care
provider to help you find a counselor.
42
5 Eye Problems
Diabetic eye disease (also called diabetic
retinopathy) is a serious problem that can lead
to loss of sight. Theres a lot you can do to take
charge and prevent such problems. Research shows
that keeping your blood glucose level closer to
normal can prevent or delay the onset of diabetic eye
disease. Keeping your blood pressure under control
is also important. Finding and treating eye problems
early can help save sight.
44
years.
diabetes.
Youre pregnant and you have diabetes.
Youre planning to become pregnant and you
have diabetes.
45
6 Kidney Problems
Diabetes can cause diabetic kidney disease
(also called diabetic nephropathy), which can
lead to kidney failure. Theres a lot you can do to
take charge and prevent kidney problems. A recent
study shows that controlling your blood glucose
can prevent or delay the onset of kidney disease.
Keeping your blood pressure under control is also
important.
The kidneys keep the right amount of water in
the body and help filter out harmful wastes. These
wastes, called urea, then pass from the body in
the urine. Diabetes can cause kidney disease by
damaging the parts of the kidneys that filter out
wastes. When the kidneys fail, a person has to
have his or her blood filtered through a machine (a
treatment called dialysis) several times a week or
has to get a kidney transplant.
47
49
If you feel dizzy, have sudden loss of sight, slur
your speech, or feel numb or weak in one arm or leg,
you may be having serious heart and blood vessel
51
52
53
If your cholesterol is
higher than 200 mg/dL on two or more checks, you
can do several things to lower it. You can work
with your health care team to improve your blood
glucose control, you can lose weight (if youre
overweight), and you can cut down on foods that
are high in fat and cholesterol. Ask your health care
team about foods that are low in fats. Also ask about
a physical activity program.
Ask your health care provider what steps to take
to reach your LDL cholesterol goal. You may need a
medicine to help control it. Ask if you need aspirin
to prevent heart attack or stroke.
54
8 Nerve Damage
Diabetic nerve damage (also called diabetic
neuropathy) is a problem for many people with
diabetes. Over time, high blood glucose levels
damage the delicate coating of nerves. This damage
can cause many problems, such as pain in your feet.
Theres a lot you can do to take charge and prevent
nerve damage. A recent study shows that controlling
your blood glucose can help prevent or delay
these problems. Controlling your blood glucose may
also help reduce the pain from some types of nerve
damage.
in many cases.
56
57
58
9 Foot Problems
Nerve damage, circulation
problems, and infections can
cause serious foot problems
for people with diabetes.
Theres a lot you can do to
prevent problems with your
feet. Controlling your blood
Take extra care of your
glucose and not smoking
feet to prevent injuries.
or using tobacco can help
protect your feet. You can
also take some simple safeguards each day to care
for and protect your feet. Over half of diabetesrelated amputations can be prevented with regular
exams and patient education.
Its helpful to understand why foot problems
happen. Nerve damage can cause you to lose feeling
in your feet. Sometimes nerve damage can deform or
misshape your feet, causing pressure points that can
turn into blisters, sores, or ulcers. Poor circulation
can make these injuries slow to heal.
61
Be Physically Active
Physical activity can help increase the circulation
in your feet. There are many ways you can exercise
your feet, even during times youre not able to walk.
Ask your health care team about things you can do
to exercise your feet and legs.
For more information on foot care, call the
National Diabetes Information Clearinghouse at
1-800-860-8747.
Being active is a
healthy way to live.
64
10 Dental Disease
65
67
68
11 Vaccinations
If you have diabetes, take extra care to keep
up-to-date on your vaccinations (also called
immunizations). Vaccines can prevent illnesses
that can be very serious for people with diabetes.
This section talks about some vaccines you need to
know about.
Influenza Vaccine
Influenza (often called the flu) is not just a bad
cold. Its a serious illness that can lead to pneumonia
and even death. The flu spreads when influenza
viruses pass from one person to the nose or throat
of others. Signs of the flu may include sudden high
fever, chills, body aches, sore throat, runny nose, dry
cough, and headache.
Pneumococcal Vaccine
Pneumococcal disease is a major source of illness
and death. It can cause serious infections of the
lungs (pneumonia), the blood (bacteremia), and the
covering of the brain (meningitis). Pneumococcal
polysaccharide vaccine (often called PPV) can help
prevent this disease.
