text:
Glyset Prescribing Information
Package insert / product label
Generic name: miglitol
Dosage form: tablet, film coated
Drug class: Alpha-glucosidase inhibitors
Medically reviewed by Drugs.com. Last updated on Apr 23, 2024.
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Glyset Description
GLYSET Tablets contain miglitol, an oral alpha-glucosidase inhibitor for use in the management of non-insulin-dependent diabetes mellitus (NIDDM). Miglitol is a desoxynojirimycin derivative, and is chemically known as 3,4,5-piperidinetriol, 1-(2-hydroxyethyl)-2-(hydroxymethyl)-, [2R-(2α,3β,4α, 5β)]-. It is a white to pale-yellow powder with a molecular weight of 207.2. Miglitol is soluble in water and has a pKa of 5.9. Its empirical formula is C8H17NO5 and its chemical structure is as follows:
GLYSET is available as 25 mg, 50 mg and 100 mg tablets for oral use. The inactive ingredients are starch, microcrystalline cellulose, magnesium stearate, hypromellose, polyethylene glycol, titanium dioxide, and polysorbate 80.
Glyset - Clinical Pharmacology
Miglitol is a desoxynojirimycin derivative that delays the digestion of ingested carbohydrates, thereby resulting in a smaller rise in blood glucose concentration following meals. As a consequence of plasma glucose reduction, GLYSET Tablets reduce levels of glycosylated hemoglobin in patients with Type II (non-insulin-dependent) diabetes mellitus. Systemic nonenzymatic protein glycosylation, as reflected by levels of glycosylated hemoglobin, is a function of average blood glucose concentration over time.
Mechanism of Action
In contrast to sulfonylureas, GLYSET does not enhance insulin secretion. The antihyperglycemic action of miglitol results from a reversible inhibition of membrane-bound intestinal α-glucoside hydrolase enzymes. Membrane-bound intestinal α-glucosidases hydrolyze oligosaccharides and disaccharides to glucose and other monosaccharides in the brush border of the small intestine. In diabetic patients, this enzyme inhibition results in delayed glucose absorption and lowering of postprandial hyperglycemia.
Because its mechanism of action is different, the effect of GLYSET to enhance glycemic control is additive to that of sulfonylureas when used in combination. In addition, GLYSET diminishes the insulinotropic and weight-increasing effects of sulfonylureas.
Miglitol has minor inhibitory activity against lactase and consequently, at the recommended doses, would not be expected to induce lactose intolerance.
Absorption of miglitol is saturable at high doses: a dose of 25 mg is completely absorbed, whereas a dose of 100 mg is 50% – 70% absorbed. For all doses, peak concentrations are reached in 2 to 3 hours. There is no evidence that systemic absorption of miglitol contributes to its therapeutic effect.
The protein binding of miglitol is negligible (<4.0%). Miglitol has a volume of distribution of 0.18 L/kg, consistent with distribution primarily into the extracellular fluid.
Miglitol is not metabolized in humans or in any animal species studied. No metabolites have been detected in plasma, urine or feces, indicating a lack of either systemic or pre-systemic metabolism.
Miglitol is eliminated by renal excretion as unchanged drug. Following a 25 mg dose, over 95% of the dose is recovered in the urine within 24 hours. At higher doses, the cumulative recovery of drug from urine is somewhat lower due to the incomplete bioavailability. The elimination half-life of miglitol from plasma is approximately 2 hours.
Special Populations
Renal Impairment
Because miglitol is excreted primarily by the kidneys, accumulation of miglitol is expected in patients with renal impairment. Patients with creatinine clearance <25 mL/min taking 25 mg 3 times daily, exhibited a greater than two-fold increase in miglitol plasma levels as compared to subjects with creatinine clearance >60 mL/min. Dosage adjustment to correct the increased plasma concentrations is not feasible because miglitol acts locally. Little information is available on the safety of miglitol in patients with creatinine clearance <25 mL/min. Therefore, treatment of these patients with miglitol is not recommended.
Hepatic impairment
Miglitol pharmacokinetics were not altered in cirrhotic patients relative to healthy control subjects. Since miglitol is not metabolized, no influence of hepatic function on the kinetics of miglitol is expected.
No significant difference in the pharmacokinetics of miglitol was observed between elderly men and women when body weight was considered.
Several pharmacokinetic studies were conducted in Japanese volunteers, with results similar to those observed in Caucasians. A study comparing the pharmacodynamic response to a single 50 mg dose in Black and Caucasian healthy volunteers indicated similar glucose and insulin responses in both populations.
Clinical Studies
Clinical Experience in Non-Insulin-Dependent Diabetes Mellitus (NIDDM) Patients on Dietary Treatment Only
GLYSET Tablets were evaluated in two U.S. and three non-U.S. controlled, fixed-dose, monotherapy studies, in which 735 patients treated with GLYSET were evaluated for efficacy analyses (see Table 1).
In Study 1, a 1-year study in which GLYSET was evaluated as monotherapy and also as combination therapy, there was a statistically significantly smaller increase in mean glycosylated hemoglobin (HbA1c) over time in the miglitol 50 mg 3 times daily monotherapy arm compared to placebo. Significant reductions in mean fasting and postprandial plasma glucose levels and in mean postprandial insulin levels were observed in patients treated with GLYSET compared with the placebo group.
In Study 2, a 14-week study, there was a significant decrease in HbA1c in patients receiving GLYSET 50 mg 3 times daily or 100 mg 3 times daily compared to placebo. In addition, there were significant reductions in postprandial plasma glucose and postprandial serum insulin levels compared to placebo.
Study 3, was a 6-month dose-ranging trial evaluating GLYSET at doses from 25 mg 3 times daily, to 200 mg 3 times daily. GLYSET produced a greater reduction in HbA1c than placebo at all doses, although the effect was statistically significant at the 100 mg 3 times daily and 200 mg 3 times daily. In addition, all doses of GLYSET produced significant reductions in postprandial plasma glucose and postprandial insulin levels compared to placebo.
Studies 4 and 5 were 6-month studies evaluating GLYSET at 50 and 100 mg 3 times daily, and 100 mg 3 times daily, respectively. As compared to placebo, GLYSET produced reductions in HbA1c, as well as a significant reduction in postprandial plasma glucose in both studies at the doses employed.
HbA1c (%) | 1-hour Postprandial Glucose (mg/dL) |
Study | Treatment | Mean Change from Baseline* | Treatment Effect† | Mean Change from Baseline | Treatment Effect† |
1 (U.S.) | Placebo | +0.71 | --- | +24 | --- |
GLYSET 50 mg 3 times daily | +0.13 | -0.58‡ | -39 | -63‡ | |
2 (U.S.) | Placebo | +0.47 | --- | +15 | --- |
GLYSET 50 mg 3 times daily | -0.22 | -0.69‡ | -52 | -67‡ | |
GLYSET 100 mg 3 times daily | -0.28 | -0.75‡ | -59 | -74‡ | |
3 (non-U.S.) | Placebo | +0.18 | --- | +2 | --- |
GLYSET 25 mg 3 times daily | -0.08 | -0.26 | -33 | -35‡ | |
GLYSET 50 mg 3 times daily | -0.22 | -0.40 | -45 | -47‡ | |
GLYSET 100 mg 3 times daily | -0.63 | -0.81‡ | -62 | -64‡ | |
GLYSET 200 mg 3 times daily § | -0.84 | -1.02‡ | -85 | -87‡ | |
4 (non-U.S.) | Placebo | +0.01 | --- | +8 | --- |
GLYSET 50 mg 3 times daily | -0.35 | -0.36‡ | -20 | -28‡ | |
GLYSET 100 mg 3 times daily | -0.57 | -0.58‡ | -25 | -33‡ | |
5 (non-U.S.) | Placebo | +0.32 | --- | +17 | --- |
GLYSET 100 mg 3 times daily | -0.43 | -0.75‡ | -38 | -55‡ |
Clinical Experience in NIDDM Patients Receiving Sulfonylureas
GLYSET was studied as adjunctive therapy to a background of maximal or near-maximal sulfonylurea (SFU) treatment in three large, double-blind, randomized studies (two U.S. and one non-U.S.) in which 471 patients treated with GLYSET were evaluated for efficacy (see Table 2).
