reactive hypoglycemia icd 10. This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information. reactive hypoglycemia icd 10

 
 This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other informationreactive hypoglycemia icd 10 2 became effective on October 1, 2023

9 - other international versions of ICD-10 E16. 2 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 251. This may result in a variety of symptoms including clumsiness, trouble talking, confusion, loss of consciousness, seizures, or death. 9 with hypoglycemia E13. 649, E10. Hyperplasia of pancreatic islet beta cell; Hypoglycemia (low blood sugar), reactive; Iatrogenic hyperinsulinism; Reactive hypoglycemia; diabetes with hypoglycemia (E08. Hyperplasia of appendix. ICD-10-CM Diagnosis Code E11. 40 Four cats had also an early death due to malignant MCA. Showing 226-250: ICD-10-CM Diagnosis Code T83. When symptomatic hypoglycemia develops, 10–15 g of oral carbohydrates (eg 3–4 glucose tabs or gel, 4 ounces of juice) are recommended to. Islet-cell hyperplasia NOS. Abstract. This is the American ICD-10-CM version of J66. The patient's insulin regimen was modified to prevent further. The 2024 edition of ICD-10-CM K94. The 2024 edition of ICD-10-CM E11. 9); hypoglycemia NOS (E16. ICD-9-CM 251. Hypoglycemia is often defined by a plasma glucose concentration below 70 mg/dL; however, signs and symptoms may not occur until plasma glucose concentrations drop below 55 mg/dL. acute or subacute hepatitis (. 12 , 27 Reactive hypoglycemia, postprandial hypoglycemia, or sugar crash is a term describing recurrent episodes of symptomatic hypoglycemia occurring within four hours [1] after a high carbohydrate meal in people with and without diabetes. Search Results. Endothelial dysfunction may also be increased by an increase in C-reactive protein and platelet. 9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 3X6D [convert to ICD-9-CM] Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs, subsequent encounter. The 2024 edition of ICD-10-CM R73. 22 became effective on October 1, 2023. 9 with hypoglycemia E08. They. 1 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 251. Applicable To. 63, and E14. This is the American ICD-10-CM version of E16. 0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Showing 1-25: ICD-10-CM Diagnosis Code T38. 39 became effective on October 1, 2023. Iatrogenic hyperinsulinism; Reactive hypoglycemia; diabetes with hypoglycemia (E08. Showing 1-25: ICD-10-CM Diagnosis Code E11. It is one of the most common types of hypoglycemia seen in emergency departments and hospitals. 39 Fourth, we repeated the analyses after excluding users of first-generation sulfonylureas, given the higher risk of hypoglycemia with the first-generation vs. [1] Hypoglycemia can be clinically classified according to its timing; it can be fasting, postprandial, or exercise-related. The 2024 edition of ICD-10-CM E15 became effective on October 1, 2023. Hypoglycemia is defined as a clinical condition when the venous blood glucose level is <55mg/dl (<3mmol/L), obtained if possible, at the time of the symptoms. Signs and symptoms. Hypoglycemia is defined as a clinical condition when the venous blood glucose level is <55mg/dl (<3mmol/L), obtained if possible, at the time of the symptoms. Non-diabetic hypoglycemia, a rare condition, is low blood glucose in people who do not have diabetes. Search Results. Diabetes mellitus type 2 w complications; Diabetes type 2 with hypoglycemia; Diabetes type 2 with hypoglycemia unawareness; Hypoglycemia due to type 2 diabetes mellitus; Insulin reactive hypoglycemia in type 2 diabetes mellitus. Drug-induced hypoglycemia without coma. 500 results found. K94. Drug induced hypoglycemia; diabetes with hypoglycemia without coma (E09. Instead of placing my primary focus on including carbohydrates with each meal and snack, I began to focus on eating. ICD-10-CM Codes. Factors regulating the magnitude of hypoglycemia associated autonomic failure include antecedent duration and frequency of hypoglycemia, prior episodes of exercise, and autonomic neuropathy. [convert to ICD-9-CM]Short description: DMII oth nt st uncntrld. 