1. Prevention of type 2 diabetes & retinopathy/blindness from type 1 & type 2 Prevent diabetes.. Exercise, Obesity, smoking, healthy diet detect diabetes.. Screen Patients’ relatives.. Family history 50% type 2.. biggest advance Treat diabetes & prevent retinopathy Exercise, Obesity, smoking, HbA1c, BP, cholesterol, ACE/ATII healthy diet Treat retinopathy.. Focal laser Grid, PRP Indirect ?pre-prolif ?investigate ?triamcinolone Improve control …retinopathy worse in short term LIGHT burns ENOUGH PRP detect retinopathy.. Screen Background … tight control Rehabilitate & support Low Vision service depression Other agencies

2. Medication & lifestyle Exercise, Obesity, smoking, HbA1c, BP, cholesterol, ACE/ATII healthy diet Exercise 30-90 minutes a day ~weight ~50% Cholesterol Statin 25% whatever level Low saturated fats (red meat, dairy products) Low trans fats (cakes etc) Fibrates ~TG ~25% Olive oil, sunflower oil, Fish x2 week ~20% HbA1c 1=38% Type 2 Diet metformin 2 nd drug insulin once insulin multiple Type 1 insulin long acting & rapid acting Platelet adhesion Aspirin Healthy diet 7-9 portions vegetables, fruit/day ~30% Blood pressure 1mmHg =1.1% 130 (eyes) 115 (kidneys) ACE/ATII 50% > amlodipine > Bendrofluazide > B blocker >other Green…% reduction in retinopathy Smoking 20 cigarettes/day probably triples retinopathy (EASDec, 2003)

4. Total quality Insulin resistance is not being treated Roy Taylor in Newcastle has shown an 90% reduction in blindness DT1 …70% screening…we need to improve our screening…good, but needs to be better I estimate can reduce blindness rate by 90% from current levels…organisation, without much extra expenditure Also know that basal bolus insulin reduces retinopathy to ~33% Laser pre-proliferative..controversial …lighter laser much earlier, + good control Intravitreal Triamcinolone…

5. Intravitreal Triamcinolone For diffuse macular oedema (laser is not effective) temporary Increases eye pressure …small % very high, rarely infection

11. Rapid control in type 2 (or type 1) Danger time…transfering to insulin Suggesting gradual improvement in control (really important never to let control get poor in the first pace) Do all diabetes practice nurses know this?