Study 6 included patients under treatment with maximal doses of SFU at entry. At the end of this 14-week study, the mean treatment effects on glycosylated hemoglobin (HbA1c) were -0.82% and -0.74% for patients receiving GLYSET 50 mg 3 times daily plus SFU, and GLYSET 100 mg 3 times daily plus SFU, respectively.
Study 7 was a 1-year study in which GLYSET at 25, 50 or 100 mg 3 times daily was added to a maximal dose of glyburide (10 mg twice daily). At the end of this study, the mean treatment effects on HbA1c of GLYSET when added to maximum glyburide therapy were -0.30%, -0.62%, and -0.73% with 25, 50 and 100 mg 3 times daily dosages of GLYSET, respectively.
In Study 8, the addition of GLYSET 100 mg 3 times daily to a background of treatment with glyburide produced an additional mean treatment effect on HbA1c of -0.66%.
HbA1c (%) | 1-hour Postprandial Glucose (mg/dL) |
Study | Treatment | Mean Change from Baseline* | Treatment Effect† | Mean Change from Baseline | Treatment Effect† |
6 (U.S.) | Placebo + SFU | +0.33 | --- | -1 | --- |
GLYSET 50 mg 3 times daily + SFU | -0.49 | -0.82‡ | -69 | -68‡ | |
GLYSET 100 mg 3 times daily + SFU | -0.41 | -0.74‡ | -73 | -72‡ | |
7 (U.S.) | Placebo + SFU | +1.01 | --- | 48 | --- |
GLYSET 25 mg 3 times daily + SFU | +0.71 | -0.30 | -2 | -50‡ | |
GLYSET 50 mg 3 times daily + SFU | +0.39 | -0.62‡ | -13 | -61‡ | |
GLYSET 100 mg 3 times daily + SFU | +0.28 | -0.73‡ | -33 | -81‡ | |
8 (non-U.S.) | Placebo + SFU | +0.16 | --- | +10 | --- |
GLYSET 100 mg 3 times daily + SFU | -0.50 | -0.66‡ | -36 | -46‡ |
Dose Response
Results from controlled, fixed-dose studies of GLYSET as monotherapy or as combination treatment with a sulfonylurea were combined to derive a pooled estimate of the difference from placebo in the mean change from baseline in glycosylated hemoglobin (HbA1c) and postprandial plasma glucose as shown in Figures 1 and 2:
Because of its mechanism of action, the primary pharmacologic effect of miglitol is manifested as a reduction in postprandial plasma glucose, as shown previously in all of the major clinical trials. GLYSET was statistically significantly different from placebo at all doses in each of the individual studies with respect to effect on mean one-hour postprandial plasma glucose, and there is a dose response from 25 to 100 mg 3 times daily for this efficacy parameter.
Indications and Usage for Glyset
GLYSET is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
GLYSET Tablets are contraindicated in patients with:
- Diabetic ketoacidosis
- Inflammatory bowel disease, colonic ulceration, or partial intestinal obstruction, and in patients predisposed to intestinal obstruction
- Chronic intestinal diseases associated with marked disorders of digestion or absorption, or with conditions that may deteriorate as a result of increased gas formation in the intestine
- Hypersensitivity to the drug or any of its components.
Macrovascular Outcomes
There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with GLYSET or any other anti-diabetic drug.
Because of its mechanism of action, GLYSET, when administered alone, should not cause hypoglycemia in the fasted or postprandial state. Sulfonylureas and insulin can cause hypoglycemia. Because GLYSET Tablets given in combination with a sulfonylurea or insulin will cause a further lowering of blood glucose, it may increase the hypoglycemic potential of the sulfonylurea or insulin. Consider reducing the dose of sulfonylureas or insulin when GLYSET is used in combination with these medications.
Oral glucose (dextrose), whose absorption is not delayed by GLYSET, should be used instead of sucrose (cane sugar) in the treatment of mild-to-moderate hypoglycemia. Sucrose, whose hydrolysis to glucose and fructose is inhibited by GLYSET, is unsuitable for the rapid correction of hypoglycemia. Severe hypoglycemia may require the use of either intravenous glucose infusion or glucagon injection.
Loss of Control of Blood Glucose
When diabetic patients are exposed to stress such as fever, trauma, infection, or surgery, a temporary loss of control of blood glucose may occur. At such times, temporary insulin therapy may be necessary.
Renal Impairment
Plasma concentrations of GLYSET in renally impaired volunteers were proportionally increased relative to the degree of renal dysfunction. Long-term clinical trials in diabetic patients with significant renal dysfunction (serum creatinine >2.0 mg/dL) have not been conducted. Therefore, treatment of these patients with GLYSET is not recommended.
Information for Patients
The following information should be provided to patients:
- GLYSET should be taken orally three times a day at the start of each main meal. It is important to continue to adhere to dietary instructions, a regular exercise program, and regular testing of urine and/or blood glucose.
- GLYSET itself does not cause hypoglycemia when administered to patients in the fasted state. Sulfonylurea drugs and insulin, however, can lower blood sugar levels and cause symptoms or life-threatening hypoglycemia. Because GLYSET given in combination with a sulfonylurea or insulin will cause a further lowering of blood sugar, it may increase the hypoglycemic potential of these agents. The risk of hypoglycemia, its symptoms and treatment, and conditions that predispose to its development should be well understood by patients and responsible family members. Because GLYSET prevents the breakdown of table sugar, a source of glucose (dextrose, D-glucose) should be readily available to treat symptoms of low blood sugar when taking GLYSET in combination with a sulfonylurea or insulin.
- If side effects occur with GLYSET, they usually develop during the first few weeks of therapy. They are most commonly mild-to-moderate dose-related gastrointestinal effects, such as flatulence, soft stools, diarrhea, or abdominal discomfort, and generally diminish in frequency and intensity with time. Discontinuation of drug usually results in rapid resolution of these gastrointestinal symptoms.
Physician Counseling Information for Patients
In initiating treatment for type 2 diabetes, diet should be emphasized as the primary form of treatment. Caloric restriction and weight loss are essential in the obese diabetic patient. Proper dietary management alone may be effective in controlling the blood glucose and symptoms of hyperglycemia. The importance of regular physical activity should also be stressed, and cardiovascular risk factors should be identified and corrective measures taken where possible. Use of GLYSET or other antidiabetic medications must be viewed by both the physician and patient as a treatment in addition to diet and not as a substitution or as a convenient mechanism for avoiding dietary restraint. Furthermore, loss of blood glucose control on diet alone may be transient, thus requiring only short-term administration of GLYSET or other antidiabetic medications. Maintenance or discontinuation of GLYSET or other antidiabetic medications should be based on clinical judgment using regular clinical and laboratory evaluations.
