Transcript Document
Diabetic retinopathy An interactive afternoon: July 2005 David Kinshuck 1. Ice breaker 2.30 2. Medical aspects of prevention of retinopathy…a reminder/update…DK 2.40 3. Laser tricks/update…DK 2.50 4. Case…Sam Mirza 3.00 5. Groups ..cases…use cases for discussion 3.10 6. Break 3.50 7. Feedback from groups…..discussion 4.10 8. DK…to tie up lose ends…?use a common database, 4.40 check everyone’s topics discussed..discuss them 9. summary 4.50..home ?4.55 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 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 Platelet adhesion Aspirin Healthy diet 7-9 portions vegetables, fruit/day ~30% Exercise 30-90 minutes a day ~weight ~50% Medication & lifestyle Cholesterol HbA1c 1=38% Exercise, Obesity, smoking, HbA1c, BP, cholesterol, ACE/ATII healthy diet Statin 25% whatever level Type 2 Blood pressure 1mmHg =1.1% 130 (eyes) 115 (kidneys) ACE/ATII 50% > amlodipine > Bendrofluazide > B blocker >other Low saturated fats (red meat, dairy products) Low trans fats Diet metformin 2nd drug insulin once insulin multiple (cakes etc) Fibrates ~TG ~25% Olive oil, sunflower oil, Fish x2 week ~20% Type 1 insulin long acting & rapid acting HbA1c 1=38% Type 2 Diet > metformin > 2nd drug > insulin once > insulin multiple Type 1 insulin long acting & rapid acting > pump As run out of insulin need more Do not assume other professionals are in control …practice nurses treat… YOU can advise the target Very hard to achieve good control…needs a lot of effort (may be too late if complications present) n o rm a l in su lin le ve l Normal glucose level b re a kfa st Insulin needs •1/2= basic demand •1/2= with food •less with exercise >30minutes; •stress..complex effects lu n ch m a in m e a l bed Type 1 insulin long acting =lantus/levemir n o rm a l in su lin le ve l & rapid acting Eg novorapid b re a kfa st But many patients are using twice daily insulin mixtures… one paper…3x retinopathy as multiple injections lu n ch m a in m e a l bed n o rm a l in s u lin le v e l g lu c o s e le v e l.. ty p e 1 d ia b e te s b re a k fa s t lu n c h m a in m e a l bed Hypo! Impossible to achieve perfect control…1000s tricks to improve, takes expert advice and a lifetime to learn Diabetes..total quality………………………….. 1. Try and join the diabetic team meetings 2. Patient does 90% of the work, professional 10% 3. 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. 4. 5. Unfortunately the disease can be vicious ..the patient may be making tremendous effort, but even this is not quite enough.