1 [convert to. Other disorders of pancreatic internal secretion (E16) Other hypoglycemia (E16. However, given the broad differential diagnosis of transient loss of consciousness, it can be challenging to determine the exact etiology. xx or ICD-10 of I50. Codes. 83 may differ. 82 for Elevated C-reactive protein (CRP) is a medical classification as listed by WHO under the range -Abnormal findings on examinatio. 355. A fast or uneven heartbeat. 82 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 1016/j. Foods with low to medium glycemic index should be. 1 - other international versions of ICD-10 E89. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code. Here are some foods that will provide about 15 grams of carbohydrate to lower blood sugar: eat three glucose tablets or four dextrose tablets. In total, 726 participants with hypoglycemia and 2852 participants without hypoglycemia were included in this study. 0X5A became effective on October 1, 2023. In general, most signs and symptoms can be attributed to (1) the effects on the brain of insufficient glucose (neuroglycopenia) or (2) to the adrenergic response of the autonomic nervous system to hypoglycemia. 4 Other Neonatal Hypoglycemia. ICD-10 Games Learn codes with classic games like Flashcards and Hangman. 7% and 32. mohseni@hul. 2015 ICD-9-CM Diagnosis Code 251. 0 may differ. A reactive release of insulin (hyperinsulinemic response) transpires (GLP-1 mediated) resulting in subsequent reactive hypoglycemia; REFERENCES. Understanding the pathophysiology of this syndrome will provide a foundation for therapy aimed at preventing severe hypoglycemia during intensive. When your blood sugar level is low, your muscles and brain cells do. Hypoglycemia was defined as any glucose < 3. Studies in both type 1 and type 2 diabetes have shown that intensive glycemic control reduces long-term complications (1–3). Symptoms usually develop within four hours of consuming food and. 3 may differ. 512S [convert to ICD-9-CM] Infection and inflammatory. I89. Acarbose can be used in IAS to dampen the postprandial rise in serum glucose and insulin, but it is poorly tolerated due to adverse gastrointestinal effects such as. Other Codes Used Similar Conditions 9. 99–2. In very rare circumstances, however, other tests, such as insulin-induced hypoglycemia, can be utilized to evaluate the pituitary-adrenal response to stress. E16. 9 became effective on October 1, 2023. 40 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The most common sites are the skin overlying the sacrum, coccyx, heels. Showing 1-25: ICD-10-CM Diagnosis Code E11. 2 ); increased secretion of glucagon (E16. 641 [convert to ICD-9-CM] Type 2 diabetes mellitus with hypoglycemia with coma. 80 - other international versions of ICD-10 M00. 355. The organism is referred to as M. Idiopathic postprandial syndrome (IPS) occurs when a person experiences low blood sugar symptoms even though their blood sugar is within a healthy range. 81 may differ. The true frequency of this condition remains uncertain, due,. 649); code for adverse effect,. 30101281. People under stress are vulnerable to functional or reactive hypoglycemia because stress negatively. According to the National. Synonyms: acute hyperglycemia, chorea due to hyperglycemia, chorea due to metabolic. It is found in the 2023 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2022 - Sep 30, 2023 . Hypoglycemia was defined based on ICD-10: E16. Documentation of a blood glucose <60 mg/dL with accompanying symptoms is crucial to diagnosing clinically significant hypoglycemia. In many patients with this self-diagnosis, other disorders can be attributed as a cause for symptoms, especially neuro. 9 with hypoglycemia E11. This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information. Select. 0, E16. 0. 