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Interview
70 Michael Williams
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Consultant with a Special Interest in DiabetesBorn in Aberdeen in 1931.
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Overview:
Michael Williams worked in general medicine at Aberdeen Royal Infirmary until 1968, when he was given three months leave to study diabetes with John Butterfield at Guy`s Hospital in London and John Malins at Birmingham General Hospital. He returned to Aberdeen to work with John Stowers as a ‘Consultant in General Medicine with Special Interest in Metabolic Diseases` until 1983 and then consultant in charge of the Infirmary`s diabetic clinic until he retired in 1994 and was succeeded by Ken McHardy. He has published several papers about his fellow Aberdonian, the co-discoverer of insulin, J.J.R. Mcleod.
Please note that Overview relates to date of recording Wednesday, July 18, 2007
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1 He found that the clinics in London and Birmingham were unable to get blood sugar results until after the patient’s appointment. The clinics were not as frequent as those in Aberdeen, and in Birmingham patients often saw a different doctor at each visit. [ 49 secs ] |  | 2 The local branch of the British Diabetic Association helped to organise teach-ins on diabetes in small townships around Aberdeen, which were attended by the staff of the diabetic clinic and hundreds of patients and their relatives. [ 59 secs ] | |
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| 01 Aberdeen Grammar & Strathallan Schools. Aberdeen University 1948-54. 1 year Aberdeen Royal Infirmary. 2 years National Service. 1957, Registrar, Aberdeen. MRCP. Senior registrar. 1961, lecturer, Aberdeen University. MD. 1968, consultant, general medicine & diabetes, including Orkney. Study leave: Guy’s (Butterfield) & Birmingham (Malins). Appointed to help John Stowers at Aberdeen. | |
| 02 1968, Guy’s & Middlesex (Nabarro): clinics less frequent than Aberdeen & couldn’t get blood sugars at appointment. Birmingham: many patients, different doctor each time, immigrants, Urdu diet sheets.
Aberdeen clinic started 1926 - Alexander Lyall. Succeeded by Stowers – diabetic himself – introduced appointments system & evening clinics. | |
| 03 Young on twice daily insulin, older patients once daily – mainly Lente. Lente didn’t produce good control – complications.
Tablets - Chlorpropamide, then Tolazamide & Fenformin, then Metformin. Clinitest.
Different insulin strengths. ‘Reverse testing’. Young given Acetest. Glass metal syringes. | |
| | 04 Daily clinics & 2 evenings monthly. Patients saw same doctor. Blood & glucose tolerance results available at appointment. 2 to 3 thousand patients treated by clinic - GPs reluctant. | |
| | 05 Carbohydrate restriction increased fat intake – harm realised later. No printed diets – written individually. Dietitians trained at Robert Gordon’s Institute. No chiropodist at first. Young admitted for education & seen every 3 months, older patients every 6 months. | |
| 06 After 1968, change to U100 insulin – avoided errors. Patients brought in filthy old syringes. Actrapid, Mixtard, Initard.
Changed new patients to human insulin, but not all patients - some felt they lost warnings of hypos. Must believe patients. | |
| 07 I did clinic twice weekly & evenings twice monthly. Started Orkney clinic.
Plastic syringes re-used - given free to poorer patients. | |
| 08 BM sticks cut in two – given free, plus diary - improved control. Later HbA1c prevented fabrication of results & showed difficulty of control.
Glybenclamide & Glipizide for Type 2. | |
| 09 Unusually, Stowers used sliding scale of insulin based on urine test results. Encouraged self-management.
Initially, little done for complications. Later, eye treatments.
Diabetics not given haemodialysis at first. Treatments improved for renal complications, hypertension, feet, vascular disease. | |
| 10 Open door policy. Kept records in clinic – computerised early 1980s.
Began shared care with GPs when workload increased. Sometimes practice nurse rather than GP. | |
| 11 Aberdeen one of first to take part in UKPDS. I was unenthusiastic, because we used different treatments, but came to see value.
Good doctor/patient relationships.
Attended meetings in clinic & community teach-ins run by local BDA. | |
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