Case: Diab retinopathy

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Case Diab retinopathy insulin pump

• 1965 DOB
• 1972 type 1 DM
• BG retinopathy
• early prolif, HbA1c 9, 23y DM
• 95-00 lots of laser, I thought burnt out

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DR pump photos

• 1998?

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DR pump photos (2)

• 1999 Recurrent vitreous haemorrhages

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DR pump blurred central vision, 6/9

• 2000

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DR pump blurred central vision, 6/9

• 2000

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DR pump photos (FFA)

• 2000

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DR pump photos (FFA)

• 2000

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DR pump photos (FFA)

• Right Left

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DR pump

• macular ischaemia
• HbA1c 7.5, high risk of renal failure
• we know 7/8 prolif ..renal failure
• severe night time hypo (lives alone)
• another patient had gone on a pump, stabilising
  her retinopathy
• pumps are recommended for night time hypos

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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)

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DR pump

• Pump since (2 years)
• Accepts it, good diabetic control
• HbA1c about 7, without nasty hypos, well
• stable retinopathy, Stable sight 6/9

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DR pump Insulin pump meeting

• Diabetes specialist nurse DSN

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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)