Bermuda has something to celebrate during November's Diabetes Awareness month – newly installed Bermudian endocrinologist Annabel Fountain.

Dr Fountain specialises in diabetes and other disorders of the endocrine system, such as hypertension, lipid disorders, obesity, hyponatraemia, hypogonadism, infertility, pituitary disorders, adrenal disorders, disorders of calcium and bone metabolism and other endocrine tumours and conditions.

She is based in the Diabetes Education Centre, which this month moved to the Fairview Court building on the Mid-Atlantic Wellness Institute Campus in Devonshire. Her services are available by physician referral. The Royal Gazette recently met with Dr Fountain to learn more about her and her work.

Are you the first Bermudian endocrinologist?

No, actually Edwin B Astwood was a Bermudian endocrinologist and he worked in Boston. He invented antithyroid drugs. He won the 1959 Laskar Award for basic contributions to our endocrine function leading to the control of hyperthyroidism. While I was studying medicine there was a previous endocrinologist on a work permit. I guess you could say I am the first Bermudian endocrinologist to work for the hospital this century.

How did you get into the endocrinology side of things?

I liked endocrinology during the second year of medical school. I found it fascinating. It makes sense to me. If your gland works properly, when the figurative switch is pressed the light goes on. If it doesn't work properly the light doesn't go on. It is an all-or-nothing body system. For me it makes sense. The diabetes side of things I find more and more fascinating. Dealing with it can be more complicated then a lot of the endocrine diseases.

Why is that?

With a thyroid patient, for example, you can make them better quite quickly. What to do is very black and white, whereas with a diabetes patient there is lifestyle and exercise involved. A much more holistic approach is required. Diabetes is really common and has so much scope for intervention and prevention. There is so much investment in someone's future. You are also looking at their health in ten or 20 years. Knowing that Bermuda had a particularly high proportion of its population with Type Two diabetes made me more determined to study endocrinology and return home to work. I have cared for inpatients and outpatients with Type One and Type Two diabetes and am experienced in the use of a wide variety of treatments for Type Two diabetes. I am especially interested in the use of newer pharmacological agents for treatment of this disorder as well as recommending lifestyle management and treatments for people who are overweight. I am particularly interested in the treatment of diabetic foot disease, diabetes in pregnancy and use of medications to ameliorate progression of nephropathy and retinopathy.

Have you been surprised at the scale of diabetes in Bermuda?

Not really. The last place I worked in the United Kingdom had a similar incidence to Bermuda but there was a large South Asian population. They have 23 percent of the population with Type Two diabetes.

Does having Type Two diabetes automatically mean you are going to lose a limb or your eyesight? Do you have to be on dialysis?

A really important message to get across to people with diabetes is if they look after their diabetes, that stuff does not happen. Just because you have Type Two diabetes that doesn't mean you will end up on dialysis or lose a limb. It doesn't just not happen as much, it does not happen. I don't think people believe that because they see family members with these problems and they think they have a death sentence.

Do most of the people you see who have diabetes take your advice and turn their lives around or do most of them struggle?

It is difficult to say. I have only been working here for two months, but I think I am quite persuasive.

How many diabetics do you think you've seen since you have been here?

I haven't seen a lot of diabetes patients yet. I have had more endocrine referrals. The GPs are used to working with diabetes patients. They know a lot about diabetes. It is only when there are more complications or the case is difficult that they are referred to me. Hopefully, there will be more coming through. I see people on the wards in the hospital, and they will be coming to me for follow-ups. If they have had an acute complication then obviously, I am the person to see them in the hospital and I can help them to prevent being hospitalised again.

Do you think it is difficult for some people because it requires almost a whole change of culture?

Definitely. That was a big challenge in the last group of patients I looked after. They have similar tastes to our population. They like a lot of sweet foods, a lot of carbohydrate-based foods such as rice and bread. Retraining people in the way they eat is very difficult. If they have been doing it one way for 50-plus years trying to persuade them to change can be difficult.

The other cultural issue is exercise. That was also something that was significant in my last hospital. A lot of times people just want to put their feet up after they retire. They may have worked really hard for 40 or 50 years. Some people want to go out and play golf or do something sporty, but that is not everyone's cup of tea. It is difficult to tell someone who wants to relax that they need to get up and get some exercise.

Do you have any personal experience with diabetes?

Yes, I had an uncle who had diabetes. He actually passed away of complications not very long ago. Then I have a friend from medical school with Type One diabetes. He has amazing control. He has been down the Amazon River and to Mount Everest base camp with his insulin. I am hoping to bring him here to speak. He is very inspiring.

Have you seen many patients with Type One?

I have probably seen an equal number, but that is just the referral pattern here. There are less than 100 Type One diabetics in Bermuda.

Is the advice any different for Type One and Type Two patients?

It is quite different. They have different issues. Type Two diabetes is more of a metabolic disease. It involves the liver and adipose tissue, which is fat. People with Type One don't have the same metabolic problems, they just don't have insulin. With Type One you can balance your insulin and exercise to keep your sugars normal. With Type Two because they have these other metabolic problems and are more higher risk for heart disease, you are approaching it in a different way. Most Type Ones are younger, or at least they are younger when it starts. It is sometimes easier to change someone's lifestyle at an earlier age.

What is causing this epidemic of diabetes on the planet?

The problem is there is an excess of food on the planet. If you look at paintings like Leonardo DaVinci's 'Last Supper', the plates are small and the food is small. The size of servings has gone up and up with industrialisation. We don't have physical jobs. Food is cheap and we don't do any exercise. That is where the balance has gone wrong.

Where were you, before you came back to Bermuda?

I have worked in London, the Isle of Wight, Bath and New Zealand since qualifying. My specialty training commenced in 2005 on the Imperial College London Rotation where I worked at Hammersmith and Charing Cross Hospitals, amongst others.