As a final-year medical student in 1959, over a 2-week period I experienced increasing thirst, polyuria and lassitude, and lost 5 kg in weight. Suspecting diabetes, I performed a urine test using Clinitest. The test was negative for glucose, and, believing my symptoms were caused by pre-examination stress, I took no action.

Golden Jubilee meeting of Diabetes Australia – NSW, 1987

The meeting marked the 50th anniversary of the foundation of the first Diabetes Association in Australia. Shown in the photo are John Townend, Chairman of Diabetes Australia – NSW; Phyllis Lush, the first person to receive insulin in Australia; Kempson Maddox (her physician); and the author.

Over the next 4 weeks my symptoms worsened rapidly, and I failed a pathology examination. I was so ill that, like all medical students at some time or other, I was convinced I had some sort of malignancy. Finally it dawned upon me that the first test might have been wrong. A repeat test showed high glucose and acetone levels — a random blood glucose level of 25 mmol/L established the diagnosis.

Immediate admission to a diabetic ward was advised, but I asked if I could delay admission until the next morning, as I had a date that evening (diabetics often rebel against their condition, but not usually as quickly as that!). There followed a hurried discussion, and my request was granted, provided I first gave myself an injection of insulin. This accomplished, I had a most enjoyable evening, and can still remember being able to sit through the first act of an opera without having to visit the toilet.

Already I had learned several valuable lessons about clinical medicine, and diabetes in particular:

• Urine-testing equipment has a limited shelf-life (in retrospect, that first test tablet must have deteriorated);

• Always trust your clinical judgement, rather than laboratory tests alone;

• People with insulin-dependent diabetes should take immediate responsibility for their condition, and should give their own first insulin injection; self-injection is easy, and not to be feared;

• The effect of insulin is dramatic;

• Wherever possible, diabetes management should be adapted to fit the patient’s lifestyle.

Given my initial fears, to learn that I had a treatable condition came as a great relief, and since that first day I have never resented my diabetes, regarding it more as a constant companion than an illness.

In fact, diabetes has proved beneficial to my career, rather than a disadvantage. I had originally hoped to become a surgeon, but was advised at the time that this path would be unwise, in view of the unpredictable hours and mealtimes it would entail. Therefore, I decided to specialise in diabetes. This has allowed me better to understand my own condition. Moreover, I believe that many patients derive comfort and confidence from knowing that their diabetes specialist, who also has diabetes, is apparently in good health! Now semi-retired, I walk 30–60 minutes daily, and am much fitter than when I worked 12-hour days. Apart from some symptomless vascular calcification, I am completely free of long-term complications. I look after the day-to-day management of my diabetes myself, but visit an endocrinologist once a year (for a full medical check-up and complications screen) and an ophthalmologist every 1–2 years.

Speaking personally, my wonderful wife has been of inestimable support over the years, and we have two splendid children and two grandchildren. I play golf, which is an ideal sport for the diabetic, as the amount of exercise is moderate and predictable (unlike tennis or cricket) and safe (unlike football). I am also active in madrigal singing. Although I am interested in motor racing, my diabetes precluded me from holding a racing licence; I also had to surrender my glider pilot’s licence on diagnosis. However, I have been able to enjoy membership of a Beefsteak & Burgundy Club, learning to adjust my insulin doses to cope with some remarkable dining extravaganzas!

I have found it easy to deal with most of the usual problems of living with diabetes. The need to eat regularly and diet carefully has lessened in more recent years with the advent of ultrashort-acting insulin and the basal-bolus insulin regimen. I am able to avoid jetlag on long trips by travelling business class and combining alcohol and temazepam to ensure 12 hours’ sleep (contrary to textbook advice!), plus aspirin to prevent deep venous thrombosis.

My biggest problem is the ever-present risk of hypoglycaemia — in particular, the problem of hypoglycaemia unawareness, which remains the “Achilles’ heel” of type 1 diabetes. Perversely, the harder one tries to avoid hyperglycaemia and achieve an HbA1c level low enough to prevent vascular and neurological complications, the greater becomes the risk of hypoglycaemia unawareness.

Now, after 45 years of living with diabetes, I have total unawareness of nocturnal hypoglycaemia, and limited ability to recognise daytime episodes. Regrettably, like most diabetics, I deny that I am hypoglycaemic, even when it is obvious to all around me, and I may become obstreperous when asked to consume carbohydrate! The reason for this denial response is obscure, but may relate to the strict warning given to all newly-diagnosed diabetics (and indelibly etched on their consiousness) to avoid sugar — a message that floats to the surface during hypoglycaemic confusion. The reason for the violent, uncooperative behaviour is equally obscure, but may simply represent release of the underlying personality from inhibition by the superego, much as occurs with alcohol intoxication. When acutely drunk, some people become aggressively antisocial, while others become quiet and morose.

International Diabetes Federation meeting in New Delhi, 1976

The author (left) enjoys himself with colleague Brian Hirschfeld and elephant.

My wife has rescued me from countless episodes of nocturnal hypoglycaemia, and has saved my life on several occasions. Fortunately, I have rarely become violent when hypoglycaemic, and have learned — admittedly slowly — that when my wife says “You’re hypo!” (a) she is always correct, and (b) it is easier to eat the jelly beans than to argue!

Certainly, the frequency of daytime and nocturnal hypoglycaemia can be reduced by using newer long-acting insulin analogues such as insulin glargine or insulin detemir, and can be virtually abolished using a continuous subcutaneous insulin infusion (CSII) — but at a price! Insulin glargine, not yet available under the Pharmaceutical Benefits Scheme, costs $800–$1200 a year. CSII costs about $2500 a year for the consumables alone, but the Federal Government, in its May 2004 Budget, promised to subsidise these costs to the value of $20 per month from September 2004. I have tried CSII on three separate occasions and, while my glycaemic control was undoubtedly better, the inconvenience, high cost, and risk of skin infections were unacceptable. A basal-bolus insulin regimen using Novorapid three times a day via an Innovo pen injector suits me well, and the Innovo memory feature is of great assistance on the occasions when I can’t remember if and when I gave the last dose. Insulin glargine at bedtime allows me much smoother glycaemic control than isophane insulin.

Of course, not all diabetics feel as positively as I do; many fear injections, fingerpricks, blindness and gangrene (but, interestingly, not heart attacks!). My view is that injections using 31-gauge needles really don’t hurt, that fingerpricks are a small price to pay for good health, and that long-term complications should be preventable without sacrificing an enjoyable lifestyle. However, diabetes is a constant companion, and one is reminded that one is diabetic every hour of every day. The ability to cope with that certainty goes a long way towards being able to live successfully with diabetes.