Inaugural Elsie Bertram Lecture Features Canadian Diabetes Expert

Next month sees the first annual Elsie Bertram Memorial Lecture take place in Norwich with a guest speaker from Edmonton Canada, Dr James Shapiro. Dr Shapiro is a pioneer of islet transplantation for diabetes patients.

The annual lecture commemorates the very significant contribution the late Elsie Bertram made to diabetes services in Norfolk over the past 25 years. Mrs Bertram helped establish the Norwich and Norfolk Diabetes Trust that led to a number of landmark developments.

• The Bertram Diabetes Centre opened in 1989
• The Bertram Diabetes Eye Unit opened in 1994
• The Bertram Diabetes Research Unit opened in 1997
• The computerised Mobile Eye Screening service started in 2000

The diabetes trust is also funding a diabetes research unit at the University of East Anglia, specialist nurses roles for diabetic patients and a new mobile eye-screening unit for North Norfolk.

Mrs Bertram died in October 2003 at the age of 91. She had developed an active interest in diabetes as a result of her two sons developing the disease. Diabetes continues to be one of the fastest growing chronis diseases in Norfolk, with 1000 new diagnoses a year locally, and 12,000 people in East Norfolk with the condition.

Consultant endocrinologist Dr Richard Greenwood; “Very little of the progress we have made in diabetes services over the past 25 years would have been possible without Elsie's energy, enthusiasm and immense powers of persuasion. ”

The first Elsie Bertram Memorial Lecture takes place on Thursday April 1, at 19:00 in the lecture theatre at the John Innes Centre, Colney Lane. The lecture is on “Progress and Promise of Clinical Islet Transplantation for Diabetes” and will given by Dr James Shapiro. Tickets are free and can be booked by calling Maggie Flatman on Norwich 286286.

The Edmonton Islet transplant programme, which is led by Dr Shapiro, has developed a method for transplanting pancreatic islet cells into patients with Type 1 diabetes which in many cases effectively cures the condition and allows themm to discontinue insulin injections.

The Norfolk and Norwich University Hospital NHS Trust is also recognising her contribution by unveiling a portrait in the Elsie Bertram Diabetes Centre at the hospital on the same day.

Background
There are two forms of diabetes. Type 1 diabetes, which occurs in younger people is where the person's pancreas stops producing insulin and they need to control their blood sugar with daily lifelong injections of insulin. The number of children being diagnosed at the N&N with Type 1 diabetes has doubled over the past 15 years. Before the 1920s, Type 1 diabetes always proved fatal. It is thought that the onset of diabetes is caused by genetic factors and factors like poor diet or lack of exercise. Type 2 diabetes, which affects older people, means the person affected may still produce insulin but they are unable to use it properly to control blood glucose levels. There are about 12,000 people with Type 2 diabetes in East Norfolk and a further 1000 are diagnosed each year locally.

Diabetes explained
Diabetes can affect babies, children, young people and adults of all ages, and is becoming more common. Diabetes can result in premature death, ill health and disability, yet these can often be prevented or delayed by high-quality care.

Diabetes is a group of disorders with many different causes, all of which include raised blood glucose levels. This is the result of a lack of the hormone insulin and/or an inability to respond to insulin. Insulin in the blood, produced by the pancreas, is the hormone which ensures that glucose (sugar) obtained from food can be used by the body.

Type I diabetes – About 20% of diabetics in England are people with Type 1 diabetes, the pancreas is no longer able to produce insulin because the insulin-producing cells (b-cells) have been destroyed by the body's immune system. Type 1 diabetes develops most frequently in children, young people and young adults. Although it is far less common than Type 2 diabetes, it is more immediately evident. The symptoms of Type 1 diabetes can develop very rapidly. These include increased thirst and urine production, weight loss despite increased appetite, tiredness and blurred vision. People with Type 1 diabetes need daily injections of insulin to survive.

Type 2 diabetes – About 80% of diabetics in England have Type 2 diabetes, where the pancreas is not able to produce enough insulin for the body's needs. The majority of people with Type 2 diabetes also have some degree of insulin resistance, where the cells in the body are not able to respond to the insulin that is produced. Type 2 diabetes is most commonly diagnosed in adults over the age of 40, although increasingly it is appearing in young people and young adults. Glucose builds up in the blood, as in people with Type 1 diabetes, but symptoms appear more gradually and the diabetes may not be diagnosed for some years. People with Type 2 diabetes need to adjust their diet and their lifestyle. Many are overweight or obese and will be advised to lose weight. Some will also need to take tablets and/or insulin to achieve control of their blood glucose level.

Effects of diabetes – Prolonged exposure to raised blood glucose levels affects tissues throughout the body by damaging the small blood vessels. The initial changes are reversible but, over time, prolonged raised blood glucose levels can lead to permanent damage. These complications include:

• damage to the eyes, which can lead to blindness (diabetic retinopathy)
• damage to the kidney, which can lead to renal failure (diabetic nephropathy)
• damage to the nerves (diabetic neuropathy). Damage to the nerves supplying the lower limbs can lead to loss of sensation in the feet, thereby predisposing to the development of foot ulcers and lower limb amputation. Damage to other nerves can lead to a variety of symptoms, including postural hypotension (feeling faint on standing up), abnormal sweating, gastrointestinal problems (such as diarrhoea), difficulties with bladder emptying and erectile dysfunction (impotence).
• People with diabetes, particularly Type 2 diabetes, are also at significantly increased risk of developing cardiovascular disease. This results from damage to the walls of the large blood vessels, which can then become blocked. Cardiovascular disease includes:
• coronary heart disease, which can lead to angina, myocardial infarction (heart attack) and heart failure
• cerebrovascular disease (stroke and transient ischaemic attacks)
• blockage of the large blood vessels supplying the lower limbs (peripheral vascular disease) resulting in poor circulation to the legs and feet, which can cause pain in the legs on walking and can also predispose to the development of foot ulcers and amputation.

Media contact: Andrew Stronach on 01603 287200.