Post on 18-Jan-2016
description
Case: Diab retinopathy & insulin pump
1965 DOB1972 type 1 DM 1994 BG retinopathy1995 early prolif, HbA1c 9%, 23y DM95-00 lots of laser, I thought burnt out
1998?
DR & pump: photos
1999 Recurrent vitreous haemorrhages
DR & pump : photos (2)
2000
DR & pump :blurred central vision, 6/9
DR & pump :blurred central vision, 6/9
2000
2000
DR & pump : photos (FFA)
2000
DR & pump : photos (FFA)
2000 Right Left
DR & pump : photos (FFA)
macular ischaemiaHbA1c 7.5%, high risk of renal
failurewe know 7/8 prolif ..renal failuresevere night time hypo (lives
alone)another patient had gone on a
pump, stabilising her retinopathy
pumps are recommended for night time hypos
DR & pump
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)
DR & pump
Pump since (2 years)Accepts it, good diabetic
controlHbA1c about 7%, without nasty
hypos, wellstable retinopathy, Stable sight
6/9
DR & pump: Insulin pump meeting
Diabetes specialist nurse =DSN
Gouda, Holland 1: 365 patients(DSN : patient)1/100 patients having/have had laser
Good Hope1 : 1333(similar area)1/10Average for UK
SHA/PCT target type 2 onlyGH will not fund more DSNs
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)