Insulin pumps  diabetic retinopathy, with a case report

Insulin pumps diabetic retinopathy, with a case report PowerPoint PPT Presentation


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Insulin pumps diabetic retinopathy, with a case report

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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

18. Progressing………why?

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

31. www.insulin-pumpers.org

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?

41. Summary

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