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2. Why is an ophthalmologist interested in insulin pumps?
Prevention or slowing of retinopathy
retinopathy still disabling
5. What is an insulin pump? Battery operated pump 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 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)
6. Patient: 1
13. A bad result…….
14. Identifying progression of retinopathy Exudates/oedema = leakage
19. Retinopathy is linked to:
20. Retinopathy is linked to:
21. Retinopathy is linked to:
22. Retinopathy is linked to:
23. Retinopathy is linked to:
24. Retinopathy is linked to:
25. Retinopathy is linked to:
26. Retinopathy is linked to:
27. Retinopathy is linked to:
28. Retinopathy is linked to:
29. Retinopathy is linked to:
30. Progressing, HbA1c > 7.0% Why? Suitable regime?………… young patients on bd insulin?
Basal bolus, but sugars fluctuate, hypos
This patient read about pumps and bought one herself
Do I mention pumps?
First patient’s retinopathy halted
Insulin pumpers web site, advice from retinopathy experts at European meetings
32. Balance motivation
33. Flexible dose insulin regime Pump probably best for very dedicated (and rich) patients (HbA1c 6.0-7.0%), controversial
Best results are if you test your blood sugar 4-6 times a day, and adjust insulin
A typical new regime: lantus (glargine) longacting insulin for basal insulin; analogue for meals (lispro/novorapid)
5% of patients are already on this new regime
Should be able to achieve HbA1c 7.0% with good nursing help, without dangerous hypos
34. Patient 2
37. Patient 2
38. Patient 3
39. Patient 4
40. What should we achieve?