Medical management of diabetic retinopathy an overview,can type 2 diabetics eat white rice nutrition,type 1 vs type 2 diabetes c peptide basso - Plans On 2016


Diabetic patients with pre-hypertension (SBP of 130 a€“ 139 or a DBP 80 -89) should receive 3 months of lifestyle modifications and if not goal BP not achieved then a renin-angiotensin system blocker should be initiated (ACE inhibitor or Angiotensin Receptor Blocker). All diabetics with hypertension should be on a regimen that includes an ACE inhibitor or ARB because of demonstrated renal protection in these patients.
In type 2 diabetic patients with hypertension and microalbuminuria, ACE inhibitors and ARBs have been shown to delay nephropathy. Orthostatic blood pressure measurements should be taken in patients with diabetes and hypertension to assess for autonomic dysfunction.
The lipid goal depends on whether the diabetic patient has a€?overta€? cardiovascular disease.
If over age 40, statin should be initiated to reduce LDL by 30-40% regardless of the patienta€™s LDL baseline. If under age 40 but at increased risk of cardiovascular risk factors who are not at lipid goals with lifestyle modifications alone should consider pharmacologic therapy. All patients should be treated with a statin to achieve an LDL reduction of 30-40% regardless of baseline. All diabetic patients should aim to decrease their triglycerides below 150, and men should increase their HDL a‰? 40 and women the HDL a‰? 50. Combination therapies may be necessary but have not been shown to decrease cardiovascular disease at this time.
Consider aspirin therapy in people between the age of 30 and 40 years, particularly in the presence of other cardiovascular risk factors.
Combination therapy using other antiplatelet agents such as clopidrogel in addition to aspirin should be used in patients with severe and progressive CVD.
Other antiplatelet agents may be a reasonable alternative for high-risk patients with aspirin allergy, bleeding tendency, receiving anticoagulant therapy, recent gastrointestinal bleeding, and clinically active hepatic disease who are not candidates for aspirin therapy.
All patients should be advised not to smoke and counseling in smoking cessation and treatment should be integrated into all diabetes care visits. In patients >55 years of age, with or without hypertension but with another cardiovascular risk factor (history of CVD, dyslipidemia, microalbuminuria, or smoking), an ACE inhibitor (if not contraindicated) should be considered to reduce the risk of cardiovascular events. In patients with a prior myocardial infarction or in patients undergoing major surgery, I?-blockers, in addition, should be considered to reduce mortality. In asymptomatic patients, consider a risk factor evaluation to stratify patients by 10-year risk and treat risk factors accordingly. The goal of nephropathy screening and treatment is to reduce the risk and slow the progress of nephropathy by optimizing the glucose control and blood pressure control. All type 2 diabetes patients should be screened annually for urine microalbumin starting at diagnosis. Which of the following treatments have controlled trials shown to be beneficial for persons with type 2 diabetes and early nephropathy? In type 2 diabetic patients with hypertension and microalbuminuria, ACE inhibitors and ARBs have been shown to delay progression to macroalbuminuria. Dihydropyridine-sensitive calcium channel blockers are not effective as initial therapy to slow progression of nephropathy and should only be used as an adjunct to an ACE inhibitor or ARB to lower blood pressure.
If ACE inhibitors, ARBs, or diuretics are used, it is recommended to check serum potassium levels.
All patients should have a comprehensive ophthalmologic examination soon after the diagnosis of diabetes is made. All patients should be screened for distal symmetric polyneuropathy (DPN) at diagnosis and at least annually and every year thereafter. Major clinic manifestations of diabetic autonomic neuropathy are resting tachycardia, exercise intolerance, orthostatic hypotension, constipation, gastroparesis, erectile dysfunction, pseudomotor dysfunction, impaired neurovascular function, hypoglycemic autonomic failure, and a€?brittle diabetesa€?. Treatment of diabetic autonomic neuropathy includes metoclopramide for gastroparesis and the use of bladder and erectile dysfunction medications. A comprehensive foot examination should be performed and patients should be provided foot self care education annually to identify risk factors predictive of ulcers and amputations. Influenza and pneumonia are preventable infectious diseases associated with a high morbidity and morality in the elderly and people with chronic diseases. Mangere Community Health Centre, 10 Waddon Place (opened 2012) is the location of the Mangere Community Health Trust’s Diabetes Hub. The Mangere Diabetes Hub is the only clinically integrated diabetes service in New Zealand. The Tattoo Removal Programme is run by the Mangere Community Health Trust (a non-profit organisation), so we are able to provide the service at a low cost. We started off by calling our programme Operation Clean Start which to us meant that we could give people a clean start in life, by removing their unwanted tattoos, which hindered their job prospects and social lives.
