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)