Because GLP-1 receptor agonists affect insulin production, Ozempics safety information label says patients should tell their healthcare provider about any other drugs they may be taking to treat diabetes, like insulin or sulfonylureas. Also, ask your doctor or pharmacist to explain the symptoms of low blood sugar and how to manage these episodes. During your Ozempic treatment, consider keeping notes on any side effects youre having, especially episodes of hypoglycemia (low blood sugar). eHealthMe is studying from 29,077 Jardiance users for its effectiveness, alternative drugs and more. Just like other drugs, it can Jardiance is used to control blood glucose levels and protect the heart in people with type 2 diabetes mellitus. These symptoms could be life threatening and require immediate medical care. Here is a table comparing the efficacies of Ozempic and Jardiance in patients with cardiovascular diseases: Patients: T2DMand high cardiovascular risk, Results: 26% reduction in the risk of major adverse cardiovascular events (MACE) (primarily stroke), Results: 14% reduction in the risk of MACE (primarily cardiovascular death), 50% reduction in the risk of kidney failure, dialysis, or kidney transplantation compared to a placebo [Ref]. People taking Ozempic can also take insulin to manage type 2 diabetes. May 12, 2023, 11:38 am, Here is a list of the commonly asked questions about Mounjaro. May 13, 2023, 12:29 pm, Weight loss transformation Before and after Mounjaro pics are collected from social media and posted here for motivation and inspiration. Symptoms include stomach pain, unusual tiredness, trouble breathing, Kidney problems e.g. A boxed warning alerts doctors and patients about drug effects that may be dangerous. Empagliflozin blocks this protein from working, reducing how much sugar your kidneys recycle. Its unclear if the drug also increases thyroid cancer risk in humans. The American Diabetes Association (ADA) guidelines recommend using the medications in. Taking Ozempic: What foods should you avoid? It is used for the treatment of type 2 diabetes to prevent glucose levels from rising after eating, by slowing the rate of digestion and helping the release of insulin in your body. May 19, 2023, 9:52 am, Mounjaro, also known as Tirzepatide, is a powerful medicine commonly used to treat diabetes. Available for Android and iOS devices. 2023 Healthline Media LLC. Ozempic may not be right for you if you have certain medical conditions or other factors that affect your health. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. This raises your blood sugar level. Diabetes is much more than just having high blood glucose levels e.g. Here you'll find all collections you've created before. What is glucagon and how is it used? It is especially indicated for obese diabetic patients with cardiovascular disease and uncontrolled blood glucose despite metformin. To learn more, see the Ozempic prescribing information. Learn more: What is Ozempic used for and how does it work? If you drink alcohol, talk with your doctor about how much may be safe for you to drink with your condition and treatment plan. Ozempic has a boxed warning about the possible risk of thyroid cancer. Severe allergic reactions to the medication e.g. They're also often prescribed for people with heart failure. They can advise you on which of these drugs may be best for you, or if another diabetes treatment may be more suitable. Rybelsus and Ozempic may not be right for you if you have certain medical conditions or other factors that affect your health. Rybelsus isnt approved by the FDA for this use. Doctors usually will not prescribe. It is a human hormone that acts on different parts of your body. For many people, metformin is a first-choice treatment for Type 2 diabetes, in addition to lifestyle changes. GLP-1 agonists such as Rybelsus and Ozempic are included in American Diabetes Association (ADA) guidelines for treating type 2 diabetes. Dr. Ahmed Swanson said patients who were on high doses of insulin before taking Ozempic, or patients who are already experiencing hypoglycemia to begin with, might be directed to reduce the amount of insulin theyre taking if theyre about to take a GLP-1 receptor agonist. Its main action involves changing the gut hormones in the body. Higher doses of Ozempic may worsen stomach side effects. Ozempic (semaglutide) is a brand-name injection that's prescribed to treat type 2 diabetes in adults. See. Note: For more information on type 2 diabetes, see our list of diabetes articles. Avoid excessive salt (sodium) in your diet. The high cost of diabetes drugs Ozempic prices can be very expensive without insurance. Avoid sugar-sweetened beverages (including fruit juice, sodas, teas and coffee drinks). Rybelsus (semaglutide) tablets, for oral use. MNT is the registered trade mark of Healthline Media. With Rybelsus, youll usually take 3 milligrams (mg) once per day for the first 30 days. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. These people have truly put in the effort and hard work to achieve their weight loss goals, and its amazing to see the results of their dedication. Acute pancreatitis usually lasts for a short period of time and goes away after treatment. Also, chronic (long-term) alcohol consumption is a common cause of pancreatitis (swelling of the pancreas). You can take Ozempic and metformin together or separately. find a walking buddy to make it fun, take a daily lunchtime walk, use the stairs instead of a lift, and set a daily step goal, Eating a healthy diet. Switch to the light mode that's kinder on your eyes at day time. Here are 14 natural ways to boost your insulin, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Note: Ozempic isnt used to treat type 1 diabetes or diabetic ketoacidosis, a serious diabetes complication. Diabetic retinopathy. If youre considering starting Rybelsus or Ozempic treatment for type 2 diabetes, or switching from one drug to the other, talk with your doctor. In addition to boxed warnings, Rybelsus and Ozempic have other warnings. Its a place where people with certain conditions can find support and connect with others. Ozempic is given by subcutaneous injection (an injection under your skin). Speak to your doctor and loved ones for help. It is not known if this drug passes into breast milk. The table below compares the efficacies of Ozmepic and Jardiance in lowering A1C and body weight: Ozempic has an A1C lowering effect almost double that of Jardiance. gabapentin hydrochlorothiazide Jardiance (empagliflozin) levothyroxine lisinopril losartan magnesium oxide meloxicam metformin metoprolol montelukast This is an important benefit given that people with type 2 diabetes are at a higher risk of heart disease. The Food and Drug Administration (FDA) has approved Rybelsus and Ozempic for some of the same uses, as well as different ones. Extensive studies in the US (the Diabetes Control and Complications Trial) have shown that any improvement in blood glucose control will reduce your risk of developing complications. Erectile dysfunction (ED) is often a symptom . Learn about the different types of diabetes and how their treatment plans differ. Ozempic is not used to treat, Lower the risk of a heart attack in type 2 diabetics. If youre breastfeeding or planning to breastfeed, talk with your doctor about the risks and benefits of using Ozempic. If youre experiencing hair loss, contact your doctor right away. 0.5mg once weekly The less [insulin] that you can take, the better.. If its not, your doctor will check for other causes and discuss treatment options with you. We'll tell you what you need to know. Eat on a regular schedule, manage your portion size and limit snacking in-between meals. Ask your doctor if you should follow a low-sodium diet. Originally, Sotagliflozin was approved in 2019 by the EMA (European Medical Agency) for treating patients with Type 1 Diabetes under the brand name Zynquista. June 3, 2023, 9:26 pm, by Before starting treatment, talk with your doctor about your risk for serious side effects from this drug. Does not cause hypoglycemia but there is a risk if used in combination with insulin and sulfonylureas, 35% reduction in the risk of hospitalization due to heart failure compared to a placebo [, 25% reduction in the risk of hospitalization due to heart failure compared to a placebo [, Lower the risk of hospitalization due to heart failure by 35%, Lower the risk of hospitalization due to heart failure by 25%, 39% reduction in the risk of nonfatal stroke compared to placebo [, 24% reduction in the risk of stroke compared to placebo [. Some of the drugs studied include birth control pills, heart medications, blood thinners and cholesterol medications, she says. May 30, 2023, 5:54 am, Mounjaro is a medication that works similarly to other drugs like Ozempic, Trulicity, and Victoza. The makers of Ozempic say that taking the drug alongside insulin or other diabetes medications might increase the chance of low blood sugars. To reach your blood sugar goals while using Ozempic, you should follow the nutrition guidelines that your doctor recommends. Mounjaro and Farxiga or Jardiance Together: Pros and Cons. These drugs havent been directly compared in clinical studies. Last updated on Oct 7, 2022. Both Rybelsus and Ozempic have a boxed warning. Trans fats are now prohibited from processed foods in the U.S. Limit the amount of red meat you consume, which can be high in fat content. Ozempic has caused thyroid cancer in animals. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Our website services, content, and products are for informational purposes only. By Laura Hensley With a focus on managing obesity, diabetes, hypertension, asthma, depression, arthritis, migraine, high cholesterol levels, and many more medical conditions in his patients, he shares his knowledge and expertise through writing health-related articles for dibesity.com. Dr. Ahmed Over the last few years, new potassium-binding resins have been approved which are considered safer than kayexalate and may be more [] More, by Introduction Ozempic (semaglutide) is a brand-name prescription drug used to manage blood sugar levels in adults with type 2 diabetes. They may suggest an OTC treatment to manage your symptoms. This is a myth if you thought this was a trap and you can not discontinue it. But if you have any symptoms that are ongoing or that bother you, talk with your doctor or pharmacist. The active ingredient in Ozempic is semaglutide. This article explains the main similarities and differences between Rybelsus and Ozempic. Center your meals around lean protein such as chicken and turkey and healthy natural fats such as nuts, seeds, avocados, salmon, flaxseeds, and extra virgin olive oil, Reduce smoking. Can diet and exercise reverse prediabetes? If you have diabetes, you're used to checking whether certain foods are OK to eat. Dosing is available in 10 mg and 25 mg empagliflozin tablets. Baqsimi is a prescription drug your doctor may prescribe to treat severe hypoglycemia (low blood sugar), which diabetes medications such as Ozempic may cause. If the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist. Follow your prescribed diabetes treatment plan, including your meal plan, to keep your blood sugar in a healthy range. Dr. Ahmed Visit www.fda.gov/medwatch or call 1-800-FDA-1088. Talk with your doctor. If so, your doctor will prescribe another diabetes treatment. angiotensin-converting enzyme (ACE) inhibitors, Ozempic Interactions: Alcohol, Medications, and Others. If any of these effects last or get worse, tell your doctor or pharmacist promptly. (2020). Ozempic can cause side effects in some people. Here are some of the most widely used medications: Over time as a type 2 diabetic, your medication will change as your diabetes progresses. If we talk about how quickly Mounjaro starts working for diabetes, it should be remembered that Mounjaro [] More, by Or you can try OTC glucose gels or chewable glucose tablets. You may also like to read: Interactions may not be a major issue. Thyroid medication is a drug that is really dependent on how much gets absorbedits very dependent on its movement through the GI tract, Swanson said. Thismay be due to the fact that taking a drug like Ozempic can improve glucose levels over time, lessening a patients reliance on injectable insulin. While using Ozempic, watch for pancreatitis symptoms, such as: Contact your doctor right away if you experience any of these symptoms. (2020). Thank you, {{form.email}}, for signing up. 2023 Healthline Media UK Ltd, Brighton, UK. If youre interested in learning more about Saxenda or other weight-management treatments, talk with your doctor. If you have diabetes, you'll likely experience fatigue at some point. May 18, 2023, 6:35 am, by Taking Ozempic with either insulin or a sulfonylurea might be problematic because youre essentially using two medications that work to lower blood sugar, Andrea Swanson, PharmD, an assistant professor in the Leslie Dan faculty of pharmacy at the University of Toronto, told Verywell. Last medically reviewed on November 7, 2022. Although most experts believe that Mounjaro and Ozempics faces are purely the result of significant rapid weight loss, there is also [] More, by If your blood sugar gets too low, it can cause symptoms or serious health problems. Phentermine may be a more accessible option to help you lose weight, but it should only be used for a few weeks. Ozempic can be taken with or without food. In general: Your doctor may suggest that you see a registered dietitian to help learn about healthful food choices and meal planning, and address any poor food habits. It is injected once per week subcutaneously (under the skin) of your stomach (abdomen), thigh, or upper arm, on the same day each week. 9: Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes 2021. Jardiance in particular is not associated with hypoglycemia even if used in combination with insulin or sulfonylureas. How do Mounjaro, Wegovy & Ozempic compare for weight loss? You can inject at any time on that day. Could a new blood