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Retinopathy.

jopar said:
Sotherngerneral

Don't forget you'll answering in the T1 forum and you'll are T2 diabetic..
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Relevance?
Are you suggesting that the opinion of a T2 is less worthy of being here than a T1? :shock:
 
I'm reminding SG that some aspects are different for T1's and T2's, so a locum telling him that she doesn't prescribe test strips wouldn't actually be said to a T1 diabetic.. And as this is the T1 forum, SG needs to inform that he's speaking from a T2 perspective and not a T1 perspective otherwise people might think that he's a T1 that had been denied test strips!
 
I really just click on New Posts rather than look what forum they are in.

I still think that the strips are very useful for T2's since they tell you what foods spike your BS. Surely the doctors should be trying to encourage their patients to take control their condition?
 
jopar said:
And what's sick about that, why should s/he know!

Did you ask what field he trained and gained his medical degree in?

See a GP isn't a specialist in all fields of medicine s/he he will have their medical degree, which after the foundation part of the degree, they would have finished their training off in a specialist field... Then taken further training and qualifications to become a General Practitioner... That enables them to handle general medical problems but not at a specialist levels, hence why they refer us onto a specialist at the hospital!

My old GP didn't know how to initiate insulin therapy...

Not because he was incompetent, he knew how to diagnose diabetes, he knew how to identify problems such as DKA, knew how to increase a dose to counteract DKA as an interim measure before admitting you to hospital, but deciding what insulin to put somebody on and a starting dose was a different matter..

In general retinopathy is the same for T1s and T2s which is why he other threads about it have a mixture of both types posting.

I totally agree that GP and -heaven help us pracice DSNs do not know everything and shouldn't be expected o ut this illustrates perfectly why the primary care of anty kind of dibees should not be left to the local practices.
Who initiates the treatment of T2 ? Who presscdribes the drugs ? Who is under pressure to mee targets with g levels ?
And who hasn't a clue that bringing down levels too quickly can cause retinopathy? Yes- the GP and the practice nurse!
What on earth is the point of the hospital staff knowing this when hey have no conrol over the treatment and only see the paient when it is too late?
That is eactly what happpened to me. My doctor sen me o the hospital eye clinic immediately upon diagnosis [before annual reinal screening] because he thought he could see something on my macula. When I went to the hospital they could find only background reinopahy but said they would see me every three onth and then discharge me if all was well. This they did . Meanwhile the Diabees dostor in the practice wa determnd to reduce my levels - which were no actually that high.
When he finally succeeded in reducing them dramatically overnight he as really pleased with himself. I had been to the hospital the prevous week for a final check up and the doctor had suggesed that I have my retinal screen there as i had missed out in the newly introduced screen ing in my area. I went along expecting to be discharged and happened to see a visiting consultant who wanted o look at my eyes before discharge. he took one look and ran out of the room to try to arrange immediate laser as i had suffered a massive bleed. This was atributed to the sudden sharp drop in my bg levels . I had not been conscious of it but had started taking the new pills the day after my previous appointment I reurned to the hospital in less than a week and have
been treated there eve r since.
the hospital just acceped the reason as a matter of course. My doctor was devastated. So o, in the case of T2s and even for T1s who might be reated in the local practice , I cannot agree that GOPs should not know this vital piece of informaion.
hose responsible for the reatment should be aware that this is the case. What other pieces of vital information in the treatment of diabees are thy ignorant of while being responsible for?

Now hat the treament is left mainly to Nurses what chance do we sand at all? No certainly they canno be expeced to know everything but they should know smething so important - or they should not be expected to deal wih any newly diagnosed diabetic. We should all aend hospital unil the condition is stabilised and then and only then should the local practice take over.
It might save the NHS thousands in the long run.

As he explained, his training etc was in Gyno, which where he trained was next door to the diabetic department, so any diabetic females get help from the diabetic department allow the ones who knew sort a problem out! His general practitioner training was based on identifying problems, basic treatment and referring to a specialist!

So unless the locum, had trained in endo/diabetes then this bit of information isn't derogatory not to know!
Click to expand...
 