0 - other international versions of ICD-10 D13. Basal insulin administration was defined as any. . People experience these symptoms. Hypoglycemia reduces neuroendocrine, symptomatic, and cognitive dysfunction responses to a given level of subsequent hypoglycemia in nondiabetic individuals (29,56–58), people with type 1 diabetes (18,30,31), and those with type 2 diabetes . The 2024 edition of ICD-10-CM T38. Hypoglycemia was discovered in 1924 by Seale Harris, M. Hypoketotic hypoglycemia affects your blood sugar (glucose) level and energy. 12-Month follow-up (prediction year) 1 January–31 December 2014 1 January–31 December 2017 Baseline HRU risk categories (%) ICD-9-CM 251. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code (or codes). Reactive hypoglycemia is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 2-4 hours after a high carbohydrate meal (or oral glucose load). Glucose is a sugar that is typically obtained from consuming carbohydrates, such as bread or fruit. 641, E11. 63, E13. pylori infection increases the incidence of diabetes due to its increased levels of C-reactive protein and interleukin 6 (IL-6), which results in. Hypoglycemia, or low blood sugar, has a variety of causes, but most often occurs as a result of insulin therapy or other medications in patients with diabetes. 649, E10. September 7, 2021 / Nutrition How to Treat Reactive Hypoglycemia A registered dietitian gives tips and diet help If you’ve ever felt a little woozy after a meal, maybe a little shaky. Hypoglycemia in pregnancy is very common. ICD-9-CM 251. 174 results found. E16. 0): 008 Simultaneous pancreas and kidney transplant; 010 Pancreas transplant; 019 Simultaneous pancreas and kidney transplant with hemodialysis; 637. 1) E16. Applicable To. Short description: Oth spcf hypoglycemia. 649 [convert to ICD-9-CM] Type 2 diabetes mellitus with hypoglycemia without coma. Centers for Medicare and Medicaid Services and the National Center for Health. Sugar is the best treatment. Search All ICD-10; ICD-10-CM Diagnosis Codes; ICD-10-PCS Procedure Codes; ICD-10-CM Diagnosis Index; ICD-10-CM External Causes Index;. 0 may differ. The most common cause of hyperinsulinemic hypoglycemia in adults is insulinoma. A diagnosis of PBH requires documented low venous glucose accompanied by neuroglycopenic symptoms. Hyperinsulinism; Hyperinsulinism, iatrogenic; Hyperplasia of pancreatic islet beta cell; Hypoglycemia (low blood sugar), reactive; Iatrogenic hyperinsulinism; Reactive hypoglycemia; diabetes with hypoglycemia (E08. Reactive hypoglycemia is a condition that occurs when an individual experiences a significant fall in their blood glucose level. 8 Even when patients with type B insulin resistance present with hypoglycemia, hyperinsulinism that is inappropriate to the. This is the American ICD-10-CM version of O99. 1 - Other hypoglycemia. Type 2 diabetes with mild nonp rtnop with macular edema, bi. ICD-10-CM Diagnosis Codes. J45. Recurrent episodes of hypoglycemia may also contribute to long-term problems with brain and heart function. The. Transitory neonatal hypoglycemia coma E15 ICD-10-CM Diagnosis Code E15 Nondiabetic hypoglycemic coma 2016 2017 2018 2019 2020 2021 2022 2023 2024. 0 mmol/L or higher. Type 1 Excludes. Short description: Hypoglycemia NOS. ICD-10-CM Diagnosis Code E11. E16. ICD-9-CM is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, should only be used for claims with a date of service on or before September 30, 2015. Unfortunately, severe hypoglycemia remains a major problem in adults with insulin-requiring diabetes (4). ICD-9-CM is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, should only be used for claims with a date of service on or before September 30, 2015. Purpose of review: The Roux-en-Y gastric bypass surgery (RYGB) improves glucose control in majority of patients with type 2 diabetes. 2018-00528. In type 1 diabetes, the pancreas does not produce insulin. Fifth, although, cirrhosis was excluded using the ICD-10 code, patients with undiagnosed cirrhosis were likely to have been included in the analysis, as NHIS records do not have histological or imaging data of liver. 