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|01 Mother diabetic - in hospital 3 months before my birth, 1940s. Afterwards, her diabetes uncontrolled.|
|02 Mother’s sister in hospital with diabetic complications. Family remembered deaths pre-insulin. Aunt died 1950s - had diets for renal failure. Mother’s brothers developed diabetes, 1950s. When sweets off rations, no difference to us.|
|03 Mother’s Globin Zinc, uncle’s soluble insulin, glass syringes, huge needles, Clinitest.|
|04 No sweets or sauces. Mother weighed food. Meticulous at first – aware insulin a gift. Uncle guessed amounts - perhaps more leeway on 2 injections. Father taught me to deal with hypos.|
|05 Moved south. Coped with mother’s hypo in street. Discovered not every family ate at precise times.|
|06 Father had been in army medical corps - gave daily injection in bottom; didn’t mind omitting sweet food; good at treating hypos. |
I accompanied mother to hospital. When moved south, mother went to GP only – inadequate to check complications.
|07 When developed pernicious anaemia, transferred to hospital, but complications already developing. She took more care of diet. Went on 2 injections. I’d qualified as dietitian – didn’t listen to me!|
|08 Mother had dental clearance, aged 36. |
Childhood not much affected by diabetes, but affected career choice.
|09 State school, Manchester. Private schooling down south. Went to college to study dietetics.|
|10 Dietetics not all-graduate. Only degree, Battersea College, science-orientated. I preferred practical diploma, Ealing College – visited London teaching hospitals. New profession - British Dietetic Assoc formed 1936.|
|11 1960s - interest in diet developed, especially renal & paediatric. I was interested in diabetes. 3 years theory, 1 year practical. Finals 1971. Council for Professions Supplementary number 1281 – only about 1100 practising dietitians.|
|12 1960s - taught insulin-dependent diabetes diagnosed before age 40, non-insulin-dependent after 40. Non-insulin-dependent often died of complications before required insulin. Little obesity during & after War. No drugs to treat hypertension. In 60s & early 70s never saw insulin-requiring Type 2.|
|13 First post in South Essex working with diabetes consultant in different hospitals. Dietitians rare & consultants had relied on BDA leaflets. I advised newly-diagnosed. No blood-glucose monitoring. Urine-testing unreliable. Weight important in assessing control.|
|14 Moved to Surrey – no dietitians needed, so worked in personnel, then stopped work to have children, 1974-9. Returned to work at new district general hospital, part-time at first, some diabetes. Much changed. There ever since.|
|15 1983, British Dietetic Assoc. guidelines – abandoned 10 gram carbohydrate exchanges, emphasised high fibre quality rather than quantity. I still thought quantity important. Blood glucose meters available but expensive. Most tested urine. (In early 90s, BDA allowed 25 grams sugar daily.)|
|16 Never abandoned exchanges. 1980s - blood glucose monitoring became more common. Guildford hospital acquired DSN – had diabetic sister-in-law. We both understood patients’ experiences. Both thought carbohydrate load mattered as well as type. Taught some patients carbohydrate measurement – blood glucose monitoring measured effects. |
|17 Multidisciplinary team (MDT) developed, 1980s. Late 80s, as District Head of Service, I sold dietetic services to fund-holding GPs to form own MDTs - mini diabetic clinics. “Share care” meetings for primary & secondary. |
Dietitians no longer seen as nasty - resource.
|18 1990s - GPs looked after most Type 2 – obese. Hospitals specialised in insulin dependence & complications. Saw more Type 2 insulin-requiring – insulin made them put on weight. Tried low calorie diets.|
|19 Local university developed low glycaemic index crackers – disliked by patients. Patients must be part of MDT – underlined by Expert Patient Programme & DAFNE.|
|20 DSN has done Expert Patients & we’re both learning to be DAFNE educators. Patients gained from each other. Isolated patient made me realise my mother not isolated. DCCT & other research shows attention improves results. Diagnosis traumatic – patients only take in 10% of consultation.|
|21 I work with gestational diabetes – seems more common – older mums, overweight, traumatised by diagnosis.|
|22 Want to be seen as resource, not threat. Now concentrate on reasons why people eat too much. Need for exercise. |
Gastric banding now available.
|23 Improvements - Pre-NHS, paid for mother’s insulin. Mother in hospital 3 months before birth – not nowadays. Outcomes better. More flexibility. Diabetics lead long, healthy lives. |