We were pleased to find that as we began removing their tattoos, we noticed a major change in their attitudes and personalities.
Their self esteem and motivation became strengthened and they found it much easier to communicate with people without having a stigma.
We have trained several qualified people to become Laser Technicians and have helped Organisations to set up their own Laser Clinic. The Mangere Community Health Trust’s podiatry service provides individual patient consultations involving a foot check to diagnose and treat common foot complaints, assess blood flow and sensory changes and where unsatisfactory refer patients to a vascular team.


Diabetic eye disease is the leading cause of blindness in our under 65 year olds and is a huge problem in Counties Manukau. This service is free to patients and available from many GPs’ rooms and from established clinics in Mangere, Otara and Papakura where routine diabetic care is given. This is a one-on-one home visiting service where we offer support, advice and, if required, subsidised nicotine replacement therapy. On our cessation staff we have one Maori, one Cook Island Maori, one Niuean and a European practitioner and will match clients appropriately where possible. 2.    You must provide a referral letter from your school, on school letterhead confirming you are currently enrolled as a full time student. Ink stays in the skin because the ink is too large for the white blood cells in the body to absorb and remove.
If we were to have treatments every week it would be pointless, because we haven’t given the body enough time to break down & remove the ink.
Laser treatment is painful, and it is like hot fat splattering onto the skin when cooking bacon and eggs!
The end result with a black or red coloured tattoo is usually clear skin if there were no complications, though sometimes a small amount of colour from the tattoo or pigment can be seen. Our laser does not remove professional light green or light blue coloured tattoos, however it may fade them if those inks were used with a mixture of black ink. Skin Pigment LossSometimes when the laser breaks up the ink, it can also break up the pigment in the skin.
AFTER TREATMENT CARE• Immediately after treatment you may apply an ice pack, cold water or aloe vera gel to sooth and reduce swelling.• You can use a burn cream if necessary, otherwise aloe vera is good to use over the six-week break, either straight from the plant, a cream or gel.
PAIN RELIEFFor the first treatment we usually prefer that no pain relief be used, this way we can both determine whether or not it is needed.
Consuming alcohol or drugs before treatment is not advisable, as it makes you more aware of the pain.
We retain the right to refuse treatment to those displaying symptoms of alcohol or drug use. LKC Technologies has successfully completed a rigorous multi-center clinical trial, which designed to evaluate the effectiveness of RETeval based visual electrophysiology in assessing sight threatening diabetic retinopathy (DR) in comparison to the generally accepted gold standard for DR diagnosis. RETeval is a handheld DR screening device that enables virtually any health care provider to screen for sight-threatening DR in less than three minutes per patient with no dilation regardless of pupil size or the presence of a cataract.
The study recruited over 400 diabetic patients and the primary investigator of the study was Dr Stephen Fransen, associate professor at the Dean McGee Eye Institute, University of Oklahoma and chief medical officer of Inoveon, a provider of ETDRS 7-field stereo fundus photography services. Using skin electrodes (not corneal electrodes) and a simple handheld device, minimizes the cost and complexity of the DR screening equation, the company reported. The Berliner Glas Group is one of the leading European providers of optical key components, assemblies and systems, as well as high-quality refined technical glass.
Precision Mechatronics provides custom-designed, custom-built and fully installed equipment solutions for many industries and environments. Zeiss Pro NM Retinal Camera Fluorescein Angiography, provides everything you need for comprehensive assessment and management of typical eye diseases such as diabetic retinopathy, glaucoma and AMD in a single workstation. The high-quality system provides everything you need for comprehensive assessment and management of typical eye diseases such as diabetic retinopathy, glaucoma and AMD in a single workstation. The goal is to reduce morbidity and mortality and to reduce the direct and indirect cost on individuals, their families, and to local, national, and global resources. It is also the major cause of morbidity, and direct and indirect costs.A  Type 2 diabetes is an independent risk factor for macrovascular disease, and its common co-existing conditions in metabolic syndrome are also risk factors.
Additional medications that can be added if BP is not optimized are diuretics, beta-blockers, and calcium channel blockers). In type 2 diabetic patients with hypertension and macroalbuminuria, ARBS have been shown to delay nephropathy. In adult diabetic patients, screening for lipid disorder is recommended annually or more often to achieve goals. The thiazolidinediones (TZDs) are associated with fluid retention, and their use can be complicated by the development of CHF. Serum creatinine should be measured annually to estimate the glomerular filteration rate in all patients with diabetes regardless of microalbuminuria. Tight blood pressure control and angiotensin-converting enzyme inhibitors have controlled trials shown to be beneficial for persons with type 2 diabetes and early nephropathy. In type 2 diabetic patients with hypertension and macroalbuminuria, ARBS have been shown to delay nephropathy.