I think this is very true if your GP has the right to dispense the tablets that quickly lower your BS they should also be required to know that this may not be the smartest thing to do
 
Most of the major bleeds that take the vision out overnight/instantly are from abnormal blood vessels that have grown, not the smaller leaks that is sustained on the retina of the eye.. And the more leaks you have from these blood vessels feeding oxygen to the retina the more growth of abnormal blood vessels will grow to try to maintain the oxygen supply to the retina...

So any a swift drop or tightening of blood glucose control can have a major impact on the eyes worsening underlying retinopathy..

If you are going to criticise a HCP, then you have to also criticise those who encourage dramatic dietary changes as this can also have exactly same effect!

I was warned when I started my pump there was a possibly that eye's might get worse before getting better, but thankfully I didn't have any underlying problems with my eyes so didn't get any problems..
 
People encouraging dietary change by which I expect you mean people on this forum are hardly in the same position as a Gp prescribing medication. I was no criticising any HCPs in this case/

it is surely nonsensical for the Drs to be given the responsibility of bringing down BG levels without being told that it is dangerous o do so oo quickly. The ospita staff know this well, many patients know it too bu noone tells he Drs who are responsible for prescrinbing the medication in the forst nstance.
That s unfair to patients and Drs and enirely unnecessary. My doctor only learnt about it when i did - and he was VERY upse. The message is still not getting through.
if it is not possible for gPs to be properly trained in diabetes then maybe it should not be deal wih in the local practice.

personally I make up muy own mond about dietary issues. I have my own experiences and work out what is best for me based on my own judgemen. I have had o help with this from the NHS except from the hospital based on my eye problems.
I now have a different GP from the one I mentioned earlier - nbut all diabeic care in my practice is left to the nurse who would be even more unlikely than the nurse to know that Bg should not be reduced too quickly.
My bgs were only controlled when i began low carbing a couple of years ago when the previous mods were here . I am very grateful o hem and to several of he other posters , cathrinecherub , Noblehead and Sid ,amongst others who were also here at the time and fro m whom I learneda great deal.
My decision to accept the dietary and other advice they offfered was enirely my own decision and no one forced it upon me.
None of these people -posers unknown to me on a forum - were in the same position as my GP
I am not blaming anyone for what happened o me . maybe it could not have ben avoided as the effects of medication are unpredictable bu it migh hvae helped if the GP had at least been aware of the pssibiltty.
We expect them to be aware of the effects of the drugs they are prescribing in other conditions don't we. urely that is not tooo much to ask.
As a T" until very recently there were only a few drugs available to me for my diabees. My Practic e DSN would have prescrbed a drug to me which would have made my macular oeema worse. despite my suspicions she assured me it was asafe, the NHS leaflet didn't agree. The first paragraph carried a warnibng about it. She didnt know and couldn't be bothered checking when i queried it.,

I really do not believe that the Local practice is equipped to deal with any but controlled sable diabetics.

This is a serious matter. There is potential for a grea deal of harm alll for the want of a small pievce of knowledge being imparted to GPS .
Posters discussing their dietary theories can't have anything like the same impact. They can't prescribe it or force it upon others ..
I was criticising the system not the HCPs. I have very good reson to criicise some of my present HCRS and have said so elsewhere but hat is beside the point here.

T
 
Viv,

If you'd been diabetic long enough, perhaps you would understand the system and how we arrived at where we are today!

Retina screening was brought in, not because it was new technology that wasn't available that gave the advantage to the diabetic... As the screening as been available in one form or the other since goodness knows when, before the ability to photograph the retina, opticians draw the information by hand on your notes... It was purely brought in to counter react the high rate of diabetics, who failed to listen to their HCP's and/or their opticians concerning the importance of booking into your optician on a yearly bases to have your yearly Eye test/Examination!

GP care, even before the transfer of diabetic care to the GP surgeries, most T2 diabetics would be diagnosed by their GP and their treatment initiated by their GP, and some who did well would stay with their GP others would be referred off to the consultant... And most were referred to the hospital DSN.. So not the greatest of changes in this area, apart from GP/Nurses do have more input, the biggest changes in this area is actually for T1's and insulin users being transferred to their GP's care! When I was first diagnosed 23 years ago, my outreach outpatients was overseen by the diabetic consultant and a local GP with interest in diabetic care! Now it's one of the consultants and a registrar!

