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When glucose enters the blood, it binds to a red blood cell protein called hemoglobin. A C-peptide test can also help find the cause of low blood sugar (hypoglycemia), such as excessive use of medicine to treat diabetes or a noncancerous growth (tumor) in the pancreas (insulinoma). Low blood sugar or hypoglycemia is a complication of type 1 and type 2 diabetes. Initial A1C tests help physicians work out an individual's baseline A1C level for later comparison. Here's what you should aim for instead. “Any condition that prolongs the life of the erythrocyte or is associated with decreased red cell turnover exposes the cell to glucose for a longer period of time, resulting in higher A1c levels. 1). Low hemoglobin A1c (<4.0%) was associated with an increased risk of all-cause mortality. A slight decrease in hemoglobin does not necessarily indicate an illness. Published online before print May 26, 2011, doi: 10.2337/db11-0085 You can read a good explanation of what this study means in this report from Science Daily: Science Daily: Super-Sticky 'Ultra-Bad' Cholesterol Revealed in People at High Risk of Heart Disease In brief the finding is this: LDL becomes dangerous mostly when it becomes glycated--i.e. Symptoms include anxiety, sweating, palpitations, nausea, and weakness. What is an A1C test? Often, that means trying to get their HbA1c, a measure of long-term blood sugar levels, under 6.5. How Much Should I Eat Daily To Control My Blood Sugar Levels With Diabetes? A1C tests are done using blood obtained by a finger prick or blood draw. FARXIGA, combined with diet and exercise, was studied alone as well as in combination with other diabetes medicines you may be taking. If your A1C test result is falsely low, your doctor may think your diabetes is well controlled even though it isn’t. A person with type 2 diabetes can have a normal or high level of C-peptide. Continue reading >>, Ads by Google Wise men learn from other men's mistakes; fools insist on learning from their own. In hyperinsulinemia the pancreas produces more insulin than normal so there are higher levels of insulin circulating in the blood stream. What is Hemoglobin A1c (HbA1c) Test for Diabetes? Further investigations revealed that the patient was heterozygous for a rare Hb variant, namely Hb Iraq-Halabja (β10 Ala→Val). Bone marrow conditions - include leukemia, multiple myelomas (plasm RESEARCH DESIGN AND METHODS Prospective cohort study of 13,288 participants in the Atherosclerosis Risk in Communities Study. A1C can be increases or decreases by various factors; they are: Decrease or increase in erythrocyte (RBC) makes your A1C lower or increase respectively. Insulin also helps to pack glucose into the fat cells as triglycerides. In non-randomised data, values of HbA1c that are either <6.5% or >9.0% may be associated with increased mortality within one year in clinical type 2 diabetes. 2). Aspirin interfered with some assay methods and falsely increasing result. When is the A1c unreliable? Diabetes dilemma: Prevalent disease is on rise, but it's largely preventable, Diabetes’ JDRF Tries Shock Ad to Push the FDA, World's first diabetes app will be able to check glucose levels without drawing a drop of blood and will be able to reveal what a can of coke REALLY does to sugar levels. If you have an uncommon form of hemoglobin (known as a hemoglobin variant), your A1C test result may be falsely high or falsely low. Amphetamine “one of the illegal drugs” can cause Urine Sugar Levels to increase. If your once-controlled A1c has spun out of control despite your best efforts, it’s possible you don’t have type 2 diabetes at all. Continue reading >>, Heart disease is the leading cause of death for people with Type 2 diabetes. Fasting for the blood test is not necessary. 2017 Mar 16;16(3):381-398. doi: 10.1039/c6pp00294c. HbA1c may be separated by charge and size from the other hemoglobin A components in blood by a procedure called high pressure (or performance) liquid chromatography (HPLC). The test for hemoglobin A1c depends on the chemical (electrical) charge on the molecule of HbA1c, which differs from the charges on the other components of hemoglobin. American Diabetes Association (ADA) recommends that adults aim for an A1c level of <7.0%, and highlight that this goal may be adjusted Elevated hemoglobin F has an association with thalassemia syndromes, also affects some assay methods. Most fruits, like apples, for instance, have high fiber content and are useful in controlling blood sugar. Hemoglobin E trait affects 10% to more than 50% of Southeast Asians in California. What Are Normal Levels of Hemoglobin A1c (Chart)? Chronic alcohol abuse produces a false high. Therefore, a hemoglobin (Hb)2 A1c analysis was performed. The A1C test is the primary test used for diabetes management.1 Before we can tackle the problem, we must understand what causes the increase in A1C levels. Structured Diet Plan Improves A1c in Type 2 Diabetes _____________________________________________________________________________________________________________________________________________________ Q1. Chart of Normal and Elevated HbA1c Levels Diagnosis* A1C Level *Any test for diagnosis of diabetes requires confirmation with a second measurement unless there are clear symptoms of diabetes. The oft-demonstrated close correlation between A1c and heart attack suggests that this dangerous glycation of LDL occurs at the same rate as the glycosylation of red blood cells--which what the A1c test measures. Finally, Robertson et al. This goes a long way to explaining why there is such a poor correlation between measured LDL levels and the occurrence of heart attack. Insulin and some oral medicines use my result at the lab, fasting, was 32mg/dL. Does it have any relationship with extremely low blood glucose? The ADA recommend that maintaining fair control Falsely Lowered A1c Continue reading >>, Abstract This study aimed to evaluate mortality within 365 days of HbA1c values of <6.5% or >9.0% in participants with clinical type 2 diabetes mellitus. The inability of the body’s cells to utilize the insulin is called insulin resistance. Though the makers of expensive statin drugs have brainwashed doctors into believing that high cholesterol translates into high risk of heart attack quality research has never borne this out--just as it hasn't borne out the idea that lowering cholesterol with statin drugs will prevent heart attacks in the general population. Previously i had been unable to type. Continue reading >>, Although hemoglobin A1c is usually the best test to estimate the average glycemic control in patients with diabetes, it is unreliable in some clinical circumstances. Why do some doctors still recommend the lower number? Causes of Low Hemoglobin Count. A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes, Common Insulin Pen Errors: Diabetes Questions & Answers, Diabetes: Heart attack risk due to loss of small blood vessels around the heart, Newly published research provides new insight into how diabetes leads to retinopathy. Also evident was another large peak (53.0%) that eluted earlier than Hb A, which we called P2. Moreover, fiber in the fruits take longer to digest and that prevents you from feeling hungry quickly. Even understanding the chemistry at work — the drugs act in very different ways to lower bl *Expect falsely low A1c values through the 2nd trimester, but may rise during the 3rd trimester. While there were no additional HbA1c measurements in the intervening 17 months, a gradual decrease in total hemoglobin concentration over the prior 9 months was noted ( Figure 1 ), and his physician was concerned about … To do this, an A1C test averages the percentage of sugar-bound hemoglobin in a blood sample. A C-peptide test is done to: Help tell the difference between type 1 diabetes and type 2 diabetes. The HbA1c test. Continue reading >>, The evidence has been accumulating throughout the past decade that the A1c test is a much better predictor of heart attack than any test of cholesterol levels. 2014;29(2):388-394. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912281/, Am Fam Physician. Hemoglobin decreases slightly during normal pregnancy. But before we get into that, let's briefly go over why A1Cis used to approximate average glucose over ~3 months: 1. High bilirubin interferes with some assay methods and increases result. Active blood infection “sepsis” often come with hyperglycemia without increase in HbA1c results. 2008 reported an additional cause of falsely low A1C in a patient with type 2 diabetes and chronic hepatitis who was taking ribavirin. A: A1c represents the percent of hemoglobin A with glucose bound to it. In people with metabolic disorders or obesity insulin levels remain elevated. Relative risks may be higher at younger ages. Real patients. VIKAS AGGARWAL, MD 1 ANDREA L.C. When the riba - virin was stopped, the patient’s A1C In fact, according to the American Diabetes Association (ADA), about 10 percent of people diagnosed with type 2 diabetes actually have latent autoimmune diabetes (LADA). But in fact, for several years now diabetes experts have known that for most people that's not only unnecessary, but potentially harmful. Long-term studies have also shown that early and intensive blood glucose control can reduce cardiovascular complications in people with type 1 or 2 diabetes. Kale. An A1c level of 5.5% to 6.0% means an 86% higher risk of … If you have