641 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Symptomatic. INTRODUCTION. 7 Possible mechanisms of hyperinsulinism include increased insulin secretion to compensate for the peripheral insulin resistance and, in many cases, reduced insulin clearance. 4); specific findings indicating disorder of amino. 39 Fourth, we repeated the analyses after excluding users of first-generation sulfonylureas, given the higher risk of hypoglycemia with the first-generation vs. The 2024 edition of ICD-10-CM E27. Nesidioblastosis is a rare, but well-recognized disorder of persistent hyperinsulinemic hypoglycemia in infancy, but adult-onset nesidioblastosis associated with hyperinsulinemic hypoglycemia, termed noninsulinoma pancreatogenous hypoglycemic syndrome. patientsand triggersevolution of cirrhosis to fibrosis. , a year after the Canadian physician Frederick Banting, M. The 2024 edition of ICD-10-CM E89. Type 2 diabetes mellitus with hypoglycemia. Type 1 Excludes. Use Additional code for adverse effect, if applicable, to identify drug. 2 [convert to ICD-9-CM] Hypoglycemia, unspecified. Postprandial hyperinsulinemic hypoglycemia (PHH) after Roux-en-Y gastric. Search Results. Whether or not you should have a. 649 with coma E08. 1 for Other hypoglycemia is a medical classification as listed by WHO under the range - Endocrine, nutritional and metabolic diseases . This is the American ICD-10-CM version of I89. 0 - other international versions of ICD-10 K64. 2 [convert to ICD-9-CM] Hypoglycemia, unspecified. Search All ICD-10 Toggle Dropdown. 8 mmol/L) after an oral glucose tolerance test (OGTT) . 40 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 649 ICD-10 code E11. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. Search online 72,000+ ICD-10 codes by number, disease, injury, drug, or keyword. Z96. ↓ See below for any exclusions, inclusions or special notations. 3 +/- 4. 196 results found. When the first-phase insulin response decreases, firstly, blood glucose starts to rise. Feeling weak or tired. (50 mg/dl) as much as 10% of the time; the average patient suffers two episodes of symptomatic hypoglycemia per week and one episode of severe, temporarily disabling. Persistent mood disorder. 2 - other international versions of ICD-10 R14. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. Ketotic hypoglycemia is a common type of low blood sugar that occurs mostly in children without diabetes who are between 6 months and 6 years old. J66. 86. 80 may differ. ICD-9-CM 251. Short description: Oth spcf hypoglycemia. 641 [convert to ICD-9-CM] Other specified diabetes mellitus with hypoglycemia with coma. Summary. We hope you find it helpful, and thanks for stopping by!HYPOGLYCEMIA: A WORKING DEFINITION Hypoglycemia may be defined as a clinical syndrome in which low serum glucose levels lead to symptoms and signs of neuroglycopenia (eg, an altered sensorium and seizures) and sympathoadrenal activation. Showing 1-25: ICD-10-CM Diagnosis Code E15. Gestational diabetes occurs in up to 10% of pregnant people in the United States. [convert to ICD-9-CM]Type 2 diabetes mellitus with hypoglycemia without coma. 9 mmol/L within 24 h of admission (Hypo 1day) or throughout hospitalization (Hypo T) and any. Other disorders of glucose regulation and pancreatic internal secretion. diabetic - see Diabetes, hypoglycemia dietary counseling and surveillance Z71. Hunger. Short description: Adverse effect of insulin and oral hypoglycemic drugs, init The 2024 edition of ICD-10-CM T38. 5 vs. The most effective treatment for this condition is to follow a reactive hypoglycemia diet, which involves eating several small meals consisting of high-fiber and starchy foods, limiting sugar, and regular exercise. Fifth, although, cirrhosis was excluded using the ICD-10 code, patients with undiagnosed cirrhosis were likely to have been included in the analysis, as NHIS records do not have histological or imaging data of liver. Patient Education 8. For example, “infantile colic often occurs during the perinatal period, but it does not have an ICD-10 neonatal P code assigned to it,” says Donna Walaszek, CCS-P, billing manager, credentialing/coding specialist for Northampton Area Pediatrics, LLP, in Northampton, Massachusetts. The 2024 edition of ICD-10-CM E16. We hope you find it helpful, and thanks for stopping by!ICD-10-CM Diagnosis Code E10. 