biomarker help predict Alzheimer's risk? No, Ozempic shouldnt cause hair loss. Theyll review your personal health history, as well as the potential positives and negatives of both drugs. If your burping is related to acid reflux or indigestion, your doctor may suggest an OTC antacid, such as Pepcid (famotidine) or Tums (calcium carbonate tablets). On May, 11, 2023 533 people who take Jardiance and Ozempic together, and have interactions are studied. Avoid trans fats and saturated fats (whole milk, butter, cream, cheese, ice cream, red meats). If you have a personal or family history of thyroid cancer. A healthcare professional from your diabetes care team will advise you on the correct way to inject. Plainsboro, NJ. What is Jardiance? Eating a poor diet can increase your weight, blood pressure, and cholesterol. Talk with your doctor about your specific risk for side effects from this drug. Continue reading to learn about the drugs effectiveness, cost, and more. Baqsimi contains glucagon, a hormone that your body normally makes. Symptoms of pancreatitis include severe abdominal pain /stomach pain, nausea, and vomiting that doesnt stop, Very low blood sugar (hypoglycemia) causing shakiness, fast heartbeat. According to Wharton, reducing the amount of injectable insulin due to Ozempic use can be a good thing. Drugs like Ozempic are supposed to be monitored over timenot prescribed without any followup. However, both Rybelsus and Ozempic have been found effective for helping improve blood sugar levels in people with type 2 diabetes when used with diet and exercise. How much Rybelsus or Ozempic costs depends on the treatment plan your doctor prescribes, your insurance plan, and your pharmacy. Does Medicare Pay for Insulin and Diabetes Medications? 2016;29(3):152160. Baqsimi is a nasal (nose) spray. These factors can affect your blood sugar and may make you more likely to have episodes of hypoglycemia. For example, in patients already using metformin, semaglutide injections (brand name Ozempic) were better at lowering HbA1c (a measure of glucose control over the previous two to three months) levels than other treatments. Novo Nordisk. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. In the EMPEROR-Reduced trial, Jardiance was associated with a 27% reduction in the risk of cardiovascular death compared to placebo. These are both digestive system side effects that can occur with Ozempic, too. Before using Rybelsus or Ozempic, talk with your doctor if any of the following conditions or health factors apply to you: To learn more about these drugs, see the in-depth articles on Rybelsus and Ozempic. What's the Difference Between Ozempic, Wegovy, and Mounjaro? We'll give you the facts on differences, similarities, causes, risk factors, treatment, and more. In these studies, Ozempic was either used alone or with other treatments for type 2 diabetes. But if youre taking prescription insulin in addition, that can be problematic because youre stimulating the bodys natural insulin when you eat, plus taking additional insulin.. Another diabetes drug, Saxenda (liraglutide), is approved for weight loss in people with type 2 diabetes. Some of these side effects are mentioned below. It causes your pancreas to secrete more insulin, helping to, Improve blood sugar levels in adults with type 2 diabetes mellitus alongside diet and exercise, Lower the risk of cardiovascular death from a heart attack, stroke, or, Ozempic and Jardiance belong to different drug classes and work in the body differently. However, one should have at least some knowledge about these types of diabetic emergencies to identify them at the earliest. For information about how these drugs performed in clinical studies, see the prescribing information for Rybelsus and Ozempic. Ozempic only stimulates insulin release after you eatso [youre] in a state of high glucose, and youre just lowering it, Swanson said. June 7, 2023, 10:21 am, Brand Name: Belsomra Drug Name: Suvorexant Blesomra Drug Class: Hypnotic, Orexin receptor inhibitor FDA Approval date: 13th August 2014 [Ref] Primary Indications: Insomnia Manufacturer: Merck and Co Orexin inhibitors used for the treatment of Insomnia, other than Belsomra include: Dayvigo (Lemborexant) Daridorexant (Quviviq) Belsomra (Suvorexant) Uses: Belsomra is an FDA-approved drug for the treatment of [] More, by Because of its superior efficacy, it has been approved for heart failure with preserved and reduced ejection fraction (HFpEF and HFrEF). May 30, 2023, 6:29 am, by It has also been approved for non-diabetic patients with heart failure with preserved and reduced ejection fraction (HFpEF and HFrEF). Also, the drug can be taken with or without food. These