kidney failure on dialysis, A1C levels may not be the best way to monitor your diabetes. Blood donations can make your A1C test inaccurate either way 2. It's usually caused by diabetes medications; however foods, drinks, exercise, and stress also can cause it. In studies, FARXIGA: Additionally, FARXIGA may help you: Do not take FARXIGA if you: have severe kidney problems or are on dialysis. In select patient populations, measuring fructosamine and glycated albumin levels may also be useful. Because HbA1c is not affected by short-term fluctuations in blood glucose concentrations, for example, due to meals, blood can be drawn for HbA1c testing without regard to when food was eaten. I soon found that i had very impaired coordination. Continue reading >>, A 52-year-old woman with a medical history of hepatitis B, hyperlipidemia, hypertension, anemia, and depression presented to the internal medicine clinic for a routine visit. Hyperinsulinism; Meals high in refined carbohydrates such as white bread or foods high in sugar; Prediabetes; Any surgery of the digestive system; What are the signs and symptoms of non-diabetic hypoglycemia? This condition need immediate treatment. Now scientists have discovered a mechanism that may explain why this is the case. Hemoglobin is the same protein that carries oxygen in your bloodstream, and it is what gives blood its red color 3. HbA1c testing is done on a blood sample. As more glucose (blood sugar) circulates in the blood on a daily basis, more glucose is bound to the circulating hemoglobin. The higher blood glucose levels are, the more hemoglobin is bound. Basically, I’d rather see someone with an A1c of 6.9% and low blood sugar variability than an A1c of 6.2% with lots of variability” Gary Scheiner, MS, CDE: Insulin weight gain-understanding diabetes better, Diabetes: New compounds may lower blood sugar but prevent weight gain, Diet drinks and food actually trigger weight gain and diabetes, says new study, Why Drinking Tea May Help Prevent and Manage Type 2 Diabetes, Omega-3s may help to treat type 1 diabetes, Why the ketogenic diet may help fight diabetes, cancer. References / Further Reading Some hemoglobin variants can affect some HbA1c methods, but not all of them. Here are specific foods that will help you lower A1C levels. There are 12 classes of drugs on the market and two or three different agents in each class. Some people adapt to slightly low hemoglobin count, like woman who are menstruating or pregnant. For instance, certain variants can cause falsely high or low A1C test results depending on the method used. Other medications have no effect on heart risk, while still others lower the odds of heart disease but may have other drawbacks, like high cost or side effects. If this newest research finding holds up, it may turn out that testing for glycosylated LDL will predict with good accuracy whose LDL levels put th Maybe downsize your weight loss goal. Continue reading >>, How Is Hemoglobin A1c Measured? It also can correlate with average glycemic control during the past 2 to 3 months. Studies in patients with and without diabetes have demonstrated that treatment of iron deficiency anemia lowers A1c, although the exact mechanism remains unclear. ~ Albanian Proverb 9 Undesirable Factors Affecting HbA1C test Any variation in the RBC (or erythrocyte) or hemoglobin may cause hba1c errors. Conditional logistic regression was used to model the odds ratio for mortality adjusting for comorbidity and drug utilisation. A subsequent Hb electrophoretic analysis at pH 6.0 (QuickGel Acid; Helena Laboratories) identified Hb S and another abnormal band with a mobility similar to Hb F (not shown). Lowering A1C levels Many studies have shown that lowering A1C levels can help reduce the risk or intensity of diabetes complications. Melons such as muskmelon, cantaloupe, watermelon, and honeydew are rich sources of potassium, anti-oxidants, vitamin C, and folate. Hemoglobin values as low as 2.8% were detected in this nationally representative study. Patients who are fighting back, sharing their challenges—and their successes—managing their type 2 diabetes. A diet comprising fresh organic veggies can transform our health positively. Unusual or discrepant HbA1c test results should prompt further investigations for potentially interfering factors, including rare Hb variants. This table is from J Gen Intern Med. These changes could cause low blood glucose, called hypoglycemia, or other side effects. Hemoglobin A1c levels should be below 5.6% yet more than one in five people test over 6%. A little doubt saves many a mistake. Many years ago I had a conversation with a research... 