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| 01 Decided against political career. Chose medicine as revenge on doctors! Medical schools wanted Latin, didn’t want women. One offer - London Hospital Medical College. | |
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| 02 1st MB at Queen Mary. 2nd MB. Medical college, Whitechapel. Intercalated MSc in anatomy. Clinical work started 1954. Learnt from patients & from Dick Bomford – ran clinics outside working hours – caught on 50 years later! | |
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| 03 Carbohydrate exchanges. Line diets. Eating fat encouraged. Complications emerging. Slow to realise need for control. Urine testing only. Reverse testing. Some thought high sugar required insulin – death resulted. Glass syringes. Boiling in test tubes. | |
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04 Reverse testing started USA. Morning insulin dose depended on evening urine test & vice-versa. Patients adjusted own treatment.
Tablets introduced for Type 2 – better without?
Dick Bomford’s humanity good example. | |
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05 Huge clinics. Long hours. Patients waited. Did all education - none in community. Sorted problems now done by DSN. Got some of first DSNs appointed.
Waiting led to hypos. | |
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| 06 Change in 1960s from dietitians issuing orders to listening. Already had chiropodists in 1950s – re-introduced with shared care. Consultants got what they requested. | |
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| 07 During obstetrics training saw babies of diabetic mothers die & mothers with complications – may have led me into diabetes care. With Wendy Savage set up shared care. Kings had reduced mortality. Few young doctors chose diabetes. | |
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| 08 Qualified 1957. House jobs. Resident pathology jobs. Junior clinical lectureship - met husband – couldn’t work in same firm – became NHS Registrar. Retained attachment to Stuart Mason in diabetes & endocrinology – encouraged adjusting diabetes to lifestyle. Became Senior Registrar, then in 1970 Consultant in General Medicine with Special Interest in Radioisotopes. Began diabetes research. | |
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| 09 In 1960s, did diabetic clinic & treated emergencies – hypos. Admitted, so could talk re causes. Treated ketoacidosis with too much insulin – people died. No bedside blood sugar testing. | |
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| 10 In 1960s, tablets considered answer to Type 2. Tolbutamide first. Chlorpropamide led to more hypos. Phenformin led to lactic acidosis. Type 2 complications. In late 1960s I was convinced of need for control: older diabetologists weren’t. | |
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| 11 Having children no more problematic than being woman in medicine in 1960s. | |
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| 12 Became consultant, 1970 – maybe first female physician at London Hospital. Eventually ran immunoassay lab & diabetes service. Joint clinics with Wendy Savage at Mile End & obstetricians at Whitechapel. Aim to get good blood sugars. | |
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| 13 Learnt to involve patients. Late 1970s, clinics more demanding. Shared care system with John Yudkin & others. Published with Simon Welch re measuring glycosylated haemoglobin. Control abysmal. | |
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| 14 Got GPs involved. Specialist nurses – Margaret Fisher. Information recorded centrally, measured HbA1c improvements, published 1984. Not enough money to extend service, until supported by Graham Hitman. Before I retired, district-wide service. GPs’ role fluctuated. Too much to teach practice nurses in short time. Now evening clinics at last! | |
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| 15 In 1980s, hand-held meters for blood sugars transformed pregnant diabetes clinic. | |
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16 In 1980s move from once-daily long-acting insulin to more frequent doses. Husband, Bob Cohen, showed Phenformin dangerous – banned. Metformin good – still used.
Change from high-fat line diet to normal eating. Self-help groups. | |
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| 17 First patients Cockneys, many Yiddish-speaking Jewish people, then Bangladeshis – 50% of deliveries, ¾ of gestational diabetes. Appointed advocates. Used Lord Young’s Language Line. Now younger Bangladeshi staff. I managed to make women understand – time-consuming. | |
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| 18 Began writing letters to patient with copy to GP. Computerisation meant letter written alongside patient. Disadvantage – looking at computer, not patient. Need for voice recognition. | |
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| 19 1990s changes – less time in clinics. American study showed benefits of improved glycaemic control for Type 1 & UKPDS for Type 2 – Also showed benefit of controlling blood pressure. Husband helped get money to complete UKPDS. | |
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| 20 During 1990s, importance of lipid control realised – I was dubious, but eventually convinced. Audits. Control still great effort for patient. Insulin pumps haven’t been answer. Islet transplants? | |
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| 21 Measuring HbA1c gradually easier. At BDA meeting, 1981, I was criticised for suggesting it could be used to screen for diabetes. Now beginning to happen. | |
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22 Improvements – realisation that blood sugar control and blood pressure matter. Disposable syringes & needles. Education helping patients to adjust treatment to lifestyle. HbA1c encourages some, threatens others. Specialist nurses. GP surveillance – if not just box-ticking to get money.
Need to reduce stress - raises blood sugar.
Government should give more money. | |
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| 23 By retirement, 1999, no cure, no easy method of control. Better relationships with patients. Attempts to organise round their needs. Diabetes now on agenda. Still no way of getting islets into people. | |
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| 24 Since retirement, some clinical work, mostly research – need for Vitamin D among British Bangladeshis & everyone. | |
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25 Also research, with colleague in Taiwan, to show betel-chewing risk factor for Type 2 diabetes. Last week re-submitted paper showing betel risk factor for heart disease.
Need for large Vitamin D trial, for lifestyle changes, for legislation re junk food. Perhaps I should have done politics! | |
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-t.jpg "Children`s ward as it was in 1950s (in fact taken 1943)")
-t.jpg "As house officer, 1957-8 (2nd row, in spectacles)")
-t.jpg "As registrar, 1960 (2nd row, in spectacles)")
