The Pharmaceutical Journal
Vol 268 No 7186 p250-251
23 February 2002

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Diabetes

Pharmacists, who are also patients, describe in their own words what it is like to have to take a medicine for life

Living with diabetes: community pharmacists have an important role to play

In 1955 I was 19 years old and was in a laboratory at Chelsea College. I dropped a pipetteful of Fehling's solution into a sample of my urine and turned a bright orange to everyone's surprise, not least my own. I had been in London for three months and had no GP. I was sent to St Stephen's Hospital in Fulham and from there to the diabetes clinic at St George's, Hyde Park Corner. Since then, I have never looked back. I have worked at St George's or one of the hospitals in that group all my working life.

Since I had been injecting mice in the laboratory I had no problem with giving myself injections. The problem was that Lente insulin given once a day could give me a "hypo" on the top of a London bus at 6pm if the traffic was bad and my supper was delayed. I found Isophane twice daily more convenient.

A wise consultant told me in the first week that once I had given the injection I was "normal" and that I should not go through life imagining myself to be an invalid or disabled. I determined that nothing would stop me living a normal — even exciting — life and I have been privileged to travel all over the world.

Patients know more

I have given birth to three sons by Caesarian section; each was a planned delivery three weeks early yet their birth weights were normal. I had a hysterectomy and three weeks in hospital with tuberculosis (to which people with diabetes are more susceptible). I could recount horror stories of nurses drawing 1.5ml instead of 15 units of insulin or of the hospital kitchen announcing that since I could not eat sugar or carbohydrate all they could offer me for supper was a piece of cauliflower. Thankfully, if the nurses knew I was a pharmacist they would check doses with me. Anyway, the maxim is that patients with diabetes know more about themselves and their treatment than the medics do.

Once my boys were at secondary school I was able to return to work full-time for 22 years. My managers were always sympathetic to my need for lunch at 12.30pm every day — I would get a slight clouding of consciousness if left until 1pm. But this was useful, and it showed that my diabetes control was pretty good. I only once had to have a week in hospital with stress which had led to incredibly high blood sugar. Stress does nobody any good! I also had a week in hospital with shigella which I had picked up from a poor water or food supply in India — a ghastly way to lose a stone in a week.

However, in the past year things have become more difficult. I have been diabetic for nearly 50 years and retired for over three years. Thank God I have no retinopathy, neuropathy or nephropathy as I write. But I have lost all sensation of the warning signs of a "hypo". I therefore need to do blood tests two or three times a day. The blood sugar may be 15 or 1.5 — I can't tell the difference, which can be dangerous, especially in the middle of the night. I also find that life in retirement is more flexible than at work. One day I might be mowing the grass and sweeping the leaves; the next, I might sit and read or go for a drive. So my insulin requirements can change from day to day, again necessitating frequent blood tests.

Then there is the question of diet and avoiding high cholesterol. In 1955, dietitians told us to make up for the low carbohydrate intake by eating cheese! Now I eat very little dairy produce in an attempt to keep my cholesterol below 6. I have never smoked, I am not overweight, I have never had high blood pressure and I have always exercised.

So much good research has been done of late on the kind of carbohydrates to eat (those slowly metabolised) and I try to eat pasta, pulses, oats and whole grains. I also try to keep my glycosated haemoglobin to below 8 but find it difficult without running into "hypos" on effort. Research shows that this is important to avoid strokes and infarctions.

I owe much to an excellent diabetes nurse in the clinic, but pharmacists in the community have an important role to play, too, because they come alongside patients with diabetes with all their fears, questions and needs. We have come a long way from the glass and metal syringe kept in a jam-jar of "spirit" to the "pen" which is so light and easy to use. Let us continue the progress.