Systemic disease , medication & the eye

Question 1

What are important H&S Q’s to ask ?

Answer 1

KEEP qs open:
-Tell me about your general health/ do you have any health conditions?
-take medication on a regular basis?
*specific meds: drug dose duration
-Suffer from any allergies like hay fever/ or to any medication.
-If HBP/Hchol/diabetes when last checked? How well controlled it is?
-Last NHS health check ?

Question 2

What is the NHS health check?

Answer 2

• 40 to 74 and do not have a pre-existing health condition- should be invited to an NHS Health Check by your GP or local council every 5 years.
• gp + even some pharmacists checking bp/chol/height/weight/ to see risk of C.V disease
  -if not contacted find out if offered

Question 3

What the key H&S q’s for diabetes?

Answer 3

-Type : 1 IDDM, 2 NIDDM
-Diagnosis: how long have they been diabetic?
(longer their diabetic= more risk of complication)
-Control: how well controlled is their diabetes, is it stable
- Treatment: diet & exercise, tablets, insulin
-Diabetic retinal screening: are they enrolled, when was last screening? Result?

Question 4

What is a diabetic test entitlement?

Answer 4

If on DRS - entitled to GOS test every 2 yrs
If NOT on DRS - every year and recommend to dilate

Question 5

What are 4 examples of endocrine/metabolic systemic diseases?

Answer 5

 Diabetes
 Hypertension
 Hypercholesterolemia
 Thyroid dysfunction
Endocrine disorder: most often the result of a hormone imbalance, characterized by a gland producing too much or too little of a hormone.
Metabolic disorder: when chemical reactions in the body do not occur as usual.

Question 6

What is the definition of diabetes & insulin?

Answer 6

• A chronic endocrine condition where blood glucose levels are too high due to a
  lack of insulin
  -Carbohydrate from food and drink gets turned it into glucose
• Insulin is an essential hormone produced in the Pancreas, that breaks down
  glucose and converts it into energy.

Question 7

What is type 1 diabetes?

Answer 7

TYPE 1: insulin dependent diabetes mellitus (IDDM)
- body can’t produce insulin as it attacks its own cells in the pancreas –> so no insulin to break down glucose into energy
-More and more glucose builds up in your bloodstream –>leading to high blood sugar levels
Sum up t1: bodies immune system attacks/destroys cells that produce insulin.(islet cells)

Question 8

What is types 2 diabetes?

Answer 8

Non-insulin dependent diabetes mellitus (NIDDM)
-The pancreas releases insulin as a response to the carbohydrate and glucose.
-But because this insulin can’t work properly–> blood sugar levels keep rising. This means more insulin is released.
-This can eventually tire the pancreas out, meaning their body makes
less and less insulin.
To sum up type 2: Pancreas not producing enough insulin OR bodies cells don’t react to insulin/use it well -taking in less sugar(insulin resistance)

Question 9

What percentage of people have T2 diabetes?

Answer 9

10% of over 40’s

Question 10

What are some symptoms of diabites?

Answer 10

Symptoms include some of the following:
 3Ps - polydipsia (drinking too much) polyphagia (eating too much) & polyuria (urinating too much)
 Blurred vision
 Weight loss (type I)
 Mouth or genital ulcers

Question 11

Why do diabetic get the 3 P’S?

Answer 11

> Polydipsia & polyphagia : because not enough glucose in the body is getting to the cells–> so eat/drink lots to get more glucose in .

> Polyuria : body is trying to get rid of excess glucose - through the kidneys –> so keep urinating .

Question 12

Why does diabetes affect vision & ulcers?

Answer 12

-Blurred vision- experienced by unstable diabetics /newly diagnosed .
>Bc increased B.sugar levels cause lens inside eye to swell–> alters refractive error
-Ulcers- will take longer to heal e.g diabetic px with CLPU/any ulcer of cornea takes longer
>Diabetic neuropathy

Question 13

How is diabetes diagnosed?

Answer 13

-Blood test- diagnosis by GP
-HbA1c >48mmol/mol
(HbA1c= average blood sugar levels over past 3 months (reflects long -term glucose control)
High no= too much sugar in blood-more likely to develop complication like in eyes/feet.
-Fasting plasma glucose > 7mmol/L
(reflects blood glucose at a point in time)
2hr plasma glucose concentration >11.1mmol/L
(A glucose tolerance test- Drink glucose solution and blood taken to compare Glucose levels 2hrs later) -screens t2 /gestational