Laboratory Tests
Therapeutic response to GLYSET may be monitored by periodic blood glucose tests. Measurement of glycosylated hemoglobin levels is recommended for the monitoring of long-term glycemic control.
Drug Interactions
Several studies investigated the possible interaction between miglitol and glyburide. In six healthy volunteers given a single dose of 5 mg glyburide on a background of 6 days treatment with miglitol (50 mg 3 times daily for 4 days followed by 100 mg 3 times daily for 2 days) or placebo, the mean Cmax and AUC values for glyburide were 17% and 25% lower, respectively, when glyburide was given with miglitol. In a study in diabetic patients in which the effects of adding miglitol 100 mg 3 times daily for 7 days or placebo to a background regimen of 3.5 mg glyburide daily were investigated, the mean AUC value for glyburide was 18% lower in the group treated with miglitol, although this difference was not statistically significant. Information on a potential interaction with glyburide was obtained from one of the large U.S. clinical trials (Study 7) in which patients were dosed with either miglitol or placebo on a background of glyburide 10 mg twice daily. At the 6-month and 1-year clinic visits, patients taking concomitant miglitol 100 mg 3 times daily exhibited mean Cmax values for glyburide that were 16% and 8% lower, respectively, compared to patients taking glyburide alone. However, these differences were not statistically significant. Thus, although there was a trend toward lower AUC and Cmax values for glyburide when co-administered with GLYSET, no definitive statement regarding a potential interaction can be made based on the foregoing three studies.
The effect of miglitol (100 mg 3 times daily for 7 days) on the pharmacokinetics of a single 1000 mg dose of metformin was investigated in healthy volunteers. Mean AUC and Cmax values for metformin were 12% to 13% lower when the volunteers were given miglitol as compared with placebo, but this difference was not statistically significant.
In a study with healthy volunteers, co-administration of either 50 mg or 100 mg miglitol 3 times daily together with digoxin reduced the average plasma concentrations of digoxin by 19% and 28%, respectively. However, in diabetic patients under treatment with digoxin, plasma digoxin concentrations were not altered by co-administration of miglitol 100 mg 3 times daily for 14 days.
Other healthy volunteer studies have demonstrated that miglitol may significantly reduce the bioavailability of ranitidine and propranolol by 60% and 40%, respectively. No effect of miglitol was observed on the pharmacokinetics or pharmacodynamics of either warfarin or nifedipine.
Intestinal adsorbents (e.g., charcoal) and digestive enzyme preparations containing carbohydrate-splitting enzymes (e.g., amylase, pancreatin) may reduce the effect of GLYSET and should not be taken concomitantly.
In 12 healthy males, concomitantly administered antacid did not influence the pharmacokinetics of miglitol.
Carcinogenesis, Mutagenesis, and Impairment of Fertility
Miglitol was administered to mice by the dietary route at doses as high as approximately 500 mg/kg body weight (corresponding to greater than 5 times the exposure in humans based on AUC) for 21 months. In a two-year rat study, miglitol was administered in the diet at exposures comparable to the maximum human exposures based on AUC. There was no evidence of carcinogenicity resulting from dietary treatment with miglitol.
In vitro, miglitol was found to be nonmutagenic in the bacterial mutagenesis (Ames) assay and the eukaryotic forward mutation assay (CHO/HGPRT). Miglitol did not have any clastogenic effects in vivo in the mouse micronucleus test. There were no heritable mutations detected in dominant lethal assay.
A combined male and female fertility study conducted in Wistar rats treated orally with miglitol at dose levels of 300 mg/kg body weight (approximately 8 times the maximum human exposure based on body surface area) produced no untoward effect on reproductive performance or capability to reproduce. Survival, growth, development, and fertility of the offspring were not compromised.
Teratogenic Effects
The safety of GLYSET in pregnant women has not been established. Developmental toxicology studies have been performed in rats at doses of 50, 150 and 450 mg/kg, corresponding to levels of approximately 1.5, 4, and 12 times the maximum recommended human exposure based on body surface area. In rabbits, doses of 10, 45, and 200 mg/kg corresponding to levels of approximately 0.5, 3, and 10 times the human exposure were examined. These studies revealed no evidence of fetal malformations attributable to miglitol. Doses of miglitol up to 4 and 3 times the human dose (based on body surface area), for rats and rabbits respectively, did not reveal evidence of impaired fertility or harm to the fetus. The highest doses tested in these studies, 450 mg/kg in the rat and 200 mg/kg in the rabbit promoted maternal and/or fetal toxicity. Fetotoxicity was indicated by a slight but significant reduction in fetal weight in the rat study and slight reduction in fetal weight, delayed ossification of the fetal skeleton and increase in the percentage of non-viable fetuses in the rabbit study. In the peri-postnatal study in rats, the NOAEL (No Observed Adverse Effect Level) was 100 mg/kg (corresponding to approximately four times the exposure to humans, based on body surface area). An increase in stillborn progeny was noted at the high dose (300 mg/kg) in the rat peri-postnatal study, but not at the high dose (450 mg/kg) in the delivery segment of the rat developmental toxicity study. Otherwise, there was no adverse effect on survival, growth, development, behavior, or fertility in either the rat developmental toxicity or peri-postnatal studies. There are however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, miglitol should be used during pregnancy only if clearly needed.
Nursing Mothers
Miglitol has been shown to be excreted in human milk to a very small degree. Total excretion into milk accounted for 0.02% of a 100 mg maternal dose. The estimated exposure to a nursing infant is approximately 0.4% of the maternal dose. Although the levels of miglitol reached in human milk are exceedingly low, it is recommended that GLYSET not be administered to a nursing woman.
Geriatric Use
Of the total number of subjects in clinical studies of GLYSET in the United States, patients valid for safety analyses included 24% over 65, and 3% over 75. No overall differences in safety and effectiveness were observed between these subjects and younger subjects. The pharmacokinetics of miglitol were studied in elderly and young males (n=8 per group). At the dosage of 100 mg 3 times daily for 3 days, no differences between the two groups were found.
Adverse Reactions/Side Effects
Gastrointestinal symptoms are the most common reactions to GLYSET Tablets. In U.S. placebo-controlled trials, the incidences of abdominal pain, diarrhea, and flatulence were 11.7%, 28.7%, and 41.5% respectively in 962 patients treated with GLYSET 25 100 mg 3 times daily, whereas the corresponding incidences were 4.7%, 10.0%, and 12.0% in 603 placebo-treated patients. The incidence of diarrhea and abdominal pain tended to diminish with continued treatment.
Skin rash was reported in 4.3% of patients treated with GLYSET compared to 2.4% of placebo-treated patients. Rashes were generally transient and most were assessed as unrelated to GLYSET by physician investigators.
Abnormal Laboratory Findings
Low serum iron occurred more often in patients treated with GLYSET (9.2%) than in placebo-treated patients (4.2%) but did not persist in the majority of cases and was not associated with reductions in hemoglobin or changes in other hematologic indices.
