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|01 Brought up in Leicester. Went to Cambridge Univ, then Guy`s Hospital.|
|02 Qualified 1968. Met diabetes ‘66/`67 – complications, as taught in my BSc in Pathology. Saw no children. |
Complications considered patients` fault.
|03 When SHO at Guy`s, clinic run by Christopher Hardwick & Harry Keen . Clinic disorganised – put me off diabetes. Over 10 years later, consultant asked me to set up 1st specialist diabetes clinic for children in Bristol.|
|04 I emphasised psychosocial influences; consultant thought insulin dosage sole important factor. (Hard to assess control, 1976-7 – no blood tests.) Later, consultant wrote re psychosocial aspects! |
Moved to Exeter. Failed to set up clinic - consultants reluctant. With Charles Fox set up 1st BDA parents` support group.
|05 Guys` clinics - late 60s/early 70s – Victorian buildings, 80 people given same appointment, minimal ancillary services. Urine testing important…|
|06 1972 - saw children at Sheffield Children`s Hospital – admitted to ward. Poor control blamed on them or parents.|
|07 In Exeter, 1978, read re HbA1c. Failed to set up assay - too busy. |
Read re blood glucose monitoring: I thought children would find it difficult – wrong.
While at Torbay district hospital, thought…
|08 …urine testing inadequate. |
Parents` group keen on children meeting each other.
|09 Appointed consultant at Leicester. Strong history. John Hearnshaw cared for all ages – thought paediatricians didn`t take diabetes seriously. His predecessor, Joan Walker, pleased paediatrician appointed.|
|10 Joan Walker (See Extras) ran diabetes during war. Set up study with Harry Keen. Appointed 1st diabetes specialist health visitor, 1953 (53. Joan Wilson). Treated children at home. Hearnshaw did same.|
|11 From 1979, I was consultant with special interest in diabetes. Saw children with Hearnshaw & joined his home visits. Also visited alone & set up own children`s clinic – Hearnshaw not keen, but was necessary. |
1979 - used HbA1 & blood glucose monitoring.
Went on BDA children`s holiday...
|12 …Saw boy have major hypo – I learnt from this. |
Persuaded children to do blood monitoring - wrote paper after 2nd trip. On 2nd trip, young man took extra insulin…
|13 …to get attention. |
Hearnshaws set up parent support group, 1975. I studied American camps & parents helped me organise camp for Leicestershire children, 1984…
|14 …& every year since. Parents main organisers. Physical exercise. Idea hasn`t spread. Diabetes UK still has national holidays.|
|15 Camps improve confidence. Children grew up & led camps. Age range 7 to 17. |
|16 1979 - only 1 other paediatrician, David Baum, publishing in England. Scotland ahead - Jim Farquhar, Edinburgh, & Oman Craig, Glasgow. Baum & I did national survey, 1988…|
|17 …not enough specialist children`s clinics, few using HbA1c, few specialist nurses & dietitians, no psychological help. By 2004, most seen in specialist clinics & more nurses. Need more dietitians & mental health workers.|
|18 Insulin regime less important than psychological factors. Not enough psychological help – unlike elsewhere. |
|19 Obvious some families will find diabetes hard. Some children & mothers get depressed. Diabetes adds to adolescent problems. Not enough resources.|
|20 Before 1980s, diabetes unpopular specialty. Now popular: better control – HbA1c, adult medications, DCCT & UKPDS studies, lifestyle changes, patient support.|
|21 Children Type 1, but Type 2 emerging - lots in USA. Also more Type 1 – home visiting difficult. More interest in diabetes since HbA1c, blood glucose monitoring & greater understanding.|
|22 In 2000, produced International Society for Paediatric and Adolescent Diabetes` Type 1 Guidelines. Also, international group has studied care standards worldwide – clear targets achieve better control.|
|23 A few tragedies due to hypos, more among poor families. Many parents & children do brilliantly. I`ve seen children develop friendships & achieve great things – most important result of my work. |