PPV can be given at the same time as the flu
vaccineor at any time of the year. Most people only
have to take PPV once in their life. Ask your health
care provider whether you might need a second
vaccination. This vaccine is fully covered under
Medicare Part B.
70
Other Vaccines
You may need vaccines to protect you against
other illnesses. Ask your health care provider if you
need any of these:
Measles/Mumps/Rubella vaccine.
Hepatitis A and B vaccines.
Varicella (chicken pox) vaccine.
Polio vaccine.
Vaccines for travel to other countries.
71
72
12 Pregnancy and
Womens Health
Becoming Pregnant When You
Have Diabetes
Women with diabetes can
have healthy babies, but it
takes planning ahead and
effort. Pregnancy can make
both high and low blood
glucose levels happen more
often. It can make diabetic
eye disease and diabetic
kidney disease worse.
High glucose levels during
pregnancy are dangerous for
the baby, too.
If you dont want to
become pregnant, talk with
your health care provider
about birth control.
73
RECORDS
Records for Sick Days . . . . . . . . . . . . . . . . . . . . . . . 79
Checks and Goals for Each Visit . . . . . . . . . . . . . . . 89
Checks and Goals for Each Year . . . . . . . . . . . . . . . 99
Glucose Record Sheets . . . . . . . . . . . . . . . . . . . . . . 105
Your Health Care Team . . . . . . . . . . . . . . . . . . . .
77
109
78
(Cut here if you want to take only this page to visits with your health care provider.)
Question
Answer
Every day
How much do
you weigh today?
_____ pounds
Every evening
_____ a.m.
_____ p.m.
Time Dose
_____ _____
_____ _____
_____ _____
_____ _____
_____ _____
_____ _____
Time Ketones
_____ _______
_____ _______
_____ _______
_____ _______
_____ _______
_____ _______
Time Condition
_____ _________
_____ _________
_____ _________
_____ _________
_____ _________
_____ _________
your urine.
! (Cut here if you want to take only this page to visits with your health care provider.)
Every 4 to
How are you
6 hours
breathing?
(Cut here if you want to take only this page to visits with your health care provider.)
Question
Answer
Every day
How much do
you weigh today?
_____ pounds
Every evening
_____ a.m.
_____ p.m.
Time Dose
_____ _____
_____ _____
_____ _____
_____ _____
_____ _____
_____ _____
Time Ketones
_____ _______
_____ _______
_____ _______
_____ _______
_____ _______
_____ _______
Time Condition
_____ _________
_____ _________
_____ _________
_____ _________
_____ _________
_____ _________
your urine.
! (Cut here if you want to take only this page to visits with your health care provider.)
Every 4 to
How are you
6 hours
breathing?
(Cut here if you want to take only this page to visits with your health care provider.)
Question
Answer
Every day
How much do
you weigh today?
_____ pounds
Every evening
_____ a.m.
_____ p.m.
Time Dose
_____ _____
_____ _____
_____ _____
_____ _____
_____ _____
_____ _____
Time Ketones
_____ _______
_____ _______
_____ _______
_____ _______
_____ _______
_____ _______
Time Condition
_____ _________
_____ _________
_____ _________
_____ _________
_____ _________
_____ _________
your urine.
! (Cut here if you want to take only this page to visits with your health care provider.)
Every 4 to
How are you
6 hours
breathing?
(Cut here if you want to take only this page to visits with your health care provider.)
Question
Answer
Every day
How much do
you weigh today?
_____ pounds
Every evening
_____ a.m.
_____ p.m.
Time Dose
_____ _____
_____ _____
_____ _____
_____ _____
_____ _____
_____ _____
Time Ketones
_____ _______
_____ _______
_____ _______
_____ _______
_____ _______
_____ _______
Time Condition
_____ _________
_____ _________
_____ _________
_____ _________
_____ _________
_____ _________
your urine.
! (Cut here if you want to take only this page to visits with your health care provider.)
Every 4 to
How are you
6 hours
breathing?
(Cut here if you want to take only this page to visits with your health care provider.)
Question
Answer
Every day
How much do
you weigh today?
_____ pounds
Every evening
_____ a.m.
_____ p.m.
Time Dose
_____ _____
_____ _____
_____ _____
_____ _____
_____ _____
_____ _____
Time Ketones
_____ _______
_____ _______
_____ _______
_____ _______
_____ _______
_____ _______
Time Condition
_____ _________
_____ _________
_____ _________
_____ _________
_____ _________
_____ _________
your urine.