Postmarketing Experience
The following adverse reactions have been reported during post-approval use of GLYSET. Because these reactions are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Gastrointestinal Disorders: ileus (including paralytic ileus), subileus, gastrointestinal pain, nausea, abdominal distention.
- Pneumatosis Cystoides Intestinalis
There have been rare postmarketing reports of pneumatosis cystoides intestinalis associated with the use of alpha-glucosidase inhibitors, including GLYSET. Pneumatosis cystoides intestinalis may present with symptoms of diarrhea, mucus discharge, rectal bleeding, and constipation. Complications may include pneumoperitoneum, volvulus, intestinal obstruction, intussusception, intestinal hemorrhage, and intestinal perforation. If pneumatosis cystoides intestinalis is suspected, discontinue Glyset and perform the appropriate diagnostic imaging.
Unlike sulfonylureas or insulin, an overdose of GLYSET tablets will not result in hypoglycemia. An overdose may result in transient increases in flatulence, diarrhea, and abdominal discomfort. Because of the lack of extra-intestinal effects seen with GLYSET, no serious systemic reactions are expected in the event of an overdose.
Glyset Dosage and Administration
There is no fixed dosage regimen for the management of diabetes mellitus with GLYSET Tablets or any other pharmacologic agent. Dosage of GLYSET must be individualized on the basis of both effectiveness and tolerance while not exceeding the maximum recommended dosage of 100 mg 3 times daily. GLYSET should be taken three times daily at the start of each main meal. GLYSET should be started at 25 mg, and the dosage gradually increased both to reduce gastrointestinal adverse effects and to permit identification of the minimum dose required for adequate glycemic control of the patient.
During treatment initiation and dose titration one-hour postprandial plasma glucose may be used to determine the therapeutic response to GLYSET and identify the minimum effective dose for the patient. Thereafter, glycosylated hemoglobin should be measured at intervals of approximately 3 months. The therapeutic goal should be to decrease both postprandial plasma glucose and glycosylated hemoglobin levels to normal or near normal by using the lowest effective dose of GLYSET, either as monotherapy or in combination with a sulfonylurea.
Initial Dosage
The recommended starting dosage of GLYSET is 25 mg, given orally three times daily at the start of each main meal. However, some patients may benefit by starting at 25 mg once daily to minimize gastrointestinal adverse effects, and gradually increasing the frequency of administration to 3 times daily.
Maintenance Dosage
The usual maintenance dose of GLYSET is 50 mg taken 3 times daily, although some patients may benefit from increasing the dose to 100 mg 3 times daily. To allow adaptation to potential gastrointestinal adverse effects, it is recommended that GLYSET therapy be initiated at a dosage of 25 mg 3 times daily, then gradually titrated upward to allow adaptation. After 4 to 8 weeks of the 25 mg 3 times daily regimen, the dosage should be increased to 50 mg 3 times daily for approximately three months, following which a glycosylated hemoglobin level should be measured to assess therapeutic response. If at that time, the glycosylated hemoglobin level is not satisfactory, the dosage may be further increased to 100 mg 3 times daily, the maximum recommended dosage.
Pooled data from controlled studies suggest a dose-response for both HbA1c and one-hour postprandial plasma glucose throughout the recommended dosage range. However, no single study has examined the effect on glycemic control of titrating patients' doses upwards within the same study. If no further reduction in postprandial glucose or glycosylated hemoglobin levels is observed with titration to 100 mg 3 times daily, consideration should be given to lowering the dose. Once an effective and tolerated dosage is established, it should be maintained.
Maximum Dosage
The maximum recommended dosage of GLYSET is 100 mg 3 times daily. In one clinical trial, 200 mg 3 times daily gave additional improved glycemic control but increased the incidence of the gastrointestinal symptoms described above.
Patients Receiving Sulfonylureas
Sulfonylurea agents may cause hypoglycemia. There was no increased incidence of hypoglycemia in patients who took GLYSET in combination with sulfonylurea agents compared to the incidence of hypoglycemia in patients receiving sulfonylureas alone in any clinical trial. However, GLYSET given in combination with a sulfonylurea will cause a further lowering of blood glucose and may increase the risk of hypoglycemia due to the additive effects of the two agents. If hypoglycemia occurs, appropriate adjustments in the dosage of these agents should be made (see PRECAUTIONS).
How is Glyset supplied
GLYSET Tablets are available as 25 mg, 50 mg, and 100 mg tablets.
Strength | NDC |
Bottles of 100: | |
25 mg | 0009-5012-01 |
50 mg | 0009-5013-01 |
100 mg | 0009-5014-01 |
Manufactured by
Bayer HealthCare Pharmaceuticals Inc.
GLYSET is a registered trademark of Bayer HealthCare Pharmaceuticals Inc. used under license.
August 2016
PRINCIPAL DISPLAY PANEL - 25 mg Tablet Bottle Label
(miglitol) tablets
25 mg
100 Tablets
Rx only
miglitol tablet, film coated |
miglitol tablet, film coated |
miglitol tablet, film coated |
Labeler - Pharmacia & Upjohn Company LLC (618054084) |
Establishment | |||
Name | Address | ID/FEI | Business Operations |
Pharmacia & Upjohn Company LLC | 618054084 | ANALYSIS(0009-5012, 0009-5013, 0009-5014) , MANUFACTURE(0009-5012, 0009-5013, 0009-5014) , API MANUFACTURE(0009-5012, 0009-5013, 0009-5014) , PACK(0009-5012, 0009-5013, 0009-5014) , LABEL(0009-5012, 0009-5013, 0009-5014) |
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The Rules Committee has made in order consideration of en bloc amendments to be offered by Reps. Inslee, Eshoo, and others, that purport to address some of the concerns identified by the Administration, as well as consideration of an amendment in the nature of a substitute to be offered by Reps. Gephardt, Dingell, LaFalce and Conyers. The Administration believes that the en bloc amendments fall short of eliminating the serious defects in H.R. 1714, and the Secretaries of Commerce, Housing and Urban Development and of the Treasury will recommend that the President veto H.R. 1714, with the en bloc amendments. For the reasons explained below and in the enclosed Statement of Administration Policy, the Administration would support adoption of the Gephardt-Dingell-LaFalce-Conyers substitute (previously introduced as H.R. 3220).
The legislation that was initially considered by the House Commerce Committee was designed to ensure the legal validity of contracts in electronic form that are signed with electronic signatures (the States currently are considering the Uniform Electronic Transactions Act, which updates state contract law to recognize electronic contracts). These provisions are not controversial. They are embodied in the Abraham-Wyden-Leahy amendment to S.761 (which may be considered by the Senate this week) and in the Gephardt-Dingell-LaFalce-Conyers substitute.
The bill reported by the House Commerce Committee - H.R. 1714 - goes well beyond this limited but critical objective, and adopts provisions that broadly authorize the substitution of "electronic records" that do not provide equivalent protections as those for the written documents mandated by statutes and regulations requiring consumer notifications and disclosures. The bill also would allow businesses subject to statutory and regulatory record retention requirements (insurance companies, for example) to retain electronic records while not providing equivalent access to the written records required by those statutes and regulations. The Administration believes strongly that these provisions will leave on-line consumers with fewer consumer protections than they have in other forms of commerce.
