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As community dietitian (right) 1981

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As community dietitian (right) 1981 Celebrating end of Finals (front right) 1977 Pam Dyson, 2008
 
 
Interview 93 Pam Dyson

Research Dietitian
Born in Lincoln in 1954.


Overview: Pam Dyson has been involved with the nutritional management of diabetes and obesity for 25 years. She began her working life with the Medical Research Council at the Dunn Nutrition Unit in Cambridge and since then has practised as a community dietician, diabetes specialist dietician for both in and out-patients and has been closely involved with clinical research. Since 2004, she has been employed by Oxford University as a diabetes research dietician. Her main interests are in the delivery of diabetes dietary education, behavioural aspects of lifestyle change and weight management.

Please note that Overview relates to date of recording 13 March 2008

 Short samples

1 When Pam was training in the 1970s, people with Type 1 diabetes had to follow a diet that restricted carbohydrate by an exchange system, which she feels was not well understood by many dietitians, and “certainly not... by the majority of patients”. [ 62 secs ]

2 Now that dietitians recommend a more flexible regime of healthy eating and exercise, people understand it easily, but still find it hard to achieve. Pam’s work involves helping them to identify their particular obstacles and find their own solutions. [ 60 secs ]

 
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01 Father RAF. Boarding school. Read article re dietitians – chose school subjects accordingly. New degree in nutrition & dietetics, Leeds, 1973 – girls. (1st male later.)
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02 First clinical experience aged 20, Addenbrookes Hospital, renal ward round – student fainted. Patients chose food & we altered their choices!
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03 Type 1 admitted - stabilisation & teaching. Ten gram carbohydrate exchanges. Type 1s given set of balances – ceased by time I qualified.
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04 Ward staff summoned me to man having deliberate hypo – questionable practice.
Students prepared sugar-free food – rejected!
Huge outpatients. No appointments. Dietitians in waiting-room.
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05 Type 2 considered mild – suitable for student training. Urine test showed poor control – took woman`s diet history, gave instructions, angered her. Supervisor threatened complications – common.
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06 Total of fortnight on diabetes at Leeds. Graduated 1977. Job at Dunn Nutrition Unit, Cambridge - family food survey – noticed separate diet for diabetes. Step-grandfather developed diabetes.
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07 1981, community dietitian, Cambridge - GPs` Type 2 mini-clinics. (Addenbrookes struggling - increasing numbers.) I realised management mainly at home.
High fibre, carbohydrate, low fat. Exchanges used less. No sugar. BDA`s first guidelines.
Blood glucose monitors given to Type 1. Limited drugs. Diet, weight, foot-care, not cholesterol, blood pressure. Patients liked GP care.
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08 1983, stopped work, had child, moved to Kent, 2nd child. 1986, moved to Bath - district hospital job. Many outpatients, mainly Type 2. John Reckless` diabetes ward – insulin when needed (unlike many hospitals now).
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09 1986 – healthy eating, more fibre. 1984, BDA`s ‘Carbohydrate Countdown` coding depended on sugar content. Carbohydrate total matters more than whether starch or sugar.
1986-91, mainly diabetes & obesity. I replaced prescriptive diet sheets. Differentiated healthy eating & foods which raise blood glucose.
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10 1970s restricted carbohydrate & later eating of starchy carbohydrate didn`t achieve good blood sugars. Dietitians attended Diabetic Assoc meetings. Dietitians criticised for changing mind. People wanted portion sizes.
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11 1991, moved near Oxford. Research job as lifestyle advisor with Robert Turner & Rury Holman`s Fasting Hyperglycaemia Study – healthy eating & exercise. Noticed weight lost regained. Must change manner of advice.
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12 Need for exercise. Dietitian, Liz Eeley, of UKPDS, & I noticed changes not maintained. Changed consultation style. Attended courses e.g. Charles Fox`s in Northampton. Explore feelings. Weight management groups for insulin-dependent.
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13 Woman avoided snacks by knitting. Type 1 man learnt new insulins don`t require snacks.
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14 Since early 1990s - trad medical model doesn`t apply to chronic disease. People manage own diabetes – support, not rebuke.
2004, became research dietitian. (New Diabetes UK recommendations, 2003.) Individual choice replacing prescriptive diets. Type 1s adjust insulin to carbohydrate. DAFNE. Oxford`s InSight course – results at Diabetes UK, 2008. Structured education doesn`t suit all, but offered.
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15 Type 2 no longer considered mild since UKPDS, 1998. Structured education for Type 2 - DESMOND & Oxford`s ‘Diabetes Together` .
Quality Outcome Framework meant most Type 2s treated by GP.
Dietitian no longer isolated - multidisciplinary team.
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