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|01 Educated Aberdeen Grammar School|
|02 1973 - Aberdeen University. |
|03 Met first diabetic at City Hospital where John Stowers & Mike Williams consultant diabetologists. |
Training included diabetes. Project re diabetes screening: interviewed Stowers & Lilian Murchison. Watched Stowers consulting – diabetic himself.
|04 I still consult on corridor attended over 30 years ago – when many patients marshalled by few nurses. Diabetes not about acute problem-solving. |
Senior lecturer berated patient for disobedience.
Training included nutrition, but probably not diabetic diet.
|05 1978 - 6 month house job, Aberdeen Royal Infirmary – new Alberti regime of multiple insulin doses. 6 months paediatric surgery. Then medical SHO rotation. 1980, accompanied Lilian Murchison to clinic in Orkney. Aberdeen provided service for Shetland & Orkney.|
|06 1 year temporary lectureship in endocrinology. Completed MRCP. |
Joined medical registrar rotation. 1981, 6 months as diabetes registrar - 7 ½ clinics per week. Visual aid to show different pills. No computers. Different strengths of insulin confused patients. Patients wouldn`t always obey.
|07 Provided diabetic support for inpatients in all Aberdeen hospitals with less help than junior doctors now. Non-specialist staff sometimes knew less than patients.|
|08 Acute problem affected patient`s ability to manage. Good to meet variety of professionals. Mistakes made by non-specialists. I could make difference – attraction of diabetes care.|
|09 John Stowers & Hamish Sutherland organised symposia on obstetric diabetes. At their clinic saw early days of human insulin. |
Pregnant women motivated re control.
Stowers & Sutherland encouraged having babies, but met older women who`d been discouraged - also people advised against certain careers.
|10 1982, Raigmore Hospital, Inverness. No consultant diabetologist, but Donald Pearson had interest. Every insulin dose written up. Sliding scale insulin regimes. Nurses avoided sugar to treat hypo. Reluctance to use pre-mixed insulins – first introduced to Inverness, 1982.|
|11 Returned to Aberdeen – year at Woodend Hospital. Married. Became ward-based diabetes registrar under Stowers & Williams. Did swaps with diabetic clinic registrar. Conversion to U100 insulin. Human insulin. NovoPens for sale – marketed for use 4 times daily. (Some still used only twice daily).|
|12 Learnt from Stowers (academic) & Mike Williams (pragmatic).|
|13 Legends re Stowers` management of own diabetes, work ethic & thrift – divided BM strip.|
|14 People measured own blood glucose. |
Saw Stowers have hypo – loss of awareness.
Plastic syringes introduced.
|15 1984 - Rowett Research Institute near Aberdeen: MD project. Still did clinical cover for diabetics. |
1986, resumed regular clinics. Became lecturer at Aberdeen University. Continued research in diabetes & endocrinology. Completed clinical training. Shared management of complications with other units – ophthalmic, renal & cardiovascular.
|16 Learnt re nutrition at Rowett. When began, patients remembered red & black lines. In 1980s, used carbohydrate exchanges. Patients matched diet to insulin – now adapt insulin to diet. |
Diabetes a disorder of fat, carbohydrate & metabolism, but focus always on blood sugar & carbohydrate – perhaps overrated. Now healthy mixed diet advocated. Dietitians take lead role e.g. in DAFNE project.
|17 1993, did part of Donald Pearson`s job as consultant diabetologist. 1994, succeeded Mike Williams as full-time consultant. Blood sugar meters. Greater understanding of patients anticipated by RD Lawrence, 1925.|
|18 Pharmaceutical interest in complications – new medications. |
Emphasis on team-work. Importance of DSNs.
|19 15 years ago published re management of patients solely in hospital & shared with primary care. Developed integrated care – diabetic clinics in primary care venues & professional education for GPs & practice nurses. Doubling of known cases in around 5 years, due to more screening, ageing population, less exercise, more obesity.|
|20 Primary care essential, but specialist support needed. |
Involve patients, but unattainable targets stressful for all.
|21 Stress caused by responsibility to make things happen without power to do so. Patients have life other than diabetes. If patients choose to ignore guidance, staff not responsible.|
|22 Acute emergencies sometimes over-managed - high-anxiety introduction to diabetes affects later attitudes.|
|23 Patients` self-management important, but professional input & education needed. |
DAFNE programmes enable patients to reflect & meet peers, but may lead to false expectations.
|24 More renal transplants, pancreatic transplants, cardiovascular intervention & management of eye disease. Adjust targets for older patients` multi-system disorders.|
|25 Diabetes care suits me. RD Lawrence recognised importance of patients` role – had diabetes himself – saved by insulin. JJR McLeod co-discovered insulin. Mike Williams wrote his biography. All attended Aberdeen Grammar School. |