Introduction: Enter Dr Lawrence

Diabetes commonsense

Introduction: Enter Dr Lawrence
Balance: Signpost to Success
Juggling the Blue Carbohydrate and Red Insulin Balls
The Great Debate: Natural Animal or Artificial ‘Human’ Insulin?
Conclusion: Commonsense Rules


Diabetes Common Sense

Introduction: Enter Dr Lawrence

I am a diabetic and have been on insulin for seventy years. For much of that time, I was a patient of Dr. R. D. Lawrence, 1892 – 1968. The wisdom and compassion he bestowed on me has enriched and protected my life. I shall be happy if I can pass on to my fellow diabetics some of what I gained from knowing him.

Dr. Lawrence was one of the first people whose life was saved by the discovery of insulin in 1921. “In the successful treatment of diabetics the patient, the nurse, the practitioner and the specialist are often partners working together to establish the patient’s health. In the long run the most important part, the melody, is played by the patient and the accompaniment may be almost unheard.”(1)

When patients visited Dr. Lawrence in his Harley Street rooms, he greeted them with a hearty handshake. He always had a pink carnation in his buttonhole and never wore a white coat. After a friendly exchange of family news, I remember he would always ask to be shown the glucose sweets I was carrying. He would explain, with a twinkle in his eye, that in the past his patients had seemed too good to be true. Every one of them said they always carried glucose sweets ready for an emergency. When he asked to see what they were carrying, he found his fears were justified. Only about one in ten could produce the sweets they said they had. He told me he wouldn’t like me to be one of those irresponsible people on insulin who go around without the sugar they will need to counteract a hypo.

The next conversation would be about blood sugar. Dr. Lawrence would say, “We’ll both guess what we think your blood sugar is now. I’ll write down the answers and put them in front of us on my desk. No cheating! Of course, you should be right and I should be wrong. I can’t expect to know as much about how your body works as you can.” Sometimes we were both slightly wrong but most times I was the winner.

We would then discuss the new medium and long-lasting insulins that were coming on to the market. He would try them out on himself in different strengths and combinations. He would often say, “Your diabetes seems to be happy as it is. I see no advantage for you in disturbing things. Why should you change?”

I have followed his advice to this day. Neutral, quick-acting animal insulin is the only one I have ever used, except for the distressing interlude when I hoped to take advantage of the promised, but never fulfilled, wonders of ‘human’ insulin. The result of this conservative behaviour is that my body has fallen into the habit of good diabetic control. It has not had to undergo the stress of fitting itself into the rhythms of new insulins or learn to tolerate the additives mixed in to make insulin last for a longer or shorter time. Perhaps this simplicity is what has found favour with my hormones and helps to explain the health and happiness that have coloured my life.

Fate was kind on that overcast afternoon so long ago in 1930 when it sent me to see Dr. Lawrence for the first time. He taught me many things, and one of these was not to regard the doctor as a god. One day, after examining my eyes to detect early signs of diabetic retinopathy, he looked worried and said “Always remember, Beatrice, for all our expertise and training, we doctors really know very little about the fundamental problems of life. We don’t understand the cause of diabetic retinopathy, we can’t prevent liver cancer or even cure the common cold.” This humility and wisdom gave me lifelong courage and insight. The wise man is the one who knows he does not know.