9 may differ. R79. Signs of a diabetic coma include an altered mental state, inability to speak, visual problems, drowsiness, weakness, headache, and restlessness. 9 with hypoglycemia E10. 4-) ICD-10-CM Diagnosis Code R97. diabetes with hypoglycemia (E08. Abnormal glucose complicating pregnancy, childbirth and the puerperium. 0 became effective on October 1, 2023. 2 should only be used for claims with a date of service on or before September 30, 2015. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code. 1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 2 with hypoglycemia; Diabetes type 2 with hypoglycemia unawareness; Hypoglycemia due to type 2 diabetes mellitus; Insulin reactive hypoglycemia in type 2 diabetes mellitus;. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code (or codes). They said "both physicians and the public deserve major re-education. 8 may differ. 40 Fifth, we performed a negative. This chapter includes symptoms, signs, abnormal. Showing 1-25: ICD-10-CM Diagnosis Code E10. Background. Article Google Scholar. This is the American ICD-10-CM version of E16. The 2022 edition of ICD-10-CM E11. ICD-10-CM Diagnosis Code E11. 2 became effective on October 1, 2023. Applicable To. 1 may differ. All neoplasms, whether functionally active or. 44, 47,48,57 When insulin secretion is evaluated in these individuals, approximately 90% of them will have hyperinsulinism or dysinsulinism (that is, a delayed retarded * References 1, 10, 44, 47, 48, 65, 77, 83, 100,. Showing 1-25: ICD-10-CM Diagnosis Code E13. 1 [convert to ICD-9-CM] Other hypoglycemia. 77. 649); hypoglycemia in infant of. O99. Use Additional code for adverse effect, if applicable, to identify drug. Hypoglycemia; Hypoglycemia (low blood sugar); Hypoglycemia post gi surgery; Hypoglycemia unawareness; Hypoglycemic encephalopathy; Loss of hypoglycemic warning; Post gastrointestinal tract surgery. 500 results found. Postprocedural hypoinsulinemia. Methods: The study group (SG) included non-diabetic individuals with symptoms consistent with RH. 82 became effective on October 1, 2023. 41 may differ. While most often considered in the context of diabetes and its treatment, hypoglycemia also occurs outside of diabetes and can be further classified as fasting or reactive (after meals, activity, and other conditions). For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM. xx or ICD-10 E08-13. 649, E11. 649,. This chapter includes symptoms, signs, abnormal. Third, we investigated the risk of hypoglycemia-related hospitalizations captured by validated ICD-9 and ICD-10 codes. Despite well-documented benefits for long-term morbidity and mortality [1, 2], bariatric procedures are not without risks even years after the initial intervention. Diabetes mellitus due to underlying condition with hypoglycemia. 3 result found: ICD-10-CM Diagnosis Code P70. Coma, hypoglycemic; Coma, hypoglycemic, nondiabetic; Hypoglycemic coma; Non-diabetic hypoglycemic coma; drug-induced insulin coma in nondiabetic; hyperinsulinism with hypoglycemic coma; hypoglycemic coma NOS. Idiopathic postprandial syndrome (IPS) occurs when a person experiences low blood sugar symptoms even though their blood sugar is within a healthy range. 0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Your blood sugar when tested is 4. Code History E16. After significant weight loss, insulin sensitivity is usually restored and can trigger clinical manifestations of GH deficiency. 354 results found. The prevalence of hypoglycemia (defined as blood glucose < 3. 