For example, the bill ostensibly requires consumers to "opt-in" to electronic notices, but the consumer need not be told of the right to obtain information in written form or which specific records would be affected. Neither the States nor federal regulators will have any ability to eliminate abuses that may occur. And even with respect to notices concerning health and safety, the States (but not the federal government) can reinstate regulatory requirements, but the bill creates a gap in protection for the years that will elapse before reenactment occurs. Finally, the bill deprives the States of all authority to oversee retention of electronic records - businesses may decide for themselves how to keep information electronically, even if they do so in a way that makes it impossible for state regulators to do their jobs.
The en bloc amendments do not come close to addressing the Administration's concerns. Although it improves the "opt-in" standard by requiring that the consumer's consent be "conspicuous and visually separate" and that the consumer be informed of the hardware and software needed to access electronic records, it still does not require that the consumer be told of the right to receive written notice or of the particular notices and disclosures that would be affected. Moreover, the amendment does nothing to restore regulators' authority to prevent abuses by overreaching corporations. Rather, it weakens the already diminished ability of the States to protect health and safety. Under the version considered November 1 under suspension of the rules, and here again today, States could reenact requirements of written notices "necessary for the protection of the safety or health of an individual consumer"; under the en bloc amendments the States' power is restored only if notices are necessary for the protection of the "public health or safety of consumers," a standard that is plainly less protective of individual consumers. Finally, the en bloc amendments would subject consumers to the bill's electronic delivery provisions without adequate protections for at least 18 months while a study of the impact on consumers is completed.
The Gephardt-Dingell-LaFalce-Conyers substitute, by contrast, accomplishes the highly laudable goal of ensuring that signatures and contracts will not be denied legal effect solely because they are electronic in form. The Administration supports this substitute because it preserves long standing government authority to establish safeguards, such as consumer protection laws; covers only commercial transactions between private parties that affect interstate commerce; does not affect Federal laws or regulations; and sunsets completely when a state enacts the Uniform Electronic Transactions Act. The Senate may consider this week a proposal that is virtually identical to the Gephardt-Dingell-LaFalce-Conyers substitute. Hence, the important objectives accomplished by that substitute could be codified in legislation that is enrolled and presented to the President for signature virtually immediately.
Electronic commerce will play an important role in expanding our economy at the same time that it provides new benefits to consumers. The Administration believes that reliable electronic signature technology, used properly, is necessary to reap the full benefits of electronic commerce for consumers. The States and the Federal government can assist the growth of electronic commerce by ensuring a predicable legal environment with regard to the validity of electronic signatures and contracts.
In certain circumstances it will be appropriate for the law to allow ongoing communication between parties to be conducted in electronic form. Statutory changes to accomplish this task must be done with great care, however, to avoid placing vulnerable consumers at risk. The Federal Reserve is currently engaged in a public rulemaking process to evaluate various consumer protection regulations and determine the appropriateness of electronic disclosures and notices on a statute-by-statute basis. The Administration supports this process, which should not simply be preempted by H.R. 1714 or similar legislation.
The Administration recognizes that a number of Representatives also wish to address the issues of electronic records and electronic record retention and maintenance requirements that would not be addressed by the Gephardt-Dingell-LaFalce-Conyers substitute. The Administration is committed to working constructively with those Representatives to discuss their concerns and develop appropriate legislation that avoids the problems identified herein.
The Budget | Legislative Information | Management Reform/GPRA | Grants Management Financial Management | Procurement Policy | Information & Regulatory Policy Contact the White House Web Master Privacy Statement

subset: commoncrawl


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What is the distinction between an internet designer and a web developer ? You could have a minimum GPA of 3.0, be pc proficient in Microsoft Office applications and interested in working in one of many following departments automotive technology, advertising, public affairs, productions engineering, human assets, finance, digital media, creative design, communications and enterprise to be thought-about for this position.
Within the case of internet design and graphic design, machine learning helps automate tedious and boring duties The vast majority of graphic designers haven't got to fret about algorithms stealing their jobs anytime soon as a result of, whereas machine studying is nice for understanding giant information units and making recommendations, it's terrible at analyzing subjective things similar to taste.
A model id design is the visible component that represents how a company wants to be seen; it is the firm's visual identification or picture.†An organization's model identification is built-in throughout all elements of a company's supplies reminiscent of business playing cards, stationary, media advertising, promotions, and many others., and can be represented by way of a novel logo or signage.
Multimedia designers are liable for designing props, sets, and costumes, directing set assistants on design interpretations, and advising on different areas of technical manufacturing comparable to lighting and sound to ensure the production set intently resembles their designs.
The important thing factor to remember about graphic design, particularly when compared to visual communication, is that it's a slim, extremely specialized field that focuses only on the creation of key graphics for a broader promoting campaign, website, or print supplies.


text: Open Access journals are an ideal platform for the publication of your research enabling you to reach the widest available audience of biomedical professionals in your field of expertise. Publication in our Journal means that your research articles will be available for free access online being immediately citable. Our Journal shortens the time needed before publication, offers a high quality peer-review system, highly-professional scientific copyediting, DOI assignment, and submission to many online directories.


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Knowledge Platform
Promoting integration of migrants and refugees in and through education: Toolkit
Education unions are defending the right to learn and to teach of newcomers. They develop advocacy to promote more inclusive schools in the context of increasingly diverse communities and in reaction to the rise of populist anti-immigration political forces. These strategies and practical actions are now compiled in a new toolkit by Education International. The aim of the publication is to give practitioners concrete, hands-on recommendations and advice that will help them contribute to making education more inclusive and an effective right for all children.
This toolkit aims to build on these experiences and facilitate education unions to develop their work in this area. It also assists unions by exploring the issues around integrating migrants and refugees in education and sharing what others have been doing in this domain.
This toolkit will support both unions that have not yet been active in this domain and those that are willing to further develop their activities with regards to migrants and refugees. It can be used at different levels of the organisation


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Posted October 4, 2011
Award-winning author and popular speaker David Shenk, whose book The Forgetting is widely considered one of the best ever written about Alzheimer's, has joined Cure Alzheimer's Fund as a senior adviser. Shenk will be deeply involved with writing, events and fundraising on a project basis at CAF.
"We are thrilled to be working closely with David to help people better understand the urgency of this disease and how everyone can join in to help stop it," says Tim Armour, president and CEO of Cure Alzheimer's Fund.
Shenk, author of five other acclaimed nonfiction books (see davidshenk.com), also has advised the President's Council on Bioethics and is a nationally recognized Alzheimer's filmmaker. In recent years, he has written and directed five short "pocket films" aimed at educating the public about the disease. This year, MetLife Foundation commissioned him to produce four new documentary films about the family caregiving experience.
He first came to the Alzheimer's world a dozen years ago, he says, after overhearing the story of a husband and wife facing the disease together. "The woman was still living at home," he recalls, "but she had gotten to the stage where she no longer recognized her husband. It was so devastatingly sad. I had to know more about this disease. From there, the more I learned about Alzheimer's, the more I felt like I had to be a part of helping people understand it better."
Shenk first met Rudy Tanzi at a scientific conference in 1999 while researching The Forgetting (and while Tanzi was writing his own soon-to-be-acclaimed book Decoding Darkness), and they've crossed paths several times over the years. Recently, Tanzi introduced Shenk to CAF, and the fit was obvious.
