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| 01 Classicist at school. Changed course - medicine. Reserved occupation. Biology & physics, Bristol, 1943. Pre-clinical, 1944. Clinical, 1946. | |
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| 02 Saw admissions with ketosis, but not diabetic clinic. Training for general practice – different from now. | |
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03 Learnt re insulin & carbohydrate metabolism. No Type 1/2 distinction. Saw ketoacidosis, but not complications – untreatable.
Year as house surgeon & physician. Ketoacidosis had high mortality. | |
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| 04 Year as pathologist, Sheffield. Then army pathologist. Taught at university in Singapore. | |
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| 05 1953-55 - Bristol Dept. of Pathology. 1955-56 - SHO, Bristol. 1956-58 – research. Then Senior Registrar, first at peripheral hospital, then Sheffield teaching hospital. Research - insulin antibodies & insulin binding deposits in diabetic kidney. Also did diabetic clinic… | |
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06 …about 1962, blood sugar results for first time before clinic ended.
No treatment for complications – just control. Not enough re smoking. | |
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| 07 1960-63 – boss saw new patients. I did follow-up – about 30 per morning. Patients admitted for starting insulin. Didn’t use word ‘team’, but had doctors, dietitian & could get chiropody. Can’t recall nurses’ role in clinic. | |
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| 08 Worked for year on management of diabetic pregnancy at Jessop Hospital for Women. Peel & Oakley had shown still births reduced by Caesarians at 37 weeks. | |
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09 As SHO in 1956, helped with student Finals - volunteer patient had hypo.
In Derby 1958-60, unsuccessful research on nerve transmission in legs of patients with diabetic ketosis. | |
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| 10 1963 – went to Dartford as general physician. Never designated ‘with special interest in diabetes’ but did diabetic clinics. Strict dietitian. | |
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11 Around 150 patients seen every 3 months. Lawrence Line diet. Clinitest. Tablets. Admitted to go on insulin – taught by dietitian & ward sisters.
Helped by GP clinical assistants. Lady complained re being weighed in public! | |
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12 Clinical assistant essential. One went to work for Pike at King’s.
Some patients admitted 10 days to 3 weeks. I was slow to recognise shock of diagnosis. | |
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13 When I got to Dartford, booklet said ‘2 diabetics should never marry’. Wrote replacement with BDA help. Glass syringes sterilised at home. Sepsis.
Exercise not emphasised.
Referrals to chiropodist. Hadn’t heard of podiatry. | |
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| 14 Burroughs Wellcome in Dartford. I studied insulin levels in non-diabetic obese people & published with George Stewart of Wellcome Foundation c.1969. | |
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| 15 1948 medical act said money only for patients. Around 1960, money given for postgrad medical education. I became tutor 1964. 1972 – postgrad medical centre opened, Joyce Green Hospital. In 2000, moved to Darent Valley Hospital. | |
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16 Now called Philip Farrant Education Centre.
Dialysis at first only offered to non-diabetics. By late 60s, one diabetic patient referred for dialysis. | |
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17 1970s - clinics got bigger. New outpatient centre at West Hill Hospital. With Queen Mary’s, Sidcup, had community liaison sister – taught patients re insulin – avoided some being admitted.
Young patients depressed by seeing older patients. | |
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18 GP responsibility for diabetes didn’t come until 1980s.
By late 70s - treatment for diabetic retinopathy
Community nurses went into homes – patients open with them. | |
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| 19 1976 - mentioned need for local BDA to patient, Alan Partridge. He helped found one – raised money & helped patients. | |
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| 20 Alan talked to patients. Raised money for glucose meters & equipment to measure HbA1c – uncommon. | |
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| 21 Clinics too big in 1970s - my interest in diabetes known; my hospital became responsible for Gravesend Hospital; postgrad education taught diagnosis. | |
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| 22 Local BDA helped open diabetic day centre – volunteers & community liaison sister. Opened by diabetic Spurs captain, Gary Mabbutt. | |
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| 23 Established diabetic youth group, helped by Novo Nordisk. I asked girl to join… | |
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24 …she later wrote in Balance re reluctance. She became secretary. Disco & walks. I feared hypos, but they managed well.
Later in 80s, youth had own section of clinic – no longer exposed to complications. | |
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| 25 My lack of understanding re life with diabetes due to my training? Wife understood personal aspects better. Youth group helped understanding. | |
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26 Compared HbA1c in youth group with similar age group, helped by Burroughs Wellcome.
Early 80s - got GPs interested in running own clinics, helped by community nurse & own nurses – several by retirement in 1988 – no more ‘dinosaur’ clinics. | |
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27 Early 1980s - new insulin pen. Local BDA helped purchase Dextrostix – before became prescribable, mid-80s.
Diabetic pregnancies - didn’t manage joint clinic, but talked to obstetrician. Obstetric nurses interested in reducing diabetic still births – originally 30%. | |
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28 1980s - more interested in hypertension.
From late 70s, dietitian introduced high fibre diet – relief to give up weighing 10g portions. | |
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29 Retired 1988. Gave talk – we should refer to ‘people with diabetes’, not ‘diabetics’. Puzzle of Type 1s with poor control but no complications.
Control better nowadays. | |
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| 30 Retirement meal with youth group – Important to learn from patients. | |
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