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Prevention of type 2 diabetes & retinopathy/blindness from type 1 & type 2

Prevention of type 2 diabetes & retinopathy/blindness from type 1 & type 2. detect retinopathy .. Screen Background … tight control. detect diabetes .. Screen Patients’ relatives.. Family history 50% type 2.. biggest advance. Prevent diabetes .. Exercise, Obesity, smoking, healthy diet.

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Prevention of type 2 diabetes & retinopathy/blindness from type 1 & type 2

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  1. Prevention of type 2 diabetes & retinopathy/blindness from type 1 & type 2 detect retinopathy..Screen Background…tight control detect diabetes..Screen Patients’ relatives.. Family history 50% type 2..biggest advance Prevent diabetes..Exercise,Obesity, smoking,healthy diet 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 Rehabilitate & support Low Vision servicedepressionOther agencies

  2. Green…% reduction in retinopathy Smoking 20 cigarettes/day probably triples retinopathy (EASDec, 2003) Platelet adhesion Aspirin Healthy diet 7-9 portions vegetables, fruit/day ~30% 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 Medication & lifestyle Exercise,Obesity,smoking,HbA1c,BP,cholesterol,ACE/ATII healthy diet Exercise 30-90 minutes a day ~weight ~50% Blood pressure1mmHg =1.1% 130 (eyes) 115 (kidneys) ACE/ATII 50%> amlodipine > Bendrofluazide > B blocker >other

  3. 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…

  4. For diffuse macular oedema (laser is not effective) temporary Increases eye pressure …small % very high, rarely infection Intravitreal Triamcinolone

  5. 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?

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