! (Cut here if you want to take only this page to visits with your health care provider.)
Every 4 to
How are you
6 hours
breathing?
result and set a target goal for your next test. (See
the sample form on page 90.)
talk about.
89
2/1/2000
145
9.0
Foot Check
Blood Pressure
(goal:___
Hg)
120 /___mm
80
Weight/Goal
(pounds)
A1C
Test/Goal (%)
e
l
p
m
170
140 / 90
180
8.0
a
S
165
8.0
140 / 86
175
8.9
6/11/2000
118
165
138 / 84
172
7.5
9/28/2000
180
8.4
165
136 / 82
170
not done
1/5/2001
105
160
7.5
124 / 80
165
8.2
4/3/2001
110
Have your health care provider do these tests and set goals with you.
(Record dates and results in the boxes below.)
Each Visit
! (Cut here if you want to take only this page to visits with your health care provider.)
90
91
Blood Pressure
(goal:___ /___mm Hg)
Weight/Goal
(pounds)
A1C
Test/Goal (%)
Foot Check
Each Visit
Have your health care provider do these tests and set goals with you.
(Record dates and results in the boxes below.)
(Cut here if you want to take only this page to visits with your health care provider.)
Foot Check
Blood Pressure
(goal:___ /___mm Hg)
Weight/Goal
(pounds)
A1C
Test/Goal (%)
Have your health care provider do these tests and set goals with you.
(Record dates and results in the boxes below.)
Each Visit
! (Cut here if you want to take only this page to visits with your health care provider.)
92
93
Blood Pressure
(goal:___ /___mm Hg)
Weight/Goal
(pounds)
A1C
Test/Goal (%)
Foot Check
Each Visit
Have your health care provider do these tests and set goals with you.
(Record dates and results in the boxes below.)
(Cut here if you want to take only this page to visits with your health care provider.)
Foot Check
Blood Pressure
(goal:___ /___mm Hg)
Weight/Goal
(pounds)
A1C
Test/Goal (%)
Have your health care provider do these tests and set goals with you.
(Record dates and results in the boxes below.)
Each Visit
! (Cut here if you want to take only this page to visits with your health care provider.)
94
95
Blood Pressure
(goal:___ /___mm Hg)
Weight/Goal
(pounds)
A1C
Test/Goal (%)
Foot Check
Each Visit
Have your health care provider do these tests and set goals with you.
(Record dates and results in the boxes below.)
(Cut here if you want to take only this page to visits with your health care provider.)
Foot Check
Blood Pressure
(goal:___ /___mm Hg)
Weight/Goal
(pounds)
A1C
Test/Goal (%)
Have your health care provider do these tests and set goals with you.
(Record dates and results in the boxes below.)
Each Visit
! (Cut here if you want to take only this page to visits with your health care provider.)
96
97
Blood Pressure
(goal:___ /___mm Hg)
Weight/Goal
(pounds)
A1C
Test/Goal (%)
Foot Check
Each Visit
Have your health care provider do these tests and set goals with you.
(Record dates and results in the boxes below.)
(Cut here if you want to take only this page to visits with your health care provider.)
Foot Check
Blood Pressure
(goal:___ /___mm Hg)
Weight/Goal
(pounds)
A1C
Test/Goal (%)
Have your health care provider do these tests and set goals with you.
(Record dates and results in the boxes below.)
Each Visit
! (Cut here if you want to take only this page to visits with your health care provider.)
98
and nerves).
Total cholesterol.
High-density lipoprotein (HDL).
Low-density lipoprotein (LDL).
Triglycerides.
e
l
p
m
a
S
338
Foot Exam
2 cigars
5 cigars a day
250
40
135
300
35
140
Tobacco Use
Triglycerides (mg/dL)
190
30
150
175
Urine Protein or
Microalbumin (mg)
Flu Shot
Have your health care provider do these tests and other services for you.
You may want to set some goals for these.
(Record the dates and results in the boxes below.)
! (Cut here if you want to take only this page to visits with your health care provider.)
100
101
Tobacco Use
Triglycerides (mg/dL)
Urine Protein or
Microalbumin (mg)
Flu Shot
Foot Exam
Have your health care provider do these tests and other services for you.