As to your comments about dietary advise on this forum, when somebody tells other members to dismiss the advise given to them by health care professionals, claiming that they are giving wrong information, Informing other members that their is a specific amount of carbs an diabetic can eat or telling members that what foods they have to exclude or include in their diets.. They are effectively acting as a HCP who is prescribing diets...

So if a HCP can be criticised for not seemly having the correct information or training, then the rules apply to those who overstep the mark concerning prescribing and providing information, when they lack the knowledge to certain factors of the information they are giving to other members...
 
If you mean to answer me Jo, I am not VIV.. I am aware of much of what you have posted above . I have several T1 friends and T2 is in my family so I am well aware of how he system worked.

I know of several t!s now relegated o the tender mercies of the practice DSN. Once more i was NOT criticising the Gps for failing o be omniscient.
I am criticuising the system which make s hospital referrals more difficult and which expects too much of them. Diabees is a serious disease. It should not be left o the GPs or even worse he Practice Nurses to cope with large numbers of patients without giving them the relevant information. They are not specialists but generalists and they are expected o ake on the rrole of specialiss.

We will just have to agree to differ. It gets boring for others when they read the same arguments time after ime and this thread was abou retinopathy checks
We all have our own opinions and experiences and an equal right to express them. I am sure we all hope our experiences will elp others but it is not an offficial medical forum - just a self -help group where people are free to speak of their own experiences and opinions unlike the HCPs wo have o oe he official line whether they agree with it or not.

Thank goodness we can all express our opinons freely and others are free to oppose hem. The reader has to make up his /her own mind in the end.
 
I make my apologises to Viv, and unbeliever for getting them mixed up..

Sorry unbeliever, yes I can agree to disagree with you over over your personal point of view concerning the 'System' and that readers should make their own mind up concerning information provided!

But I won't agree that that because you or anybody else finds it boring that members can face a counter debate on information that's being provided, as it's important for any member/reader to being informed of all information, not just a very carefully selected views or set of instructions...

At the end of the day, just because an HCP doesn't give your the information/advise you want to hear or want to follow, doesn't make them incompetent or wrong, or should be dismissed out of hand... Which seems to be something that is actually encouraged on this forum!

Being informed that I because I am not an athlete I can't eat 160g's of carbs, as it's only athlete who can managed that is attempting to prescribe and enforce an opinion on me or anybody else who's reading...

And talking about boring, it's dam boring to have thread such as this one, constantly interrupted with comments concerning HCP's which wasn't even relevant to the OP question or what had been discussed at that point! I Just ensured readers where aware of the full facts...
 
Some posters seem to be under the impression that they can

a) dictate the subject matter under discussion

b) control the way that others choose to post

c) act as 'whips' to make other posters keep to a tight subject discussion rather than allowing for natural developments and digressions in most adult conversations, which often leads to new pathways and learning opportunities.

d) do not understand the difference between counter-argument and suppression.

e) do not appear to have realised that there are no prefects in charge here except the Mods.

I rest my case M'lud
 
jopar said:
Here some good basic info on Retinopathy http://www.stlukeseye.com/Conditions/Di ... pathy.html

Floaters aren't diabetic linked everybody gets them, if the vision is being blocked as it shows in the link I gave, it's from bleeds and if the bleed is only slight the gel in the eye can reabsorb the blood...

it's virtually imposable for a diabetic to suffer a degree of retinopathy, but the good news is that this leading to blindness, or server impairment of vision is below 0.5% here's so more information http://www.medpagetoday.com/Ophthalmolo ... logy/16261

Good control is the best way of helping to ensure that eye problems are kept to a minimum, avoiding large fluctuations in control, as it's not just your overall HbA1c that can increase the risk of bleeds, but several other factors, such as high blood pressure, large variations in blood glucose levels on a daily bases, and also dropping high glucose levels too quicker or tightening up your control too quickly...

But the most important thing is never miss an eye test... And when I mean eye test I mean both the screening and your normal optician test.. As I've got no problems I have a yearly screening, so I arrange my optician eye test 6 months afterwards... So any probs start brewing hopefully they be picked up early..

