Transcript Document
Prevention of type 2 diabetes & retinopathy/blindness from type 1 & type 2 detect retinopathy.. Screen detect diabetes.. Screen Background … tight control Patients’ relatives.. Family history Prevent diabetes.. Exercise, Obesity, smoking, healthy diet 50% type 2.. biggest advance Rehabilitate & support Low Vision service depression Other agencies Treat diabetes & prevent retinopathy Treat retinopathy.. Focal laser Grid, PRP Indirect Exercise, Obesity, smoking, HbA1c, BP, cholesterol, ACE/ATII healthy diet ?pre-prolif ?investigate ?triamcinolone Improve control …retinopathy worse in short term LIGHT burns ENOUGH PRP Green…% reduction in retinopathy Smoking 20 cigarettes/day probably triples retinopathy (EASDec, 2003) Platelet adhesion Medication & lifestyle Aspirin Exercise, Obesity, smoking, HbA1c, BP, cholesterol, ACE/ATII healthy diet Healthy diet 7-9 portions vegetables, fruit/day ~30% Exercise 30-90 minutes a day ~weight ~50% Blood pressure 1mmHg =1.1% 130 (eyes) 115 (kidneys) ACE/ATII 50% > amlodipine > Bendrofluazide > B blocker >other Cholesterol HbA1c 1=38% Statin 25% Type 2 whatever level Low saturated fats (red meat, dairy products) Low trans fats Diet metformin 2nd drug insulin once insulin multiple (cakes etc) Type 1 Fibrates ~TG ~25% Olive oil, sunflower oil, insulin long acting & rapid acting Fish x2 week ~20% Total quality • Insulin resistance is not being treated • Roy Taylor in Newcastle has shown an 90% reduction in blindness • DT1 …70% screening…we need to improve our screening…good, but needs to be better • I estimate can reduce blindness rate by 90% from current levels…organisation, without much extra expenditure • Also know that basal bolus insulin reduces retinopathy to ~33% • Laser pre-proliferative..controversial …lighter laser much earlier, + good control • Intravitreal Triamcinolone… Intravitreal Triamcinolone For diffuse macular oedema (laser is not effective) temporary Increases eye pressure …small % very high, rarely infection Rapid control in type 2 (or type 1) • Danger time…transfering to insulin • Suggesting gradual improvement in control • (really important never to let control get poor in the first pace) • Do all diabetes practice nurses know this?