Diabetic retinopathy

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Diabetic retinopathy

• An interactive afternoon July 2005 David
  Kinshuck
• Ice breaker 2.30
• Medical aspects of prevention of retinopathya
  reminder/updateDK 2.40
• Laser tricks/updateDK 2.50
• CaseSam Mirza 3.00
• Groups ..casesuse cases for discussion 3.10
• Break 3.50
• Feedback from groups..discussion 4.10
• DKto tie up lose ends?use a common database,
  4.40 check everyones topics discussed..discuss
  them
• summary 4.50..home ?4.55

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Groups...

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

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Prevention of type 2 diabetes
retinopathy/blindness from type 1 type 2
Prevent diabetes..Exercise,Obesity,
smoking,healthy diet
detect diabetes..Screen Patients
relatives.. Family history 50 type 2..biggest
advance
Treatdiabetes prevent retinopathy Exercise,Obe
sity,smoking,HbA1c,BP,cholesterol,ACE/ATII
healthy diet
Treatretinopathy..Focal laserGrid, PRP
Indirect ?pre-prolif?investigate?triamcinolone I
mprove control retinopathy worse in short
term LIGHT burns ENOUGH PRP
detect retinopathy..Screen Backgroundtight
control
Rehabilitate support Low Vision
servicedepressionOther agencies
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Green reduction in retinopathy
Medication lifestyle Exercise,Obesity,smoking
,HbA1c,BP,cholesterol,ACE/ATII healthy diet
Exercise 30-90 minutes a day weight 50
Cholesterol Statin 25 whatever level Low
saturated fats (red meat, dairy products) Low
trans fats (cakes etc) Fibrates TG25 Olive
oil, sunflower oil, Fish x2 week 20
HbA1c 138 Type 2 Dietmetformin2nd
druginsulin onceinsulin multiple Type
1 insulin long acting rapid acting
Platelet adhesion Aspirin Healthy diet 7-9
portions vegetables, fruit/day 30
Blood pressure 1mmHg 1.1 130 (eyes) 115
(kidneys) ACE/ATII 50 gt amlodipine
gt Bendrofluazide gt B blocker gtother
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As run out of insulin need more
Do not assume other professionals are in control
practice nurses treatYOU can advise the target
HbA1c 138 Type 2Diet gtmetformin gt2nd drug
gtinsulin once gtinsulin multiple Type
1insulin long acting rapid acting gtpump
Very hard to achieve good controlneeds a lot of
effort (may be too late if complications present)
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• Insulin needs
• 1/2 basic demand
• 1/2 with food
• less with exercise gt30minutes
• stress..complex effects

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Type 1insulin long actinglantus/levemir ra
pid actingEg novorapid
But many patients are using twice daily insulin
mixturesone paper3x retinopathy as multiple
injections
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Impossible to achieve perfect control1000s
tricks to improve, takes expert advice and a
lifetime to learn
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Diabetes..total quality..

1. Try and join the diabetic team meetings
2. Patient does 90 of the work, professional 10
3. Learn from patientslistening will teach you and
   helps patientsthey realise you understand their
   problems, and so on.
4. Share information with patients show them the
   haemorrhages on the photographs, discuss what the
   HbA1c means, and so on.
5. Unfortunately the disease can be vicious ..the
   patient may be making tremendous effort, but even
   this is not quite enough.