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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… | |
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02 …Hoffenberg, Malins & Fitzgerald. Now part-time – diabetes & ophthalmology.
Cambridge biochemistry anti-medics. | |
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| 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. | |
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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. | |
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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. | |
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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. | |
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| 07 Central Middx, 1962-4, then Hammersmith. Diabetes as part of general medicine. Contacts. Met Arthur Rubenstein. | |
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| 08 Hammersmith 1964-9 – Radioimmunoassay research. Russell Fraser interested in maturity-onset diabetes, later called non-insulin-dependent, now Type 2. | |
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| 09 Good pregnancy outcomes. IGTs well-recorded. Now less prematurity, more Caesarians. Mortality still higher than in general population. | |
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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. | |
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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. | |
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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. | |
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| 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. | |
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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. | |
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15 Eye problems - could offer nothing. Wonderful now to tell patients they can preserve sight.
BDA important. I learnt from children’s camps. | |
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| 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. | |
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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. | |
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| 18 Private practice Saturday mornings. Convenient for patients, but must recognise limits. Must continue relating to GPs - basic care & prescriptions. Privilege of free prescriptions. | |
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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. | |
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| 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! | |
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-t.jpg "Dr Asher`s junior medics (A Wright left)")
-t.jpg "Cambridge biochemists, 1958, (A Wright, front, 3rd from right)")
