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|01 Good school science. Cambridge. Extra year biochemistry. King`s – diabetes locum influential. Central Middx. Brompton H. – chests. Diabetes career began 1964 - Russell Fraser, Hammersmith H. Research fellow, then registrar. McMaster University. Senior lecturer, General Hospital, Birmingham… |
|02 …Hoffenberg, Malins & Fitzgerald. Now part-time – diabetes & ophthalmology. |
Cambridge biochemistry anti-medics.
|03 King`s – small intake, personal tuition. Stayed for house jobs. Didn`t do National Service. Oakley, Pyke & Taylor. Taylor – possibility of viruses causing diabetes.|
|04 Hierarchy, but knew each other. Senior ward sisters ruled. |
First saw diabetes during locum. Diabetes team started ketoacidosis treatment in A & E, then ward. I took blood samples & did lab tests. Taught patients urine testing. No blood self-testing.
|05 Asked patients to fast before clinics; waited for blood test results. |
At King`s, some admitted to diabetes ward, some elsewhere - feet treated by orthopaedic surgeon; pregnancies admitted last 4 weeks.
Invited RD Lawrence to give talk.
|06 Lawrence`s 10g portions have endured. Now carbohydrate counting for Type 1s. |
Mixing insulins tedious. Different strengths caused mistakes. New insulins & delivery systems revolutionary. UKPDs used Ultratard.
|07 Central Middx, 1962-4, then Hammersmith. Diabetes as part of general medicine. Contacts. Met Arthur Rubenstein.|
|08 Hammersmith 1964-9 – Radioimmunoassay research. Russell Fraser interested in maturity-onset diabetes, later called non-insulin-dependent, now Type 2.|
|09 Good pregnancy outcomes. IGTs well-recorded. Now less prematurity, more Caesarians. Mortality still higher than in general population.|
|10 Joined new medical school at McMaster – Moran Campbell. Taught endocrinology & diabetes. Pioneering – problem-solving education & Bill Spaulding said specialist nurses should run clinic. |
Poor control on Indian reservation.
|11 I recommend experience abroad. American Diabetes Association fantastic. Met Best. Saw Osler`s childhood home. |
Got job at Birmingham medical school – expanded to include General Hospital – failed to introduce problem-solving education or integrated teaching. Both happen now.
|12 Diabetes suited to problem-solving. Students select option. |
1973 - huge clinic, 3 or 4 desks, little privacy, little nurse involvement. Diabetic ward useful for education.
Saw first specialist nurse education, pioneered by Janet Kinson.
|13 DSNs good re technicalities & protocols & more accessible. Also need doctors, dietitian, chiropodist, social worker. General Hospital had these in 1973 - not everywhere. Chiropody done jointly works best.|
|14 Clinics large - diabetes treated in hospital. Interested GPs assisted in clinics. Clinics saw large numbers because treatment simpler. Now routine management in primary care. |
In 1973, more blindness, less renal disease - people died.
|15 Eye problems - could offer nothing. Wonderful now to tell patients they can preserve sight. |
BDA important. I learnt from children`s camps.
|16 At General Hospital, asked by Robert Turner to be 1 of 6 pilot centres for UKPDS. 18 years. Policy advisory group. Post-study follow-up results due shortly. Importance of control of diabetes, blood pressure, lipids.|
|17 Hard to get funding for UKPDS, but cheaper than drug trials. |
General Hospital moved to Selly Oak. Semi-retired. Part-time at Walsall & Heartlands. Retain academic connection with Selly Oak.
|18 Private practice Saturday mornings. Convenient for patients, but must recognise limits. Must continue relating to GPs - basic care & prescriptions. Privilege of free prescriptions.|
|19 Too many protocols now – stifle innovation, slow trials of new drugs. |
I was slow to abandon urine-testing or recommend injecting 4 times a day. Insulin pumps good, but cost less elsewhere.
|20 Some dislike 4 times a day, some prefer pork insulin – respect them so long as it`s educated choice. Education not same as compliance!|