1. All this doesn't mean that controlling and measuring blood sugar levels is unimportant, says Marvin M. Lipman, M.D., Consumer Reports' chief medical adviser and an endocrinologist. You can find summaries of the major studies that have established this finding HERE. Whole fruits contain fiber, which helps in reducing the rate at which your body absorbs the sugar. The other medicines included metformin, glimepiride, pioglitazone, insulin, and sitagliptin. In general, low hemoglobin levels that need to be increased are caused by three circumstances: decreased red blood cell production (for example, altered bone marrow hemoglobin production, iron deficiency), increased red blood cell destruction (for example, liver disease), and by blood loss (for example, trauma from a gunshot or knife wound). Reactive hypoglycemia: The causes of reactive hypoglycemia may be unknown. The molecule of HbA1c also differs in size from the other components. The A1C test is a blood test based on the attachment of glucose to hemoglobin that provides data about a person’s average levels of blood glucose over a three-month period. Vegetables Vegetables are rich in many minerals, fiber, vitamins, anti-oxidants, polyphenols, and compounds that help lower blood sugar, A1C and inflammation. 2. If you have one of the double action anti-depressants such as Zyprexa and Cymbalta, therefore you may experience hyperglycemia but normal hemoglobin A1c. The risk associated with HbA1c <6.5% was age dependent. _______________________________________________________________________________________________________________________________________________________ Related Content Diabetes and Cardiovascular Disease: Does Lowering Hemoglobin A1c Help or Harm? There is a significant positive correlation between haemoglobin concentration and HbA1c in the patients with haemolytic anaemia. It is generally found in amounts equal to insulin because insulin and C-peptide are linked when first made by the pancreas. It is recommended that treatment of diabetes be directed at keeping an individual's HbA1c level as close to normal as possible (<6%) without episodes of hypoglycemia (low blood glucose levels). But as far back as 2008, studies were showing that people who lowered their HbA1c levels to under 6.5 had a higher risk of death than those whose levels were between 7 and 8. A1C tests are also used to monitor diabetes treatment plans. Insulin enables liver and muscle cells to take up blood sugar (glucose) for energy production or storage. Most people have only one type of hemoglobin, called hemoglobin A. Check to see whether a tumor of the pancreas (insulinoma) was completely removed. The analysis revealed the absence of Hb A and the presence of sickle cell Hb (Hb S) (37.4%), along with normal Hb A2 (3.2%) and Hb F (<1.0%) (Fig. In a complete case analysis, the adjusted odds ratio (AOR) for mortality associated with most recent HbA1c <6.5% was 1.31 (95% confidence interval (CI): 1.21,1.42). Patients with end-stage renal disease generally have falsely low A1c values. It seemed too good to be true. Many patients take more than one drug. A level of 6.5% signals that diabetes is present. Radin MS. Pitfalls in Hemoglobin A1c Measurement: When Results may be Misleading. Vitamin C & E ingestion interfere with some assay methods and decrease result. Our diet plays a vital role in controlling our blood sugar levels. That was about a month before the lab test. Two people can have the same A1C, one with steady blood sugar levels and the other with high and low swings. These Hb variants are all reported to affect some HbA1c assay methods. Editor: Heiner K. Berthold, Charité University Medicine Berlin, Germany Received: February 14, 2013; Accepted: May 24, 2013; Pub Studies have demonstrated that the complications of diabetes can be delayed or prevented if the HbA1c level can be kept below 7%. Laboratory tests 3 months previously had revealed an impaired fasting glucose concentration of 5.9 mmol/L (106 mg/dL) [reference interval, 3.9–5.6 mmol/L (70–100 mg/dL)]. Go to: Abstract To identify predictors of low hemoglobin A1c (HbA1c) (5.0%) and to investigate the association of low HbA1c with cause-specific mortality and risk of liver disease hospitalization. A person with an insulinoma will have a high level of C-peptide in the blood when they have a high level of insulin. In a condition called hyperinsulinemia the pancreas stimulates the uptake of glucose from blood into the body’s cells. This is the second report of this variant published in the literature. The study is Glycation of LDL by Methylglyoxal Increases Arterial Atherogenicity: A Possible Contributor to Increased Risk of Cardiovascular Disease in Diabetes. The studies had more than 11,000 adults with type 2 diabetes, including more than 6,000 patients treated with FARXIGA. Continue reading >>, Many people with type 2 diabetes are still told that to reduce their risk of heart disease and other complications, they should bring their blood sugar level down low—sometimes very low. You may be at a higher risk of dehydration if you have low blood pressure; take medicines to lower your blood pressure, including water pills (diuretics); are 65 years of age or older; are on a low salt diet, or have kidney problems FARXIGA has been tested in 24 clinical studies that looked at its benefits and safety. About 5 days after the lab test, i had the second episode, worse than the first, i woke falling out of bed to the floor, couldn’t use my arm to break the fall, i didn’t have the coordination. Not long after that i got a home glucometer and i get the same kind of results on that as the lab got, in the 20s and 30s first thing in the morning, every day. 4,5 Cohen et al (2008) reported that observed variation in red blood cell survival was large enough to cause clinically important differences in HbA1c for a given mean blood glucose, 6 and haemolytic disorders may cause falsely reassuring HbA1c values. Sometimes, one of the next steps is taking a medication that may help control your blood sugar. A1C: Just Part of the Toolkit. It’s different from a finger-prick test, which is a snapshot of your blood sugar levels at a particular time, on a particular day.. You find out your HbA1c level by getting a blood test by a doctor or nurse. Because man-made (synthetic) insulin does not have C-peptide, a person with a low blood sugar level from taking too much insulin will have a low C-peptide level but a high level of insulin. Eventually i wanted to have breakfast but had great difficulty holding the measuring cup under the faucet, to get some water to heat, to make instant oatmeal, i lacked the coordination to get the water into the cup. Download figure Open in new tab In an effort to determine if the unusual Hb A1c result was due to potential hemoglobinopathies, we performed an Hb variant analysis with the Bio-Rad VARIANT CE-HPLC β-Thalassemia Short Program. "But most people should aim for an HbA1c level between 7 and 8," he says. The level of C-peptide in the blood can show how much insulin is being made by the pancreas . As glucose enters your blood, it attaches to a protein in your red blood cells called "hemoglobin." Does diabetes make a heart attack feel different? FARXIGA (far-SEE-guh) is a once-daily pill taken in the morning with or without food. The incidence is significantly higher for those under 35 years of age: About 25 percent of people in that age group have LADA.In a 20… We herein present the case of a diabetic patient with spuriously low HbA1c values on ion-exchange high-performance liquid chromatography (HPLC). A particular drug’s effect on blood sugar does not predict its effects on the heart. You may be asked to stop eating and drinking for 8 hours before having this blood test. When the fasting insulin levels are above 5 uIU/ml, this indicates a pre-diabetic state that increases the risk of degenerative disease. did not know i had hypoglycemia until i had that lab test, though i had had one episode where i woke up with ataxia, i fell while walking to the bathroom first thing in the morning, i got up and immediately fell again. Continue reading >>, A C-peptide test measures the level of this peptide in the blood. It’s becoming clear, researchers say, that there’s far too little evidence on how diabetes drugs affect the heart to make rational evidence-based judgments. Nighttime hypoglycemia can be the result of a number of factors in people with diabetes, according to Howard Wolpert, M.... Diabetes Experts Share Ways To Lower Your A1C Levels, How to lower your A1C levels: A healthful guide, How to Lower Your A1C Levels: More Steps You Can Take. I persisted and did make the instant oatmeal (pour hot water onto flakes and it’s done), and i got my lap top and was eating the oatmeal and i suddenly was aware that the symptoms were going away. Other conditions associated with decreased red cell turnover are also associated with falsely elevated A1c including vitamin B-12 and folate deficiency anemias, and asplenia. However, a number of clinically significant disorders alter hemoglobin either structurally or chemically thereby aff In all of these cases, A1C was found to be inaccurately low in comparison to blood glucose levels. Conditions such as acute and chronic blood loss, hemolytic anemia, and splenomegaly can all cause falsely lowered A1c results. The complete case analysis gave an AOR for HbA1c >9.0% of 1.51 (CI: 1.33, 1.70), in the multiple imputation analysis this was 1.29 (1.17,1.41). The initial Hb A1c evaluation by cation-exchange HPLC (CE-HPLC) (Hb A1c Program on the