Prevention of type 2 diabetes & retinopathy/blindness from type 1 & type 2
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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,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
detect retinopathy..Screen
Background…tight control
Rehabilitate & support
Low Vision servicedepressionOther agencies
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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 ~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
Platelet adhesion
Aspirin
Healthy diet
7-9 portions vegetables, fruit/day ~30%
Blood pressure 1mmHg =1.1%
130 (eyes) 115 (kidneys)
ACE/ATII 50% > amlodipine >
Bendrofluazide > B blocker >other
Green…% reduction in retinopathy
Smoking
20 cigarettes/day probably triples retinopathy (EASDec, 2003)
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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…
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Intravitreal Triamcinolone
For diffuse macular oedema (laser is not effective)
temporary
Increases eye pressure …small % very high, rarely infection
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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?