You may want to set some goals for these.
(Record the dates and results in the boxes below.)
(Cut here if you want to take only this page to visits with your health care provider.)
Foot Exam
Tobacco Use
Triglycerides (mg/dL)
Urine Protein or
Microalbumin (mg)
Flu Shot
Have your health care provider do these tests and other services for you.
You may want to set some goals for these.
(Record the dates and results in the boxes below.)
! (Cut here if you want to take only this page to visits with your health care provider.)
102
103
Tobacco Use
Triglycerides (mg/dL)
Urine Protein or
Microalbumin (mg)
Flu Shot
Foot Exam
Have your health care provider do these tests and other services for you.
You may want to set some goals for these.
(Record the dates and results in the boxes below.)
(Cut here if you want to take only this page to visits with your health care provider.)
Foot Exam
Tobacco Use
Triglycerides (mg/dL)
Urine Protein or
Microalbumin (mg)
Flu Shot
Have your health care provider do these tests and other services for you.
You may want to set some goals for these.
(Record the dates and results in the boxes below.)
! (Cut here if you want to take only this page to visits with your health care provider.)
104
105
106
Daily Log
Use this log sheetor one like it that your health care provider may
give youto keep a record of your daily blood glucose levels.
107
Daily Log
Sample
Use this log sheetor one like it that your health care provider may
give youto keep a record of your daily blood glucose levels.
108
Daily Log
Use this log sheetor one like it that your health care provider may
give youto keep a record of your daily blood glucose levels.
109
110
111
Dentist
Name: __________________________________________
Telephone number: _______________________________
Your questions: ___________________________________
________________________________________________
________________________________________________
________________________________________________
Important points: _________________________________
________________________________________________
________________________________________________
__________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
112
113
114
Counselor
Name: __________________________________________
Telephone number: _______________________________
Your questions: ___________________________________
________________________________________________
________________________________________________
________________________________________________
Important points: _________________________________
________________________________________________
________________________________________________
__________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
115
Other
Name: __________________________________________
Telephone number: _______________________________
Your questions: ___________________________________
________________________________________________
________________________________________________
________________________________________________
Important points: _________________________________
________________________________________________
________________________________________________
__________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
116
Glossary
A1CA test that sums up how much glucose has been
sticking to part of the hemoglobin during the past 34
months. Hemoglobin is a substance in the red blood
cells that supplies oxygen to the cells of the body. the
AIC goal for patients in general is an AIC goal of less
than 7%. The AIC goal for the individual patient is an
AIC as close to 6% as possible without a considerable
amount of low blood glucose.
ACE inhibitorA type of drug used to lower blood
pressure. Studies indicate that it may also help prevent
or slow the progression of kidney disease in people with
diabetes. ACE is an acronym for angiotensin-converting
enzyme.
autoimmune processA process where the bodys
immune system attacks and destroys body tissue that it
mistakes for foreign matter.
beta cellsCells that make insulin. Beta cells are found
in areas of the pancreas called the Islets of Langerhans.
bladderA hollow organ that urine drains into from the
kidneys. From the bladder, urine leaves the body.
blood glucoseThe main sugar that the body makes
from the food we eat. Glucose is carried through the
bloodstream to provide energy to all of the bodys living
cells. The cells cannot use glucose without the help of
insulin.
117
118
119
122
123
125
126
Resources
The following is a list of organizations that can provide
information on diabetes. Ask your health care team to
help you find other resources for information or support.
American Association of Diabetes Educators
100 West Monroe, Suite 400
Chicago, Illinois 60603-1901
800-832-6874
800-338-3633 (for names of diabetes educators)
http://www.diabeteseducator.org
American Diabetes Association
1701 N. Beauregard Street
Alexandria, Virginia 22311
703-549-1500
800-ADA-ORDER to order publicationstoll free
800-342-2388 (800-DIABETES) for diabetes
information
http://www.diabetes.org
American Dietetic Association
216 West Jackson Boulevard, Suite 800
Chicago, Illinois 60606-6995
800-745-0775
800-366-1655 (Consumer Nutrition Hotline,
Spanish speaker available)
http://www.eatright.org
American Heart Association National Center
7272 Greenville Avenue
Dallas, Texas 75231
214-373-6300
http://www.americanheart.org
127
Others:__________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
130
Others:__________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
131
132
133
134
135
136