guidelines recommend GLP-1 agonists as an additional treatment option when metformin doesnt lower blood sugar enough. Ozempic and Erectile Dysfunction: Treatment and Reviews. They may adjust your insulin regimen or your dosage of other diabetes drugs to help prevent low blood sugar with Ozempic. Accessed Oct. 7, 2022 at, Patient education: Delahanty L (author). Factors to consider include those in the list below. The two drugs share some of the same warnings, but they also have different ones. Investigating the power of music for dementia. However, the ADA recommends only drugs with proven heart benefits and FDA-approval for this use. However, Ozempic is used to improve blood sugar levels in adults with type 2 diabetes, and its used along with diet and exercise. Ozempic vs. Victoza: Which Is Better for Me? However, to lower the possible risk of thyroid cancer, dont use Ozempic if: While using Ozempic, tell your doctor right away if you have symptoms of thyroid cancer, such as: If youre diagnosed with thyroid cancer, your doctor will stop your Ozempic and adjust your diabetes treatment plan. May 24, 2023, 11:23 am, by Keep reading to learn more. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). The costs of prescription drugs in the United States are the highest in the world. Rybelsus and Ozempic are both brand-name drugs. Mounjaro vs Ozempic: How do they compare? Its given as one spray into one nostril during an episode of severe hypoglycemia. But overall, taking Ozempic with other medications is relatively safe based on what we know so far. Ozempic (semaglutide) injection, for subcutaneous use. Sulfonylureas work by encouraging the pancreas to release insulin to help lower blood sugar levels, so it can pose the same problem as insulin for Ozempic users. This makes you lose more sugar in your urine, rather than it being recycled back into your blood. The injections will be in your belly, thigh, or upper arm. Ozempic is approved to decrease the risk of major heart problems in people with type 2 diabetes and heart disease. Like all drugs, Ozempic may cause side effects in some people. These are known as contraindications. lack of exercise and excess body weight can contribute to type 2 diabetes. I have IBS: What Impact Would Mounjaro Have on My Gut? Diabetes Spectr. If you develop new or worsening kidney problems, they may stop your treatment. And tell them if you gain or lose a lot of weight. Using Ozempic with insulin or other diabetes drugs may raise your risk for severe hypoglycemia. They also suppress appetite by slowing down the digestive system, leaving patients fuller for longer. * Rybelsus and Ozempic have a boxed warning for the risk of thyroid C-cell tumors. How should I manage injection-site reactions with Ozempic. Note: For more information about the cost of either drug, see our articles on Rybelsus and Ozempic. What Are Target Blood Sugar Levels for Older Adults? The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. There is usually a combination of a part failure of insulin production and a reduced response to the hormone. This may necessitate a lower dosage of Ozempic. Chronic pancreatitis may develop with continued damage to the pancreas over time. This is the most serious warning from the Food and Drug Administration (FDA). After 4 weeks, your doctor will likely increase your dose to a 0.5-mg injection once a week. Below is a brief overview of the medications that may interact with Ozempic. If you have, you could have an allergic reaction to Ozempic, which could be severe. You should avoid regular consumption of foods high in fat, sugar and calories. Type 1 and Type 2 Diabetes: Whats the Difference? Some may be easily managed, too. Epkinly is the brand name of a novel drug called Epcoritamab-bysp. If the side effects feel life threatening, or if you believe youre having a medical emergency, call 911 or your local emergency number right away. Include fresh fruits, vegetables, whole grains, legumes, and low- or non-fat dairy products. (See Hypoglycemia below to learn more.). Switch to the dark mode that's kinder on your eyes at night time. Serious side effects of Ozempic can include: * To learn more about this side effect, see the Side effects explained section below. Ozempic and other drugs like Wegovy and Mounjaro are being touted as safe and effective medications to treat type 2 diabetes and aid in weight loss in patients who are overweight or obese. 