VARIANT II TURBO Link System; Bio-Rad Laboratories) showed an Hb A1c value of 115.8% (reference interval, 4.0%–6.0%) (Fig. Conditions such as acute and chronic blood loss, hemolytic anemia, and splenomegaly … Insulin is a hormone that regulates carbohydrate and fat metabolism. You can check these average blood sugar levels yourself, but you’ll have to buy a kit, whereas your healthcare professional will do it for free. Some diabetes drugs lower blood sugar, yet somehow can increase the chances of heart attacks and strokes. CKD can result in reduced red blood cell production, leading to anemia (a lower-than-normal red blood cell count), or the need for blood transfusions or medications that help your body to make more replacement red blood cells. This may make your A1C test results falsely low. My A1c was 4.7 which registered as low (L) on the lab print out–it was only slightly low. Remarkably, his hemoglobin A1c (HbA1c) concentrations had decreased from 5.7%, 17 months prior, to 4.0%, despite continued impaired fasting glucose concentrations. If you have iron deficiency anemia, your A1C test results may be falsely high. Eating fresh, whole fruits instead of juices can prevent your blood sugar from shooting up. Real stories. Chronic liver disease has false A1C low. Insulin helps the body use and control the amount of sugar (glucose) in the blood. While eating the small amount of oatmeal, i realized i could type. Normal hemoglobin A1c levels range between 4% to 5.9%. With type 2 diabetes, more controlled A1C levels have also been shown to reduce symptoms affecting the small arteries and nerves in the body. Even small changes in A1C levels can have big effects. Continue reading >>, i was recently tested for Hemoglobin A1c because i presented to an endocrinologist with extremely low blood glucose on lab test and some scary symptoms, not the ordinary hypoglycemia symptoms. Fruits Drinking fruit juice and eating whole fruits is not the same. The prime cause behind rising A1C levels are the carbohydrates and sugar in our diet. Typically reported to falsely elevate A1c, but may also result in false decrease. That has raised a medical dilemma affecting tens of millions of people with Type 2 diabetes — and for the doctors who treat them. Find the cause of low blood sugar (hypoglycemia). See Patient Stories FARXIGA works with the body to flush sugar away in urine. Red blood cells live for around 4 months, so A1C results reflect long-term blood glucose levels. Continue reading >>, An A1C blood test measures average blood sugar levels over the past 2 to 3 months. While the percent is normally low, in diabetics the higher glucose circulating in the blood causes more hemoglobin binding which results in a higher A1c level. 2014 Feb; 29(2): 388–394. Continue reading >>, Tweet Does high insulin cause weight gain? Low hemoglobin with low red blood cell count and low hematocrit indicates anemia. There were 97,450 participants with type 2 diabetes; 16,585 cases that died during follow up were matched to 16,585 controls. Kale is high in vitamin C, which might lower fasting blood sugar levels for people with type 2 … Continue reading >>, Various laboratory and patient-related factors can affect the measurement of hemoglobin A1c (HbA1c). Causes of a decrease in erythrocyte that gives lower A1C result: Anemia, Thalassemia or hemolytic anemia, and liver disease, Hemorrhage or bleeding - … i sat on the floor, i could not get up and wa This study suggested the presence of an Hb variant with a chromatographic retention time virtually identical to that of Hb A1c, in addition to Hb S (Figs. By controlling these, we can prevent the increase of A1C level. The American Diabetes Association recommends measuring A1c—≥ 6.5% (48mmol/mol)—as a diagnostic criterion for diabetes and quantifying A1c as the standard laboratory assessment to determine control of type 1 and type 2 diabetes.1 Since the publication of the Diabetes Control and Complications Trial in 1993, we know that A1c levels also directly correlate to the risk of developing diabetic complications such as retinopathy, neuropathy and nephropathy.2 Q2. My A1c was 4.7 which registered as low (L) on the lab print out–it was only slightly low. Once a burst of insulin is released in response to food ingestion, insulin levels should drop below 5 uIU/ml and only a small amount of insulin should be needed to maintain balance. Platelets stop bleeding by clumping and forming plugs in blood vessel injuries.Thrombocytopenia often occurs as a result of a separate disorder, such as leukemia or an immune system problem. A: For A1c standard test results to be reliable, normal adult hemoglobin A must be present for glucose binding.

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