1. Case: Diab retinopathy & insulin pump 1965DOB 1972 type 1 DM 1994 BG retinopathy 1995 early prolif, HbA1c 9%, 23y DM 95-00 lots of laser, I thought burnt out

2. 1998? DR & pump: photos

3. 1999 Recurrent vitreous haemorrhages DR & pump : photos (2)

4. 2000 DR & pump :blurred central vision, 6/9

5. 2000

6. DR & pump : photos (FFA)

7. 2000 DR & pump : photos (FFA)

8. 2000 RightLeft DR & pump : photos (FFA)

9. 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 DR & pump

10. 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)

11. DR & pump Pump since (2 years) Accepts it, good diabetic control HbA1c about 7%, without nasty hypos, well stable retinopathy, Stable sight 6/9

12. DR & pump: Insulin pump meeting Diabetes specialist nurse =DSN Gouda, Holland 1: 365 patients (DSN : patient) 1/100 patients having/have had laser Good Hope 1 : 1333 (similar area) 1/10 Average for UK SHA/PCT target type 2 only GH will not fund more DSNs

13. 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)