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|01 Decided against political career. Chose medicine as revenge on doctors! Medical schools wanted Latin, didn`t want women. One offer - London Hospital Medical College.|
|02 1st MB at Queen Mary. 2nd MB. Medical college, Whitechapel. Intercalated MSc in anatomy. Clinical work started 1954. Learnt from patients & from Dick Bomford – ran clinics outside working hours – caught on 50 years later!|
|03 Carbohydrate exchanges. Line diets. Eating fat encouraged. Complications emerging. Slow to realise need for control. Urine testing only. Reverse testing. Some thought high sugar required insulin – death resulted. Glass syringes. Boiling in test tubes.|
|04 Reverse testing started USA. Morning insulin dose depended on evening urine test & vice-versa. Patients adjusted own treatment. |
Tablets introduced for Type 2 – better without?
Dick Bomford`s humanity good example.
|05 Huge clinics. Long hours. Patients waited. Did all education - none in community. Sorted problems now done by DSN. Got some of first DSNs appointed. |
Waiting led to hypos.
|06 Change in 1960s from dietitians issuing orders to listening. Already had chiropodists in 1950s – re-introduced with shared care. Consultants got what they requested.|
|07 During obstetrics training saw babies of diabetic mothers die & mothers with complications – may have led me into diabetes care. With Wendy Savage set up shared care. Kings had reduced mortality. Few young doctors chose diabetes.|
|08 Qualified 1957. House jobs. Resident pathology jobs. Junior clinical lectureship - met husband – couldn`t work in same firm – became NHS Registrar. Retained attachment to Stuart Mason in diabetes & endocrinology – encouraged adjusting diabetes to lifestyle. Became Senior Registrar, then in 1970 Consultant in General Medicine with Special Interest in Radioisotopes. Began diabetes research.|
|09 In 1960s, did diabetic clinic & treated emergencies – hypos. Admitted, so could talk re causes. Treated ketoacidosis with too much insulin – people died. No bedside blood sugar testing.|
|10 In 1960s, tablets considered answer to Type 2. Tolbutamide first. Chlorpropamide led to more hypos. Phenformin led to lactic acidosis. Type 2 complications. In late 1960s I was convinced of need for control: older diabetologists weren`t.|
|11 Having children no more problematic than being woman in medicine in 1960s.|
|12 Became consultant, 1970 – maybe first female physician at London Hospital. Eventually ran immunoassay lab & diabetes service. Joint clinics with Wendy Savage at Mile End & obstetricians at Whitechapel. Aim to get good blood sugars.|
|13 Learnt to involve patients. Late 1970s, clinics more demanding. Shared care system with John Yudkin & others. Published with Simon Welch re measuring glycosylated haemoglobin. Control abysmal.|
|14 Got GPs involved. Specialist nurses – Margaret Fisher. Information recorded centrally, measured HbA1c improvements, published 1984. Not enough money to extend service, until supported by Graham Hitman. Before I retired, district-wide service. GPs` role fluctuated. Too much to teach practice nurses in short time. Now evening clinics at last!|
|15 In 1980s, hand-held meters for blood sugars transformed pregnant diabetes clinic.|
|16 In 1980s move from once-daily long-acting insulin to more frequent doses. Husband, Bob Cohen, showed Phenformin dangerous – banned. Metformin good – still used. |
Change from high-fat line diet to normal eating. Self-help groups.
|17 First patients Cockneys, many Yiddish-speaking Jewish people, then Bangladeshis – 50% of deliveries, ¾ of gestational diabetes. Appointed advocates. Used Lord Young`s Language Line. Now younger Bangladeshi staff. I managed to make women understand – time-consuming.|
|18 Began writing letters to patient with copy to GP. Computerisation meant letter written alongside patient. Disadvantage – looking at computer, not patient. Need for voice recognition.|
|19 1990s changes – less time in clinics. American study showed benefits of improved glycaemic control for Type 1 & UKPDS for Type 2 – Also showed benefit of controlling blood pressure. Husband helped get money to complete UKPDS.|
|20 During 1990s, importance of lipid control realised – I was dubious, but eventually convinced. Audits. Control still great effort for patient. Insulin pumps haven`t been answer. Islet transplants?|
|21 Measuring HbA1c gradually easier. At BDA meeting, 1981, I was criticised for suggesting it could be used to screen for diabetes. Now beginning to happen.|
|22 Improvements – realisation that blood sugar control and blood pressure matter. Disposable syringes & needles. Education helping patients to adjust treatment to lifestyle. HbA1c encourages some, threatens others. Specialist nurses. GP surveillance – if not just box-ticking to get money. |
Need to reduce stress - raises blood sugar.
Government should give more money.
|23 By retirement, 1999, no cure, no easy method of control. Better relationships with patients. Attempts to organise round their needs. Diabetes now on agenda. Still no way of getting islets into people.|
|24 Since retirement, some clinical work, mostly research – need for Vitamin D among British Bangladeshis & everyone.|
|25 Also research, with colleague in Taiwan, to show betel-chewing risk factor for Type 2 diabetes. Last week re-submitted paper showing betel risk factor for heart disease. |
Need for large Vitamin D trial, for lifestyle changes, for legislation re junk food. Perhaps I should have done politics!