366 500 injections later

“They will find a tablet quite soon to replace the jab,” my friendly GP said when, in 1954, at 14, my juvenile diabetes was confirmed. I went home to look up the “family doctor book,” which happened to be Osler's 1906 edition, and read, “In childhood the disease is rapidly progressive and may prove fatal in a few days. The outlook is bad.”

Having lived through a few days, and a few jabs, I returned to adolescent life—to the “Top 20” on Radio Luxemburg and “Rock Around the Clock”—while my parents settled down to reading Lawrence's The Diabetic Life and getting out the scales, to weigh everything according to the “10 gram exchange diet.”

Resistance to change in routine is an obsessive attitude of many diabetics

As I have now lived for 50 years with insulin dependent diabetes and without retinopathy or proteinuria, colleagues sometimes raise an eyebrow and ask, “What's your secret? Have you any inspirational advice?” I hadn't thought about this, ascribing survival to genes and luck, but I suppose a good start was the 10 g exchange diet, which—though I abandoned weighing things when I went off to university—I have always subconsciously continued.

Lack of discrimination at my interviews for medical school did credit to the panel all those years ago—but diabetes did modify my career choice. I was advised not to become a surgeon as I'd probably be blind by my mid-30s. Psychiatry offered a more predictable working life.

I was advised not to become a surgeon as I'd probably be blind by my mid-30s

When I'm asked how I would sum up the impact of diabetes on 40 years of busy clinical and academic practice, I say that it has been “bloody inconvenient.” Some inconveniences disappeared when I abandoned sterilising glass syringes and cleansing my skin for injection and stopped urinalysis when blood testing became available. I got through my house years on once daily insulin, but thereafter, with changing medical practice, I was advised to take twice daily injections, which increased the inconvenience: carrying insulin, finding toilets, and timing meals. Avoiding hypoglycaemia has always been an obsessive preoccupation.

We are now at last at the threshold of insulin by inhalation, but I won't be rushing to try it; I have never even graduated to pen injection. Resistance to change in routine is a self preserving, obsessive attitude of many diabetics—a no surrendering of personal locus of control, especially when you're in hospital. My only nasty “hypo” occurred when I was recovering from a road crash and not in control. I have rather restricted disclosing my condition, as it can be embarrassing when overly solicitous colleagues press glasses of milk on me whenever I appear puzzled during a lecture. Doctors have been very tolerant of this autonomy; nurses less so.

Since the 1950s diabetologists have always had an optimistic therapeutic partnership with me—the sort of relationship that we psychiatrists generally envy. Travelling as an academic and journal editor in different time zones and climates, I always kept the same priorities: regular thrice daily testing, traditional injecting, exercising, and a roughly 10 g exchange diet. Sadly, travel has become more complex and unpredictable. It used to be that you could go by train from Cardiff to London and back the same day and be confident of returning that evening for dinner. This is now no longer guaranteed, and I have to carry insulin and needles. Gridlock on the motorways can mean injecting through trousers; 12 hour delays in an African airport without air conditioning requires ingenuity in keeping cool.

I became diabetic just when sweet rationing was ended. I never developed a sweet tooth but have been adventurous with food and drink and have become knowledgeable. I think I was right to take risks with travel and lifestyle when I was young. It was marginally better to be arrested in an airport toilet in Kiev for carrying needles and drugs at the age of 20 than when an elderly professor. I do encourage young people with insulin dependent diabetes to have adventures and not mind the occasional high—for example, after living for a week on whisky and tea biscuits while sailing. Trying to measure insulin in a small yacht in a gale shows just how diabetes brings its excitements and inconveniences.