"I was immediately struck by how much amazing research had been spawned by this relatively small organization," Shenk says, "and I was drawn to its bold approach. CAF is doing extraordinary work in getting much-needed dollars into the right scientific hands, and I'm very proud to join that effort. The clock is ticking. We can't afford not to do better."
Shenk will join Tanzi, Harvard's Robert Moir and moderator Robert Bazell on the "Taking Control of Alzheimer's Through Research" panel at CAF's science symposium on Oct. 18 (see below).
The Los Angeles Times Book Review called David Shenk's The Forgetting "a remarkable addition to the literature of the science of the mind."


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Jeeps are one of the most popular vehicle options on the market today, and it is really no surprise why. There are many great models made by Jeep including the Cherokee, the Grand Cherokee, the Compass and the Patriot. Each of these vehicles combines the comfort, power and versatility that is in demand for consumers today. For many people, Jeep leasing is the ideal way to get the vehicle they love at the price they can afford.
If you are interested in leasing a Jeep in the NYC or Brooklyn area, we are here to help you every step of the way. Car Leasing Service has been helping people with all types of car leasing since 2008. During that time we have expanded to five locations in Manhattan, Westchester, Yonkers, Brooklyn and Paramus, NJ. No matter where in the area you live, we will have a location near you to help you find the perfect vehicle to lease.
While there is no shortage of dealerships and car lots that are willing to lease you a Jeep, they are not all created equally. The selection that is available, and the price you will have to pay, can vary significantly from place to place. Here at Car Leasing Service we work hard to provide you with the best vehicles possible, and at the lowest prices.
We do this by working directly with the factories to get beautiful Jeeps at the lowest prices we can. We also manage our inventory properly to reduce overhead further, which contributes to even lower prices. Our efforts to keep our costs down help to reduce the overall price you will have to pay when you lease a Jeep. Over the course of your lease, you can save hundreds or even thousands of dollars by working with us rather than a competing dealer.
We also accept virtually all trade in vehicles, and pay top dollar for them. This is another great way to reduce or eliminate the need for a down payment and keep your monthly payments lower as well. If you are stuck in a lease that youre not happy with, we can likely help you with that too. We are experts at helping our customers get out of existing leases early so that you can lease the Jeep you really want.
So, no matter what situation you are in, we would love the opportunity to help you get a Jeep lease that will work well for you. You can give us a call at any of our convenient locations, or just stop in anytime to speak with one of our leasing experts. We can go over all your options with you and come up with the perfect solution to help you lease the Jeep you want. Let us be your partner in finding the perfect vehicle at the perfect price to help meet all your transportation needs.


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Thursday, March 27, 2008
Riding the waves of Internet
This morning was more relaxed than usual and I've got the time for a little surfing. So let's see what news kept my eye.
The biggest news that draw my attention was that of a collaboration between Stephen King and his son, Joe Hill. Gauntlet Press will release an anthology named "He is Legend: Celebrating Richard Matheson" and the anthology will contain a novella, "Throttle", written by Stephen King and Joe Hill, their first collaboration. I am thrilled and I can hardly wait the outcome. You can find this news and the press release on Mr. King's website.
I found the trailer of "The Colour of Magic", a television adaptation of Terry Pratchett's "The Colour of Magic" and "The Light Fantastic" by Sky One. It was broadcast on Easter in UK, so it is an old news but I really enjoyed the trailer (you can see it here) and that made me curious about the interpretation of Rincewind, Twoflower, Luggage and Cohen the barbarian, and many other things. In the cast list I saw that Twoflower is played by Sean Astin, the former Samwise Gamgee, I saw Christopher Lee, and I love how he portrays villains, and I saw Jeremy Irons. I just hope that this movie will be realease on DVD too, because I would love to see it.
And since yesterday I reviewed "The Darkness That Comes Before", today I found on FantasyBookSpot the first chapter of R. Scott Bakker's forthcoming novel "Neuropath" (you can read it here). Also I found a review of this novel on Pat's Fantasy Hotlist.
Also I found the "Toll of Hounds" prologue on SFF World.
I'm happy that I found only good news but worried a bit that my wishing list is a little larger now :).
5 comments:
- Robert said...
Nice find about the Stephen King/Joe Hill collaboration! I hadn't heard anything about that, but it sounds pretty interesting...
- March 27, 2008 at 6:54 PM
- Mihai A. said...
Like I said it sounds very interesting.
- March 28, 2008 at 10:55 AM
- Harry Markov said...
You do know all the hot stuff going on. I bought today Stephen King's "On Writing" and Patrick Susskind's Patrick Süskind's "Perfume, the story of a murder". Goody, goody.
- March 28, 2008 at 8:17 PM
- Mihai A. said...
I have "On Writing" too but every time I put another book in front of it in reading line. I hope that I will read it this year.
- March 29, 2008 at 12:18 PM
- Harry Markov said...
It reads really fast and I am somewhere halfway through it and I started reading yesterday night and today and I had around fiove hours to get that far. The intro part about his life is interesting, but a tad too long running around for 90 pages. I like his sense of humor.
- March 29, 2008 at 2:50 PM
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So without further ado, meet Lady Vadore:
And to reward you all for waiting so patiently for her big reveal, I'm now going to inundate you with pictures. John and I spent a few hours Sunday night in our front room working on the best poses, so I have lots to choose from! We didn't have the best light, but considering they're night shots I think they came out ok:
The helmet is most impressive from the side:
The copper swirls started as a joke, since I thought it would be hilarious to somehow add metal Leia buns to the side of the helmet. I experimented with rounded brass mesh and having my actual hair inside them before settling on a more subtle approach.
The chest emblems and chains came from a Epbot reader last year; she sent me a small box of old jewelry and scraps. See? I *do* use the stuff you guys send me!
When John and I were figuring out poses, we named these two "Jaunty" and "Hero." I think Hero makes me look a bit shorter - an impressive feat, since I'm only five foot to begin with.
Here's a modified Hero and an Extra Jaunty:
It amuses me to name the variations, since there's so little difference. I'm hoping one of you will see me today and yell out which one you want. :D
The jacket is a heavily modified thrift store find. It originally came from Charlotte Russe, so it's extremely lightweight (aka cheap). I changed the collar, added a bustle, sewed the two sides under at an angle, and then added the buttons, trim, belt loops, and epaulettes, which are attached with Velcro so I can remove them for storage and cleaning.
My boots were my luckiest thrift store find; I'm pretty sure they were never worn, and they were only $15! They're a size too big, but when the perfect Vader boots pop up for $15, you don't complain about petty things like sizing. I jazzed them up with an extra leather strap below the ankle, trim, and gear-accented appliques. The wings on top came from ebay, and the gear sigils on the bottom are handmade from this Etsy shop.
My gloves don't show in most pics, so here's a detail shot:
These are my favorite vintage gloves - I wore them both book tours - so I attached the gears with a small stitch (covered by a gem) so I can easily remove them later.
The cane was a late addition which serves two purposes: it helps me maneuver and keep my balance, and it gives me something to pose with. (Plus I've always wanted to make one. Heh.) We've since gone back and brightened up the interior lights, since they sadly didn't show up at all in these photos. (It looks amazing in low light, though.)
I'll be adding a cane tutorial next week, so stay tuned for that. [Update: Cane tutorial here!]