1. If you have diabetes, you have a higher risk of developing high cholesterol. updated: Feb 12, 2021. Oral medications Contacting your provider Bottom line References martin-dm/E+ via Getty Images Ozempic (semaglutide) is a popular once-weekly injectable used to treat Type 2 diabetes. Read the medication guide and instructions for use that come with Jardiance for the full drug information. You can start having your Ozempic injections the day after your last dose of Rybelsus. But because fairly common side effects of Ozempic include nausea and vomiting, theres a possibility patients wont be able to keep other medications down, Tom Elliott, MBBS, FRCPC, medical director of BCDiabetes, told Verywell. With Ozempic, youll usually start with a 0.25-mg injection once a week. Replace with monounsaturated and polyunsaturated fats (fish, olive oil, nuts). Dr. Ahmed Your doctor may monitor your kidney health closely during your Ozempic treatment. This side effect is more common if you use Ozempic along with insulin or other diabetes drugs. Some of the key points to consider when comparing the drugs include: If youd like to learn more about Rybelsus or Ozempic, talk with your doctor or pharmacist. June 7, 2023, 11:59 am, Drug Name: Daridorexant Brand Name: Quviviq FDA Approval Date: 7th January 2022 [Ref] Manufacturer: Idorsia Pharmaceuticals US Inc. Primary Indication: Insomnia Daridorexant (Quviviq) is an Orexin receptor inhibitor. Blocks the reabsorption of glucose by the kidneys. If you miss your weekly dose of Ozempic and there are less than 3 days until your next dose, do not take the missed dose. Ozempic is given as a, Ozempic is approved to reduce the risk of. But with any medication, there always comes caution and there are always side effects to consider.. Accessed Oct 7, 2022 at, Type 2 diabetes. If you have diabetic retinopathy, using Ozempic may make it worse. Jardiance has other uses as well. Significant reduction in the risk of all-cause mortality compared to placebo. What Diabetes Medication Causes Weight Gain? Diabetes medication is the main way to prevent complications and gain glycemic control but the huge number of medications available can be overwhelming. [] More, The FDA on 19th May 2023 approved a novel biological drug by the name of Epkinly. After that, your doctor will typically increase your dose to 7 mg once per day. It is classed as a glucagon-like peptide-1 receptor agonist (GLP-1 receptor agonist). If your doctor confirms you had a mild allergic reaction to Ozempic, theyll decide if you should continue using the drug. If you have questions about whether you need a prescription for Baqsimi, talk with your doctor. Dr. Ahmed If you're using or plan to use Ozempic Injection as a treatment option for diabetes or weight loss, you should tell your doctor about all other medications you take daily. Of the class members, Rybelsus is the only oral option, allowing you to take a daily pill instead of a daily or weekly injection. Before starting Ozempic, tell your doctor if you take insulin or any other medications. Using Ozempic may raise your risk for pancreatitis, too. Ozempic (semaglutide) belongs to a class of drugs called glucagon-like peptide 1 (GLP-1) receptor agonists, Sean Wharton, MD PharmD, an assistant clinical professor of medicine at McMaster University in Hamilton, Ontario, told Verywell. See additional information. Before starting Ozempic, tell your doctor about all medications you take. You should always speak to your doctor regarding the risks and benefits of any treatment. Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, A Guide to Living with Diabetes and High Cholesterol, This Is the Best Time of Day to Exercise for People with Type 2 Diabetes, Continuous Glucose Monitors (CGMs) May Diagnose Prediabetes Earlier Than Blood Sugar Tests, Top Natural Ways to Improve Your Insulin Sensitivity, help lower blood sugar levels in adults with type 2 diabetes (when used with diet and exercise), help reduce the risk for certain cardiovascular problems (related to the heart or blood vessels) in adults with type 2 diabetes and, injection-site reactions, such as skin redness, discoloration, or discomfort, damaged hair follicles from long periods of high blood sugar or poor circulation, stress from managing a chronic (long-term) condition, having hypothyroidism (low thyroid hormone levels) along with diabetes, you have a rare genetic condition called multiple endocrine neoplasia type 2, abdomen (belly) pain that may radiate to your back, swelling under your skin, typically in your eyelids, lips, hands, or feet, swelling of your mouth, tongue, or throat, which can make it hard to breathe, what dose of drug you were taking when you had the side effect, how soon after starting that dose you had the side effect, what your symptoms were from the side effect, what other medications you were also taking, any other information you feel is important. 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