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|01 Classicist at school. Changed course - medicine. Reserved occupation. Biology & physics, Bristol, 1943. Pre-clinical, 1944. Clinical, 1946.|
|02 Saw admissions with ketosis, but not diabetic clinic. Training for general practice – different from now.|
|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.
|04 Year as pathologist, Sheffield. Then army pathologist. Taught at university in Singapore.|
|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…|
|06 …about 1962, blood sugar results for first time before clinic ended. |
No treatment for complications – just control. Not enough re smoking.
|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.|
|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.|
|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.
|10 1963 – went to Dartford as general physician. Never designated ‘with special interest in diabetes’ but did diabetic clinics. Strict dietitian.|
|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!
|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.
|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.
|14 Burroughs Wellcome in Dartford. I studied insulin levels in non-diabetic obese people & published with George Stewart of Wellcome Foundation c.1969.|
|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.|
|16 Now called Philip Farrant Education Centre. |
Dialysis at first only offered to non-diabetics. By late 60s, one diabetic patient referred for dialysis.
|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.
|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.
|19 1976 - mentioned need for local BDA to patient, Alan Partridge. He helped found one – raised money & helped patients.|
|20 Alan talked to patients. Raised money for glucose meters & equipment to measure HbA1c – uncommon.|
|21 Clinics too big in 1970s - my interest in diabetes known; my hospital became responsible for Gravesend Hospital; postgrad education taught diagnosis.|
|22 Local BDA helped open diabetic day centre – volunteers & community liaison sister. Opened by diabetic Spurs captain, Gary Mabbutt.|
|23 Established diabetic youth group, helped by Novo Nordisk. I asked girl to join…|
|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.
|25 My lack of understanding re life with diabetes due to my training? Wife understood personal aspects better. Youth group helped understanding.|
|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.
|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%.
|28 1980s - more interested in hypertension. |
From late 70s, dietitian introduced high fibre diet – relief to give up weighing 10g portions.
|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.
|30 Retirement meal with youth group – Important to learn from patients. |