My lower belt is made from the original cowl of the plastic Vader helmet. I noticed the curve fit my waist nicely, so I attached it to a canvas belt, weathered it, added those gorgeous gears from Sharyn, and finished it off with a leather hanger for my lightsaber made from an old belt:
The skirt is another thrift store find, a heavy canvas originally from Anne Taylor. The waist was way too high, so I cut off the entire waistband, serged the edge, and lowered the front pockets.
My lightsaber is made from an old flashlight. If you missed it, you can see that tutorial here.
Now here's my favorite part of the whole costume:
The buckle/compact is attached with extremely powerful magnets. (There's a smaller, functional buckle below it holding up the belt.)
I was determined to make it removable, so I could do this:
Inside the compact are my custom calling cards. This way if anyone at the con wants more information on my costume, I can pop off my buckle and offer them a card.
The compact has two compartments: the top only holds a few cards, but I can fit 10 or so in the lower half, which opens with a spring-loaded clasp.
More details:
I made my feather epaulettes using the same faux leather as my helmet cowl, but I aged it with copper and gold glazes. I'm tempted to do the same to the helmet. Thoughts?
Mask and goggles. These are separate pieces, so getting everything lined up on my face takes a little finagling.
The goggles are vintage welder's goggles, and the only adjustments I made was to trim them in copper, make a new leather nose piece, and replace the dark lenses with a few layers of iridescent cellophane. (I ironed it to get that neat bubbly texture.) I can actually see through them pretty well, but you can't see my eyes at all.
Gratuitous cleavage shot:
I've never had cleavage in my life, by the way, and it's pretty darned disconcerting to see myself with some here. I can't take credit for any of it, of course; that's all corset and straps and mega-push-up appliances. I think the only thing we didn't use was duct tape. Ha!
The corset is my first real corset, and it's surprisingly heavy, with tons of steel boning inside. I snagged it on clearance from Corset Story for a measly $30 + shipping; it was the very last one, and just happened to be my size. I can't tell you how much I love that pop of emerald green among all the black, gold, and copper. (And John apparently loves squeezing the life out of me while lacing it up; I've already told him he's not making it this tight for the actual con!)
Ok, one final full-body shot, just so I don't leave you with a giant picture of my boobs:
Out of morbid curiosity, I decided to tally up our expenses on the whole outfit, minus the cane & lighsaber. This is what I came up with:
Total: $260
I'm sure I'm missing a few things, but I estimated high on the trim, so I don't think I'm too far off with that estimate. Not bad, considering it's a project we've been working on since May.
And now finally finally, here I am dancing with my cane, since after a few hours things got a little punchy at our makeshift photo shoot:


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O'FALLON, Ill. — The last full moon of this decade wasn't the only beautiful sight to be seen at 12:12 a.m. on 12/12.
HSHS St. Elizabeth's Hospital announced that Denarrika Fisher and Charles Bell of Belleville, Illinois, welcomed their baby boy Denarius into the world at 12:12 a.m. on Thursday, Dec. 12.
Denarius was originally due December 30 but decided to come early.
The healthy baby boy weighed 7 pounds, 4 ounces at birth. Both he and mom are doing well.
The final full moon of 2019 — and this decade — officially occurred December 12 at 12:12 a.m EST. The full moon is called the Cold Moon.
This story was originally published on WTXL.


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The home of world-class race engines and class-leading performance upgrades.
With your support and our passion for excellence, we've been able to expand and develop our existing motorsports business to include road car performance upgrades.
Mountune road car products are designed and developed by enthusiasts, for enthusiasts, the drivers that want just that little bit more without sacrificing quality, driveability and resale value.
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The Livia Top
Get set for Summer with our gorgeous new sets, featuring clean and simple lines. These little numbers are versatile wonders, designed to look as fabulous with their corresponding counterpart (i.e. The Livia Skirt) as they do with another print! A mix and match party made in Bonita heaven!
- 100% silk viscose
- Exclusive print
- Tank style top with elasticised hem and button fastening
- Spot dry clean only
- Model height 170cm / 5'7in, size 8 and wearing size SMALL. Please note the top has been made longer in production and skirt is to be worn high on the waist so as to minimise midriff exposure.
- Please refer to our size chart here or in the size selection menu
- Mix suggestion - The Verde Skirt
Brisbane Fashion Festival image credits: Runway - Richard Smith, Backstage - Nick Azar.
PLEASE NOTE - Due to the business ceasing trade, all sales are final and cannot be returned, refunded or exchanged. Thank you for your understanding.
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UNHCR moves Congolese to transit camp following Uganda influx
UNHCR moves Congolese to transit camp following Uganda influx
GENEVA, May 22 (UNHCR) - Fighting late last week between Congolese government forces and renegade troops has forced a new influx of displaced people into south-west Uganda. A further 13,000-15,000 people crossed the border from Democratic Republic of the Congo's North Kivu province in the latest influx, according to Ugandan district officials.
UNHCR staff, accompanied by government officials handling refugee issues, visited the border town of Bunagana on Friday and found some 6,000-7,000 Congolese camping in the area, using local shelter and open space. They were from nearby villages in North Kivu's Rutshuru territory. Many had already been displaced by earlier clashes in May.
The refugee agency started the same day to transport people from the border to a transit centre at Nyakabande. "We took about 1,000 people on Friday and Saturday, while others made their own way. As of Sunday night, there were 6,163 at Nyakabande, where capacity is increasingly stretched. We are providing basic aid," UNHCR spokesman Andrej Mahecic said on Tuesday.
To ease the congestion at Nyakabande, which lies 20 kilometres from the border at Bunagana, UNHCR is stepping up transportation of those who are willing to go to the Rwamwanja settlement, about 370 kilometres, or an eight hour's drive, to the north.
"On Monday morning, we moved 1,471 people by convoy to Rwamwanja and we plan more convoys on Thursday and Sunday, with each one taking 1,000-1,500 people," said Mahecic in Geneva. "But many people wish to stay near the border in the hope that the on-off fighting will end and they can return home," he added.
The recent fighting has also caused displacement inside North Kivu province, with at least 12,000 people registered as internally displaced in Jomba and Bwesa in Rutshuru territory between May 10 and May 15. Most of the displaced are staying with host families or living in school buildings.
In Rwanda, smaller numbers of Congolese continue to cross from North Kivu and make their way to the overstretched Nkamira transit camp, which currently hosts 9,006 people. A total of 107 people went back to Congo over the weekend, Mahecic said, adding: "We're keeping an eye on this trend."
Since April 27, when the current wave of clashes between Congolese armed forces and supporters of former rebel commander Bosco Ntaganda broke out, tens of thousands of people have been displaced within North Kivu or to Uganda and Rwanda. Ntaganda joined the armed forces under a 2009 peace deal for the east, but he is sought for war crimes by the International Criminal Court. UNHCR fears further mass displacement unless the rival sides are able to agree on peace.
Amid all this, UNHCR suffered the loss of a colleague, Rocky Makabuza who was shot by assailants at his home in Goma late on Friday and died later. The motives for his killing have not been established.
By Leo Dobbs


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'Real Housewives' Star Bound + Beaten in Gruesome Home Invasion
Real Housewives of New Jersey star Dina Manzo and her boyfriend were bound and beaten Saturday (May 13) by two home invaders who wielded baseball bats.
