The letters examined provide evidence of a significant problem related to the change-over to genetically engineered ('human') insulin which has particularly affected longstanding IDD's. The problems needs to be viewed within the wider problem of the control of diabetes in order to minimise pathological developments and maximise quality of life.

The medical reason for the introduction of a new genetically engineered 'human' insulin was to reduce the long term possibility of problems resulting from the production of antibodies to insulin, the assumption being that this insulin would produce fewer antibodies. This data contains evidence of a significant problem developing fairly after the change-over to 'human' insulin for a group of people with diabetes. The main features of this problem are loss of warnings of hypos and rapidly varying blood sugar levels. Many correspondents reported that a diabetic condition which has been stable and controlled over many years and allowed a full and 'normal' life, suddenly changed and became problematic and life disrupting. For people experiencing these difficulties, the cost in terms of immediate negative effects far out-weigh any possible long-term benefits of this new insulin.

The normal management of IDD has relied on a relationship of mutual co-operation between doctor and patient with the patient taking every day responsibility for their medication and monitoring control, reporting any difficulties such as hypo's in a clinic. If the patient's account of her or his condition is dismissed this relationship starts to break down. From the patients point of view his main source of medical help is ignoring his experiences and possible need for help; and from the doctor's viewpoint a vital source of information in managing the diabetic condition- the patient's experience- is discounted. In a situation where the diabetics situation has worsened and is having a negative impact on the patients life as a result of a change of regime initiated by the doctor, there is a potential for conflict with the doctor exercising her power of prescription ad the diabetic patient left with his disrupted life. Understandably the diabetic patient is likely to try to get his voice hear and to do whatever he can do to improve his situation. In the change-over had been more negotiable in diabetic clinics, if it had been more closely monitored and in particular, if more account had been taken of patient's experiences, this problem might not have developed into the controversy that it has, with litigation and extensive medical coverage.

The letters examined constitute a source of data which amount to very much more than mere anecdotes. The nature of the problem which was unexpectedly and initially discounted is clearly and convincingly spelled out, and along with it the impact of an unstable diabetic condition and hypoglycaemia unawareness on the quality of the diabetic life.