The DPN screening test can be be done in the primary care clinical setting using pinprick sensation, temperature, vibration perception and ankle reflex testing.
The foot examination can be accomplished in a primary care setting and should include the use of a monofilament, tuning fork, palpation, and a visual examination. All patients with diabetes should be offered an influenza vaccine if greater than 6 months of age. It is a lot of information but now you are armed with the latest information about the prevention, diagnosis, and management of type 2 diabetes. Diabetic eye disease is called retinopathy and results from damage to the blood vessels in the back of the eye.


The Trust’s mobile screening service is currently operating at 21 sites throughout Counties Manukau. We worked with GP practices in these areas to bring the screening clinic into an environment where patients were already attending (bring the service to the patient). You can purchase Emla cream from a chemist, but it may be best to call and see if they have it in stock first, as not all chemists will have it. Additionally, it is being used in a number of other countries including the UK, India, Canada, Indonesia and Malaysia. With our understanding of optical systems and optical production techniques, we develop and integrate optics, mechanics and electronics into innovative system solutions. Within these sectors we provided professional services in integration, automation, prototypes and replication capability. Our product portfolio includes a wide range of universally applicable standard packaging, the ability to provide design modifications to our standard products to meet customer requirements as well as completely custom-made packaging solutions.
BAUMANN GROUP is known worldwide as a leading company in spring and stamping manufacturing.
Physicians should be aware of the signs and symptoms of cardiovascular disease and should make every effort along with the patient in reducing these risk factors.
Most patients with hypertension require more than one medication to optimize the blood pressure. Aspirin therapy should not be recommended for patients under the age of 21 years because of the increased risk of Reyea€™s syndrome. Caution in prescribing TZDs in the setting of known CHF or other heart diseases, as well as in patients with preexisting edema or concurrent insulin therapy, is required. Serum creatinine should not be used alone to measure renal function but used to measure the GFR and stage the true renal function or dysfunction. Screening can occur less often if the exam is normal or more often if retinopathy is found.
This can be accomplished with a 128-Hz tuning fork, a reflex hammer, and a 10-g monofilament test. Studies have found that DPN improves significantly with avoiding blood glucose extremes and optimization of glucose levels. A multidisciplinary approach is recommended for individuals with foot ulcers and high-risk feet, especially those with a history of prior ulcer or amputation. The retinal screening service uses a digital camera to photograph the back of the eye (the retina) to diagnose this disease.
The Trust has raised funds to purchase 2 digital retinal cameras as well as vans for transporting the equipment. This started in Dec 2002 and ran independently until October of 2005 when the CMDHB contracted and incorporated this existing service into the new look CMDHB retinal screening package for Counties Manukau.
From the initial concept right through to finished packaging product, rose plastic medical packaging offers its customers a comprehensive full service.
The family-owned group, now in its fifth generation, has eleven production sites around the globe, where more than 1,500 people design and produce technically sophisticated products for targeted industries, including the automotive, electrical engineering and medical technology sectors. The monofilament pressure sensation is best at the dorsal surface of both great toes proximal to the nail beds. DPN pain manifestations can be managed with tricyclic drugs, gabapentin, 5-hydroxytryptamine, and norepinephrineA  reuptake inhibitors. Refer patients who smoke or with prior lower-extremity complications to foot care specialists for ongoing preventive care and life-long surveillance.
Like most health problems if we are able to identify the existence of retinopathy at an early stage then we are able to treat the retinopathy in a timely manner and prevent blindness which is caused by diabetes.
Initial screening for peripheral arterial disease (PAD) should include a history for claudication and an assessment of the pedal pulses.
Do not rub it in to the skin, but when you apply it over the tattoo, make sure you can only see white cream and no tattoo. Consider obtaining an ankle-brachial index (ABI), as many patients with PAD are asymptomatic. Once the diagnosis of DPN is established, specialized foot care is critical in preventing the risk of amputation. Refer patients with significant claudication or a positive ABI for further vascular assessment and consider exercise, medications, and surgical options.
Insensitive feet should be inspected every 3 a€“ 6 months, and patients should be taught in rigorous self foot care.
Amputation and foot ulceration are the most common consequences of diabetic neuropathy and major causes of morbidity and disability in people with diabetes.
Early recognition and management of independent risk factors can prevent or delay adverse outcomes.
The risk of ulcers or amputations is increased in people who have had diabetes >10 years, are male, have poor glucose control, or have cardiovascular, retinal, or renal complications.



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