According to TMZ, Manzo and David Cantin returned to their Holmdel, New Jersey home to find the assailants already in the house. Dina was immediately punched in the face, neck and head while Cantin was assaulted with the baseball bat, which belonged to Cantin's son — TMZ says the robbers grabbed it upon breaking in.
The suspects then zip-tied Manzo and Cantin up and left them in the foyer while they stole cash and jewelry from the couple.
When the assailants left, the couple managed to wiggle their way to the kitchen, cut their ties loose with scissors and call police. They were both treated for bruises at the hospital but there were no broken bones or more severe injuries.
Some of Manzo's Housewives friends and fans of the show, alike, reached out via social media to extend their well wishes:
"Dear GOD, please no. I'm heartbroken over reading what happened to @dinamanzo," one wrote, while another noted "Sickened to hear this. Saying so many prayers for you!"
Stars Who Infamously Posed for Mugshots:


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Med Spa Las Vegas - Chic La Vie Med Spa Of Las Vegas, NV
Chic la Vie Med Spa Asserts Its Status as a Top-Rated Med Spa in Las Vegas
Chic la Vie Med Spa in Las Vegas Nevada, is a leading Med Spa. The office maintained its position as the absolute best in Las Vegas in a recent update.
(Las Vegas, NV March 2022) In a website post, Chic la Vie Med Spa has affirmed its position as the top-rated Medical Spa in Las Vegas.
Chic la Vie is committed to providing exceptional client service, efficacy, and safety in a comfortable spa-like atmosphere. The team of providers includes experienced and licensed physician's assistants, nurses, and aestheticians trained in the latest best-in-class technologies designed to achieve the most beneficial results.
Because they believe all clients are unique, their objective is to provide a customized treatment solution that correctly restores beauty and youthfulness, helping them achieve the best look and appearance while feeling refreshed and more vibrant.
As the premier medical spa clinic in Las Vegas, Chic La Vie Medical Spa only employs practitioners with top credentials and experience. Several of the in-spa procedures, even though they may seem minor, must be performed by a physician or physician assistant. Additionally, other procedures may be performed by a registered nurse, medical assistant, or medical aesthetician. Next and most important to know, patient safety is the main priority at the Medical Spa.
But how do they execute this? The team goes to great lengths to ensure a qualified practitioner performs all procedures. The practitioner will then be supervised by 4-board certified plastic surgeon Dr. Lane Smith, M.D., for the duration of the procedure.
Medical Spa Procedures - Chic la Vie
In addition, the team works passionately to help bring more beauty to clients' worlds. Every day, they are committed to improving the beauty in each patient that comes through to the spa, helping them attain their skin and body rejuvenation goals.
With multi-board-certified Dr. Lane Smith leading the team, the staff at Chic la Vie Med Spa provides the highest level of aesthetic services. Therefore, the professionally trained medical and clinical staff members become committed to helping clients enhance their beauty with state-of-the-art technology. In addition, Chic la Vie Medical Spa offers a wide variety of beauty improvement treatments, including Hydrafacial®, microdermabrasion, chemical peels, micro-needling, light therapy, custom facials, and dermaplaning. They are also pleased to offer Ultherapy at their medical spa. Learn more about their Ultherapy procedure here - https://chiclavie.com/ultherapy/
Beyond that, for anyone looking for injectables, Chic La Vie is unmatched. Learn about all of their injectables here - https://chiclavie.com/medical-spa-procedures/face/injectables/ You won't find any Med Spa in Las Vegas with more injectable services. They have lip injections, Botox, Dysport, and Xeomin, along with facial dermal fillers. And they have the latest technology in laser hair removal, including the Fraxel Dual Laser and are one of the only spas in Las Vegas to offer that. Learn more about their Fraxel Dual Laser here - https://chiclavie.com/fraxel-dual-laser/ They also offer IPL, Laser Genesis, and the Cutera Excel V. Learn more about Chic La Vie's Botox services here - https://chiclavie.com/botox/
About Chic la Vie Medical Spa
Chic la Vie Medical Spa is a world-class med spa located near Summerlin in Las Vegas and just minutes from the famous Las Vegas Strip. Their med spa and laser institute is dedicated to non-invasive cosmetic procedures that restore youth, beauty, and weight loss. Chic la Vie is under the medical direction of the world-renowned plastic surgeon Dr. Lane Smith, M.D., who holds four separate board certifications in plastic surgery. The team works passionately to improve the beauty in each patient that comes to our med spa, helping them attain their skin and body rejuvenation goals.
Chic la Vie Med Spa
7650 W Sahara Ave suite 3, Las Vegas, NV 89117
Monday: 9AM–5PM
Tuesday: 9AM–5PM
Wednesday: 9AM–5PM
Thursday: 9AM–5PM
Friday: 10AM–5PM
Saturday: 9AM–3PM
Sunday: Closed
Booking Link:
(702) 233-8535
SEO for Chic La Vie Med Spa is provided by Las Vegas SEO Experts Brooks Internet Marketing.


text: Process Control Systems, Inc. is an industry leader in speed monitoring systems. We manufacture Maxigard™ brand industrial products designed to monitor belt conveyors, bucket elevators, screw conveyors, rotary feeders as well as other types of material handling and processing equipment to prove rotation or indicate loss of rotation. Maxigard™ products are flexible enough to fit a variety of applications and come backed with our five-year warranty.


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Tyres with run-flat properties, known as SST (self-supporting tyres), offer extra safety and convenience. Even when deflated, the self-supporting tyres continue to run on the reinforced tyre sidewall at a top speed of 50mph for up to 125 miles. For safety reasons a tyre monitor display is always part of the package, because under normal driving conditions you may not notice that a tyre has deflated. This could lead to dangerous situations when cornering or under heavy braking.
Article source: www.volkswagen.co.uk


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If a variable name does not exist, it is created. In this case, if value is specified, it is assigned to the newly created variable. If no value is specified, the new variable is left undefined. If the variable already exists, it is set to value if value is specified or left unchanged if no value is given. Normally, name is unqualified (does not include the names of any containing namespaces), and the variable is created in the current namespace. If name includes any namespace qualifiers, the variable is created in the specified namespace. If the variable is not defined, it will be visible to the namespace which command, but not to the info exists command.
If the variable command is executed inside a Tcl procedure, it creates local variables linked to the corresponding namespace variables (and therefore these variables are listed by info vars.) In this way the variable command resembles the global command, although the global command only links to variables in the global namespace. If any values are given, they are used to modify the values of the associated namespace variables. If a namespace variable does not exist, it is created and optionally initialized.
A name argument cannot reference an element within an array. Instead, name should reference the entire array, and the initialization value should be left off. After the variable has been declared, elements within the array can be set using ordinary set or array commands.
namespace eval foo { variable bar 12345 }
Create an array in a namespace:
namespace eval someNS { variable someAry array set someAry { someName someValue otherName otherValue } }
Access variables in namespaces from a procedure:
namespace eval foo { proc spong {} { # Variable in this namespace variable bar puts "bar is $bar" # Variable in another namespace variable ::someNS::someAry parray someAry } }
Copyright © 1993-1997 Bell Labs Innovations for Lucent Technologies Copyright © 1997 Sun Microsystems, Inc. Copyright © 1995-1997 Roger E. Critchlow Jr.