My hubby also a T1, had a major bleed which detached his retina, so needed quite a major eye op, similar to the vitrectomy, but with the need to actually go into the eye to stitch the retina back in place, which then held in place with a gas bubble, so quite a long recovery, as movement such as standing and even sitting up, is very restricted to ensure that the gas bubble doesn't move out of place, they couldn't say before the op what sort of impairment might happen nor whether they could save his sight.. But it went very well and limited impact on his sight, he lost a little of his side vision, and it caused night blindness, but as he doesn't drive (he's never bothered learning) it doesn't have any impact at all... That was 14 years ago, They did zap a vain with the lazer about 3 months after his op...

So if you do have a problem, doesn't mean you'll on a slippery slop to blindness, as there is so much they can do, which improves with every year... And if you playing your part by keeping good control of your diabetes etc, then hopefully you may never get a problem that might causes any impairment of your vision..
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Regarding the floaters when I had my eye checks at the options not hospital i asked if retinopathy could be the reason for the floaters. She too told me they are quite common and I shouldnt be too worried. She asked if the floaters i was seeing were red as this could indicate bleeding in the eye?
 
Hello I have just read your post and I have had a large chunky red line across my eye, after the 10th June big bleed. It did dispurse but obviously I was a bit concerned by what your option said, quote ,She asked if the floaters i was seeing were red as this could indicate bleeding in the eye?

:shock: :(
 
Have to agree with you there Lucylocket. I have only been on here a short time, but I feel, sometimes, its like wading through thick fog fighting to see daylight at the other end. Hard work sometimes :roll: :wink:
 
diva19871987 said:
Regarding the floaters when I had my eye checks at the options not hospital i asked if retinopathy could be the reason for the floaters. She too told me they are quite common and I shouldnt be too worried. She asked if the floaters i was seeing were red as this could indicate bleeding in the eye?
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As mentioned, floaters are quite common for many people, not only diabetics with retinopathy. But, as you say, if you can see a redness through the floater then it is more likely to be blood. This is most likely to be a result of a small bleed. Bigger bleeds tend to be seen as a black line in the first instance, rather like ink in a jelly. Shortly following that, the line tends to spread out and thin, causing the vision to become clouded with a slightly red tint.
This is of course in my own vast experience of the problem and may not occur in the same way for everyone.
 
mrburden said:
diva19871987 said:
Regarding the floaters when I had my eye checks at the options not hospital i asked if retinopathy could be the reason for the floaters. She too told me they are quite common and I shouldnt be too worried. She asked if the floaters i was seeing were red as this could indicate bleeding in the eye?
Click to expand...

As mentioned, floaters are quite common for many people, not only diabetics with retinopathy. But, as you say, if you can see a redness through the floater then it is more likely to be blood. This is most likely to be a result of a small bleed. Bigger bleeds tend to be seen as a black line in the first instance, rather like ink in a jelly. Shortly following that, the line tends to spread out and thin, causing the vision to become clouded with a slightly red tint.
This is of course in my own vast experience of the problem and may not occur in the same way for everyone.
Click to expand...

From my eperience I totally concur qwith you mrburden..There is always the proviso that we speak from our own experience.
people can google for themselves if they want the offical version.
That is why they come to this forum though - to learn from the personal experience of others.
My consultant always asks me for the information he cannot know despite all his rainng and experience. As he says he cannot see what i see and he has never had hese experiences and never undergone these procedures personally.
So personal eperience is valuable to everyone HCP.s and Patients . We are all aware that individuals are all differnt and have
different experiences and that no two people will have exactly the same symptoms and that treatment varies and will affect individuals in different ways.
That goes without saying.
 
Unbeliever said:
mrburden said:
diva19871987 said:
Regarding the floaters when I had my eye checks at the options not hospital i asked if retinopathy could be the reason for the floaters. She too told me they are quite common and I shouldnt be too worried. She asked if the floaters i was seeing were red as this could indicate bleeding in the eye?
Click to expand...

