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|01 Mother teacher, father executive. Privileged education. Chose medicine practical application of science.|
|02 Birmingham University, 1982. Less than third female. Traditional 2 years theory, 3 years on wards. |
Learnt re diabetes less than renal disease. Saw people with diabetes have renal transplants. Early pancreas transplant.
|03 In 1987, house job, gastroenterology, General Hospital. Occasionally covered diabetes made consultants nervous. Saw ketoacidosis, sickle cell plus diabetes. Good guidelines & teaching. |
Seemed Type 1 to be treated by specialists, Type 2 considered less serious.
|04 A & E. Training scheme in market town. I didn`t choose diabetes - disagreed with hospital`s approach . |
After house jobs, maternity leave, then trainee GP - practice with diabetes clinic stayed on a few months to do it. 1992, became part-time partner in nearby town specialised in diabetes with nurse.
|05 Consultants provided good advice. Insulins more sensitive, diet relaxed. Consultants ran GP meetings. |
Practice grew. New contract chronic disease clinics we continued as before. Early 1990s, computerised prescriptions, appointments etc. By late 1990s, fitted appointments round patients.
|06 In 1992, computers enabled audit. Also had dietitian & counsellor. Dietitian temporary, later got another now obesity more time-consuming. Still have medical counsellor.|
|07 By 1990s, DCCT Trial showed Type 1 need for control. Type 2 seen as GPs` province hospital for complications or starting insulin. Children always hospital-led. |
|08 By late 1990s, ran retinal photography scheme for 3 practices. |
Began actively to look for diabetes. Knowledge improved. Insulin-dependent & complications still went to hospital.
|09 Good retinopathy. More nurses trained & doctors interested in diabetes. By 2001, paper-light, better audit. Chased people. Retinopathy for homebound. By late 1990s, some PCTs had supported doctors & nurses to get diabetes qualification. With DSNs, I set up Certificate half of county practices have doctor & nurse with Certificate.|
|10 New contract & QOF shows how good control is. More expertise. Diabetes liaison nurses. Can help Type 1s. De-medicalising. |
Better education re educating patients. Better resources where English 2nd language. Dietetic advice normal healthy diet. Choice of staff with knowledge at any time no specific clinic.
|11 Test people at risk. Warn re risk - stay thin. Good information from Diabetes UK. General public more aware. Diabetes led way in multidisciplinary teams. |
|12 Would like to employ diabetes liaison nurses currrently hospital-based. Consultants starting to come into community. |
Horror stories from non-diabetic wards not allowed to administer own insulin. Students meet our patients.
District nurses support housebound.
More research. New drugs.
|13 UKPDS - importance of control for Type 2s. Began to look at physiology of diabetes. Exenatide, new gliptins. Hospital care pathways. Podiatrists better trained. Warn re possibility of insulin not failure. Older people have other conditions.|
|14 Dietitian sees family`s main cook constant support healthy diet for all. Obesity increasing everyone needs to know re diabetes.|
|15 Knowledge better, but I have eye on computer for what needs measuring. Continuity of care eroded. People living longer to get other diseases. |
GPs get points for tests. We did well because computerised used money for extra staff. Penalises inner-city practices with greater needs.
|16 For pregnant women, in 1992, consultant-only care. Now GP must do pre-conceptual counselling. Multidisciplinary team at hospital, looking for diabetes, avoid neonatal death. In late 1980s, most Caesarian now normal delivery possible. |