Glucometer

All diabetics should have & know how to use a glucometer.Instrument is cheap, not very costly.Its a very simple user friendly instrument which can give your blood sugar levels in a minute. Anybody can use this with a little practice. This can be lifesaving. This is very true during emergencies as hypoglycemia can be fatal.

Monitoring of sugar by diabetics

Glucometer

Uristicks- Strips for monitoring of sugar in urine

This is a simple method which all diabetics can use at home to monitor sugar in urine.
One has to dip these strips in urine & look for color changes & grade it accordingly as 0, 1+, 2+, 3+.

Newer Insulins

Nowadays we see a lot of “ Newer Insulins” in the market. All these have been introduced to make diabetic patients life easier. These injections are user friendly & easy to inject. Dose calculation is also very simple. One has to just adjust the marker line given on the insulin preloaded syringe. The needle is also very small & it reaches subcutaneous space only. It doesn't reach at a deeper level. So patients or relatives can give injection at home. This is very important as wrong dose can lead to –
1. Inadequate sugar control causing high sugars

2. Excess dose leading to hypoglycemia which is very risky for life & may lead to death if not treated immediately.

Certain brand names of “Newer Insulins”
Lilly is a pharma company which is manufacturing a lot of newer insulins. Insulin is available in prefilled syringes.

fundus fluorescein angiography tests & laser Rx

Before PRP in some cases FFA(fundus fluorescein angiography) is done.This is a simple test in which a dye is injected in vein which passes through eye circulation & serial retinal photographs are taken.PRP is done in 2-3 sittings.Its a OPD procedure which is done under topical anaesthesia-anaesthetic eye drops.Its not much painful.Patient can immediately go home & start his routine work.A gap of 5 - 7 days will be there between 2 sittings.Multiple burns stop vessels from growing and leaking. Hundreds of tiny spots of laser are placed in the retina to reduce the risk of vitreous hemorrhage and retinal detachment.During followup we have to look for regression of new vessels.During the subsequent visits, repeat photo-coagulation may be applied to cover up the ara left in earlier sittings.

Presence of Clinically Significant Macular Oedema (CSME) is defined in the ETDRS .This is the most important cause of vision loss.

Diabetics have to control body mass index, systolic and diastolic BP, fasting blood glucose, post-prandial blood glucose, glycated haemoglobin (HbA1c), total cholesterol, serum triglyceride, HDL cholesterol, serum creatinine, microproteinuria and macroproteinuria .Hypertension & nephropathy have been shown as a risk factors in the development & progression of retinopathy

                   Nephropathy has to be controlled after consulting a nephrologist.Control blood urea & serum creatinine.Dialysis may be needed in very severe cases

                     With recent improvements in vitrectomy techniques,surgical prognosis has improved if done at early stage

Management of diabetic eye disease

Once Retina specialist diagnoses PDR , he advises panretinal photocoagulation(PRP).

Recent advances in management consist of use of intravitreal Anti-VEGF agents

Diabetic retinopathy

Diabetic retinopathy has emerged as a major eye health problem.Number of diabetics is increasing day by day.After 5 - 10 years of diabetes almost everybody gets retinopathy in mild,moderate or severe form.Diabetic Retinopathy is a serious eye disorder .It is commonly seen in people who have DM for 5-10 yrs.

Type 2 diabetes mellitus is the most common constituting 90-95% of all diagnosed cases of diabetes. It occurs due to insulin resistance at receptor level.

Type 1 diabetes mellitus is the most prevalent type of diabetes among children and young adults. It occurs due to absence of insulin production or less  insulin production due to pancreatic disease

 Diabetes is a complex disorder that has many possible indicators. These include unexplained weight loss, excessive hunger (polyphagia), thirst (polydipsia), frequent urination (polyuria), dehydration, leg pain when walking (claudication), fatigue, dizziness and itching (pruritus).Awareness of these signs and symptoms can be an alert to potential onset of diabetes 

 Duration of diabetes is the most important factor for the development of Diabetic Retinopathy (DR); 98% of patients with Type 1 diabetes and about 60% of patients with Type 2 diabetes will develop DR after 20 years

 
Recent trends in diagnosis include single-field nonmydriatic digital fundus camera which can be placed in a Physician's/Ophthalmologist's office.The photographs can be used for screening.

Retinal hypoxia plays an important role in pathophysiology of the disease.
In severe cases called as proliferative DR,vitreous hemorrhage occurs.Vitreous hemorrhage may clear spontaneously slowly but sometimes it doesn't clear & one has to consider vitrectomy surgery with endolaser.
You can read more about diabetes , hypertension at
www.indiastudychannel.com/forum/17367-Diabetes-Hypertension-are-silent-Killers.aspx
www.indiastudychannel.com/resources/14574-Prevent-diabetes-problems-Keep-your-eyes-healthy.aspx

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Diabetes