2 [convert to ICD-9-CM] Hypoglycemia, unspecified. These findings highlighted the importance of the correct sampling time following insulin administration and the consideration of the lab results in addition to POC. Identified in approximately 25% of patients with type 1 diabetes, IAH has complex pathophysiology, and might lead to serious and potentially lethal consequences in. Symptoms typically start to occur 1–3 years after the procedure, and. Elevated C-reactive protein (CRP) Billable Code. Surg. Reactive hypoglycemia may occur after gastric bypass surgery due to changes in the way the body absorbs and digests glucose. For some can also occur in the middle of the night (not fasting), or with activity. Sweating. 2 should only be used for claims with a date of service on or before September 30, 2015. Hypoglycemia is a challenging clinical condition that can have both immediate and long-lasting deleterious physical and psychosocial effects. Fasting hypoglycemia, which may be related to a disease. 1. Hypoglycemia risk stratification tool with 1 January 2017 baseline (updated with ICD-10-CM case identification). 0 mmol/L). Glucose is the main source of energy for your body. Lymphangitis NOS. This is in contrast to spontaneous hypoglycemia, which is a drop in. Showing 1-25: ICD-10-CM Diagnosis Code E11. These are sugary foods or drinks without protein or fat that are easily converted to sugar in the body. Depressive episode. 9 mmol/L). This is different from a fasting low blood sugar, as the cause is the release of too much insulin for the food that was eaten. Hypoglycemia; Hypoglycemia (low blood sugar); Hypoglycemia post gi surgery; Hypoglycemia unawareness; Hypoglycemic encephalopathy; Loss of hypoglycemic warning; Post gastrointestinal tract surgery hypoglycemia. 10. 1), and unspecified hypoglycemia (ICD-9: 251. 3X1A is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 69 Type 1 diabetes mellitus with other specified complication. (ICD), ICD-9 of 428. Hypoglycemia; Hypoglycemia (low blood sugar); Hypoglycemia post gi surgery; Hypoglycemia unawareness; Hypoglycemic encephalopathy; Loss of hypoglycemic warning; Post gastrointestinal tract surgery. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code (or. 81. A non-diabetic hypoglycemia diet can help keep blood sugar levels balanced. Short description: HYPOGLYCEMIA NOS. xx). If left untreated, high blood sugar can lead to hyperglycemia-related seizures. 9 - other international versions of ICD-10 E16. Reactive hypoglycemia diet should contain lots of protein and fiber-rich foods like fish, meat, whole grain, fruits, vegetables and dairy products. The main etiological causes are metabolic and/or endocrine and/or other congenital disorders. Reactive hypoglycemia (RH) is the condition of postprandially hypoglycemia occurring 2-5 hours after food intake. Patients may require 6 small meals and 2-3 snacks per day. Pancreatic endocrine cell hyperplasia NOS. 618 [convert to ICD-9-CM] Type 2 diabetes mellitus with other diabetic arthropathy. Common presenting symptoms include nausea, confusion, tremor, sweating, palpitations, or hunger. The 2024 edition of ICD-10-CM K38. Do not use code A4253 for these items. 2, E11. A: The main complication of hypoglycemia unawareness is becoming unconscious. ICD-10 Basics Check out these videos to learn more about ICD-10. 649 is grouped within Diagnostic Related. O99. 1. Reactive hypoglycemia can also result from tumors,. Hypoglycemia during hospitalization is associated with an increased hospital stay and contributes to a poorer outcome in diabetes patients in general medical wards in diabetic patients [1, 2]. , received a Nobel Prize for finding a way to extract the hormone insulin, which could help diabetics control the abnormal amounts of sugar in their blood. 641. However, in order to best utilize this modality, we must be aware of potential hazards and metabolic complications. 3) was not included in the exposure group. 500 results found. The American Diabetes Association and the Endocrine Society define the occurrence of severe hypoglycemia as an event associated with loss-of-consciousness or requiring third-party assistance for recovery. 1 is an approximate match for comparison and conversion. ICD.