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| 01 Human physiology at Manchester Medical School - 1974. Married & did 18 month Dietetics Diploma, Hollings College. Shortage of dietitians. | |
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| 02 Dietitians had been nurses or caterers. Still catering, but medical advancement - attracted me. For diabetics, restricted carbohydrates fitted round twice-daily injections. | |
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| 03 10 gram carbohydrate exchanges. Fats & salads free. Children’s allowance dependent on age - Adult’s varied slightly according to job. | |
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04 “Carbohydrate Countdown” booklet (See Extras). Never questioned counting until met patients. Nothing sweet allowed. Could buy fructose. Fat disregarded.
When training, new 10 gram exchanges had replaced Lawrence diet. | |
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05 During training, saw few children with diabetes – ‘delicate’ – only beginning to attend ordinary schools.
Started work,1979, Withington Hospital. Saw diabetic adults admitted for other things. Meals measured by kitchen. Moved to teaching hospital with children’s ward. Saw newly-diagnosed. | |
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06 Children educated on ward, 7-10 days. Then seen in outpatients.
All literature for adults. Visited children on wards – no sugar, extra protein or fat if hungry. | |
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| 07 Adults mostly Type 2 – weight control, no blood-testing, no disposable syringes - 1979-83. (Some parents bought disposables for children.) Blood-testing complicated. Occasional Type 1 adult, developing complications. Huge clinics… | |
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08 …like now. Foot & mobility problems. Most didn’t see dietitian.
Hard for overweight - no food content information. Weight Watchers reduced calories. Sympathy - prognosis poor. | |
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| 09 Left to have son. Then part-time - dietetic service for North West BUPA hospitals. Moved to Bristol, 1985 – BUPA, locums at Bristol Royal Infirmary, research. Antenatal work with diabetics – good outcomes. Moved to Midlands, 1989. | |
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| 10 Part-time in diabetic clinic, Birmingham Children’s Hospital. Locums in Solihull & worked in registry office – one stillbirth due to diabetes. | |
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| 11 Children’s Hospital offered home care. Most not hospitalised. Still used exchanges after 1990, but moving to healthy eating. | |
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| 12 Diagosis devastating. Family memories of reduced life expectancy & complications. We said children could have long lives. Now in mainstream schools – we visited. Less information before internet – most for adults. We created own - still addressed to adults. | |
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| 13 Main changes in 1990s: Move to healthy eating – vague – so I kept track of carbohydrate. First blood testing machines. Awareness re fibre. Couldn’t vary food much because tied to 2 injections. Encouraged to replace fat with carbohydrate… | |
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| 14 …before hadn’t bothered re fat. Awareness of heart disease & lipids. Avoided fast carbohydrates & fat, but enough carbohydrates for growth. Retained pre-diagnosis diet if not overweight, avoiding sweets… | |
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15 …& specialist products. Fed to appetite – sometimes adjusted insulin.
Specialist products lost favour - high fat, expensive, sorbitol laxative. | |
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16 Drinks with new sweeteners available to general public.
‘Healthy eating’ doesn’t address quantity. We tried to address quality & quantity. Now emphasis on carbohydrate counting… | |
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| 17 …but not return to past - new emphasis on glycaemic index. | |
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| 18 Focussed on healthy eating - but some foods lift blood sugars more quickly. More insulins . Introduced basal bolus - didn’t count carbohydrate. After 2000, long-acting insulins plus short-acting with meals - people could eat what liked, count carbohydrate & adjust insulin. | |
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| 19 When growing, need for insulin to match greater carbohydrate. Children slow to change to more injections. Now newly-diagnosed begin on multiple injections. Carbohydrate-counting essential: need for maths worrying… | |
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| 20 …give set doses to some, but reduces benefit. DAFNE courses for adults – some eat unhealthily & adjust insulin; some eat healthily & benefit from flexibility. New insulins may change management, but currently need to count carbohydrate. | |
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| 21 Adjust advice for Asian diet. More overweight children with Type 2. Stress this isn’t ‘mild’ diabetes. | |
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| 22 Type 1 doubled since 1990. In 1990, no Type 2s – now 5%. More diabetes combined with coeliac disease & secondary to other conditions. | |
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23 Type 1 still misdiagnosed by GPs. Children do well at sports – more normal life than 1990. 30 years ago, girls advised against pregnancy.
At DAFNE course saw different ways people have managed. Current management better for children, though must visit schools to advise on multiple injections. | |
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| 24 NHS can’t afford much home visiting. Poor attendance at outpatients. Families need to be more responsible. | |
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| 25 Home visits have pros & cons. Less home visiting might mean more school visiting & group sessions in holidays. | |
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| 26 Not many new babies, but many under one. Help with breast-feeding, weaning, ‘terrible twos’. Will start multiple injections, but I worry re future effect of ‘no food, no injections’… | |
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27 …even with twice-daily – wanted them to have insulin before food.
Next issues at school – sweets, erratic exercise. Parents encouraged to treat all children same. Early adolescence hard – balancing independence/dependence. | |
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| 28 Teens difficult - social life etc. Diabetes affects attitude to food. Multiple injections should help. Leaving home or starting work difficult. If well-adjusted & grown, we’ve succeeded. When I began, didn’t grow well, have full job opportunities, or expect children. | |
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| 29 Trials showed control avoids complications. Clearer aims – HbA1c. More monitoring & screening. Better insulins & delivery. Can’t avoid concern re carbohydrate. | |
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