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Case: Diab retinopathy & insulin pump

Case: Diab retinopathy & insulin pump. 1965 DOB 1972 type 1 DM BG retinopathy early prolif, HbA1c 9%, 23y DM 95-00 lots of laser, I thought burnt out. DR & pump: photos. 1998?. DR & pump : photos (2). 1999 Recurrent vitreous haemorrhages.

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Case: Diab retinopathy & insulin pump

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  1. Case: Diab retinopathy & insulin pump 1965 DOB 1972 type 1 DM BG retinopathy early prolif, HbA1c 9%, 23y DM 95-00 lots of laser, I thought burnt out

  2. DR & pump: photos 1998?

  3. DR & pump : photos (2) 1999 Recurrent vitreous haemorrhages

  4. DR & pump :blurred central vision, 6/9 2000

  5. DR & pump :blurred central vision, 6/9 2000

  6. DR & pump : photos (FFA) 2000

  7. DR & pump : photos (FFA) 2000

  8. DR & pump : photos (FFA) • Right Left

  9. DR & pump macular ischaemia HbA1c 7.5%, high risk of renal failure we know 7/8 prolif ..renal failure severe night time hypo (lives alone) another patient had gone on a pump, stabilising her retinopathy pumps are recommended for night time hypos

  10. DR & pump: what is an insulin pump? • Battery operated, size of mobile phone • Worn eg round waist • Insulin in a vial is injected (through a tiny tube) into cannula inserted under the skin • pump is programmed to deliver insulin constantly • patient determines rate • no other insulin injections, but still need to test glucose levels 4-6 x day (& adjust infusion rate) • ‘bolus’ insulin at meal times (amount  size of meal) • basal rates otherwise (variable rate) • much more flexibility over your life • change cannula every 2 days (disconnect to swim etc)

  11. DR & pump Pump since (2 years) Accepts it, good diabetic control HbA1c about 7%, without nasty hypos, well stable retinopathy, Stable sight 6/9

  12. DR & pump: Insulin pump meeting Diabetes specialist nurse =DSN

  13. DR & pump: summary • Good diabetic control is essential • Laser alone will not work for most • Retinopathy then renal failure • New regimes (Lantus/analogue)/pumps • (Tightening control increases retinopathy in short term) • Diabetes nurse access very limited • No funding • Laser 10 times more (Most of UK)

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