As mentioned, floaters are quite common for many people, not only diabetics with retinopathy. But, as you say, if you can see a redness through the floater then it is more likely to be blood. This is most likely to be a result of a small bleed. Bigger bleeds tend to be seen as a black line in the first instance, rather like ink in a jelly. Shortly following that, the line tends to spread out and thin, causing the vision to become clouded with a slightly red tint.
This is of course in my own vast experience of the problem and may not occur in the same way for everyone.
Click to expand...

From my eperience I totally concur qwith you mrburden..There is always the proviso that we speak from our own experience.
people can google for themselves if they want the offical version.
That is why they come to this forum though - to learn from the personal experience of others.
My consultant always asks me for the information he cannot know despite all his rainng and experience. As he says he cannot see what i see and he has never had hese experiences and never undergone these procedures personally.
So personal eperience is valuable to everyone HCP.s and Patients . We are all aware that individuals are all differnt and have
different experiences and that no two people will have exactly the same symptoms and that treatment varies and will affect individuals in different ways.
That goes without saying.
Click to expand...

When I had my last big bleed( as I'm calling it) my eye felt very heavy and I had lots of black lines and dots. After that, a large horizontial wide red fat worm shape went across my eye, it most definately red. Since then I have hadmore small black dots and lines appear. Thats my experience of these floaters and at the moment its like having a thin veil at the outside edge of my eye with squiggerly lines all over as well.

As for control, mine has been eratic of late because of extreme worry and stress, but even with very good tight control a person could still have some diabetic problems, which, unfortunately, could include the eyes :( :(
 
Robinredbreast said:
When I had my last big bleed( as I'm calling it) my eye felt very heavy and I had lots of black lines and dots. After that, a large horizontial wide red fat worm shape went across my eye, it most definately red. Since then I have hadmore small black dots and lines appear. Thats my experience of these floaters and at the moment its like having a thin veil at the outside edge of my eye with squiggerly lines all over as well.

As for control, mine has been eratic of late because of extreme worry and stress, but even with very good tight control a person could still have some diabetic problems, which, unfortunately, could include the eyes :( :(
Click to expand...

Robinredbreast,

When are you due to see the specialist, as some of what you described, the veil like edge to your vision could indicate that your retina is starting to detach!

I had a scare about 9 years ago, where my vision was like trying to look through a very thick and dirty net curtain, and at other times I would get a blue, red and yellow zigzag flashing effect around the outside of my middle vision... When I told my DSN about it, she got my GP to take a look, he couldn't actually see anything untoward, but explained that my retina might be detaching, so he was taking no chances and sending ASAP to the eye consultant, which happened within the week... Thankfully transpire it's not my retina, just symptoms of a painless migraine, I get the visual effects but not the headache's!

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Everybody gets floaters as this is just little microscopic bits of debris that falls off the eye surface, floats around in the gel until the it's reabsorbed, just like the nature process of microscopic skin tissue falling off us, our we renew the skin. completely harmless and nothing to worry about in this scenario..

However for the diabetic

But then you get floaters cause by leaks or bleeds... Leaks aren't often noticed as the eye will reabsorb these out the way, some leaks and small bleeds can sometimes be visible for a short while before the body reabsorbs them.. A large bleed won't reabsorbed so have to removed...

Colour of the line can make a difference, if the line is red is actually more likely to be a new vein growing across in front of the retina trying to create a new oxygen supply for oxygen starved cells of the retina, where small unnoticed leaks/bleeds have disrupted the oxygen supply... It shows red as it is still carrying oxygen, but these new veins are very weak and are very likely to leak or haemorrhage, which can cause all sorts of problems and damage to the retina even detaching it, if these are found they will be lasered, to prevent them from obstructing the vision and before leaking/haemorrhaging occurs.

Floaters caused by bleeds and leaks, generally if visible are black, no oxygen going through it and dependent on size can reabsorbed out of the way, causing temporary vision disruption...

As said, good control of blood glucose levels, keeping blood pressure in check all helps keeping up with regular screening, both the screening by the hospital, and ensuring regular eye test/examination (as your optician will also check your retina's for any signs of damage or problems brewing) all helps, because at the point we notice anything generally damage is well under way or more likely to cause some visual impairment... But with saying that we can only minimise our risk and sometimes our best endeavours doesn't prevent problems arising...,
 
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