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Diabetic retinopathy

Diabetic retinopathy. An interactive afternoon: July 2005 David Kinshuck Ice breaker 2.30 Medical aspects of prevention of retinopathy…a reminder/update…DK 2.40 Laser tricks/update…DK 2.50 Case…Sam Mirza 3.00 Groups ..cases…use cases for discussion 3.10

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Diabetic retinopathy

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  1. Diabetic retinopathy An interactive afternoon: July 2005 David Kinshuck Ice breaker 2.30 Medical aspects of prevention of retinopathy…a reminder/update…DK 2.40 Laser tricks/update…DK 2.50 Case…Sam Mirza 3.00 Groups ..cases…use cases for discussion 3.10 Break 3.50 Feedback from groups…..discussion 4.10 DK…to tie up lose ends…?use a common database, 4.40 check everyone’s topics discussed..discuss them summary 4.50..home ?4.55

  2. Groups... • 6 or less/group • Facilitator…present the cases • Facilitator..ensure everyone speaks/contriubutes ~equally • More expert/less expert all contribute • This facilitates deep learning and putting into practice

  3. Prevention of type 2 diabetes & retinopathy/blindness from type 1 & type 2 detect retinopathy..Screen Background…tight control detect diabetes..Screen Patients’ relatives.. Family history 50% type 2..biggest advance Prevent diabetes..Exercise,Obesity, smoking,healthy diet Treatdiabetes & prevent retinopathy Exercise,Obesity,smoking,HbA1c,BP,cholesterol,ACE/ATII healthy diet Treatretinopathy..Focal laserGrid, PRP Indirect ?pre-prolif?investigate?triamcinolone Improve control …retinopathy worse in short term LIGHT burns ENOUGH PRP Rehabilitate & support Low Vision servicedepressionOther agencies

  4. Green…% reduction in retinopathy Platelet adhesion Aspirin Healthy diet 7-9 portions vegetables, fruit/day ~30% Exercise 30-90 minutes a day ~weight ~50% Medication & lifestyle Exercise,Obesity,smoking,HbA1c,BP,cholesterol,ACE/ATII healthy diet Cholesterol Statin 25%whatever level Low saturated fats (red meat, dairy products) Low trans fats (cakes etc) Fibrates ~TG~25%Olive oil, sunflower oil, Fish x2 week~20% HbA1c 1=38% Type 2 Dietmetformin2nd druginsulin onceinsulin multiple Type 1 insulin long acting &rapid acting Blood pressure1mmHg =1.1% 130 (eyes) 115 (kidneys) ACE/ATII 50%> amlodipine > Bendrofluazide > B blocker >other

  5. As run out of insulin need more Do not assume other professionals are in control …practice nurses treat…YOU can advise the target HbA1c 1=38% Type 2Diet >metformin >2nd drug >insulin once >insulin multiple Type 1insulin long acting &rapid acting >pump Very hard to achieve good control…needs a lot of effort (may be too late if complications present)

  6. Normal glucose level • Insulin needs • 1/2= basic demand • 1/2= with food • less with exercise >30minutes; • stress..complex effects

  7. Type 1insulin long acting=lantus/levemir &rapid actingEg novorapid But many patients are using twice daily insulin mixtures…one paper…3x retinopathy as multiple injections

  8. Hypo! Impossible to achieve perfect control…1000s tricks to improve, takes expert advice and a lifetime to learn

  9. Diabetes..total quality………………………….. • Try and join the diabetic team meetings • Patient does 90% of the work, professional 10% • Learn from patients…listening will teach you and helps patients…they realise you understand their problems, and so on. • Share information with patients …show them the haemorrhages on the photographs, discuss what the HbA1c means, and so on. • Unfortunately the disease can be vicious ..the patient may be making tremendous effort, but even this is not quite enough.

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