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Managing type 1 diabetes and life as a magic circle partner

Author: James Cripps |

11 Mar 2014 | 13:42

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Slaughter and May partner James Cripps recently retired after over 35 years at the firm. Together with his former boss, Jonathan Haw, and their wives, Margaret and Hélène, they helped to establish the type 1 diabetes charity JDRF in the UK. In this article, Cripps recounts how he learned to balance the demands of his condition with the demands of his legal career

In 1984, I became Jonathan Haw's assistant in Slaughter and May's newly opened New York offices. His daughter had recently been diagnosed with type 1 diabetes, which led us to provide support and legal advice for JDRF, a charity which raises money for research to improve treatment for, and eventually to find a cure, for type 1 diabetes. Little did I know that within five years I would myself be diagnosed with this challenging and life-long condition.

The causes of type 1 diabetes are not yet fully understood, and we know of nothing that can be done to prevent it. While the average age of diagnosis is between 10 and 14, some diagnoses are shortly after birth, while I was 33 when I discovered I had the condition.

The time leading up to becoming a partner is an intense time for any lawyer. It was 1989, I was back in London and a client was buying a company in New Zealand. I was taking 24-hour flights to Auckland, working intensely for three or four days, then jetting straight back. Furthermore Margaret and my first child, Leonard, had been born in the February, which was an unsurpassed highlight but did mean the odd sleepless nights when back in the UK.

I felt increasingly fatigued and was losing weight - which I was actually quite happy about! I put it all down to the demands of fatherhood and my legal career, although I soon learnt that these are classic symptoms of the onset of type 1 diabetes. We went to stay with friends in Scotland and I became very ill, slipping into the potentially life-threatening state called diabetic ketoacidosis. I then found myself waking up on an insulin drip in intensive care in Fort William hospital, with my blood glucose level through the roof - although things improved rapidly as soon as the consultant realised what was going on.

I was allowed to leave hospital as soon as my blood glucose levels had stabilised and the sister was happy that I had learnt how to inject myself with the insulin that my pancreas could no longer produce. A few weeks later - and feeling almost normal - I was back at Slaughters, somewhat bewildered by what had happened and uncertain as to how my life and career would be affected.

I am very lucky as right from the beginning. I have received tremendous support. First at home, where my wife and mother - indeed all the family and friends - rallied round to help me make the necessary adjustments to diet and lifestyle. I received excellent medical advice from our family doctor and the diabetic specialists he recommended. At the same time everyone at the office and many of my clients were highly supportive and understanding, with many still my clients when I retired a quarter of a century later.

That said, learning how to manage the condition - and balance it with the demands of legal practice - is a very personal experience and involves quite a bit of learning - and plenty of trial and error. I was on four injections a day and initially a bit self-conscious, injecting unobserved in my room or the Slaughters corridor rather than in the meeting rooms. After a while I became less embarrassed, although injections were never something to draw to the attention of others, but I no longer left a meeting - I simply injected myself under the table. I also found that there was often at least as much understanding about diabetes when I was travelling overseas, not just in the US but especially in the Middle and Far East.

Sandwiches at meetings are an inevitable part of many legal careers, but I learnt to avoid them at all costs because white bread and fillings cause my blood glucose levels to jump rapidly - far faster than even a large dose of insulin can handle. I swapped to brown bread, salads and the odd piece of fruit, with biscuits reserved for the occasional moment when I felt a hypo might be coming on, typically because I had misjudged my insulin dose at the last meal.

My secretaries also learnt that my (very rare!) episodes of bad temper in the office were often (always?) caused by low blood sugar - so I would be told to test my blood sugar level while they disappeared, only to re-emerge with a cup of hot chocolate or sugared tea or coffee in the expectation I would be drinking it as soon as the test was finished.

In extreme cases, hypos are very dangerous, and can have a dramatic effect on motor and cognitive skills including speech, before the blood glucose level is normalised. I have been lucky enough, to date - fingers crossed - never to suffer a hypo that required medical support, but even a mild low blood sugar hypo sometimes left me feeling a bit tired, if only for a few minutes.

I also soon realised that the more demanding situations at work, such as when working against a looming deadline, closing a transaction, finalising documents for printing or simply enduring (and enjoying!) a tough negotiation were the times when I needed to take more insulin to prevent unexpected high blood sugar.

Initially I put this down to working long hours, often late into the night (if not early in the morning), combined with too long between proper meals. However, I then worked out, after discussions with my specialist, that intermittent high levels of stress have a big impact on blood glucose levels, often at least as much as what I was eating. Indeed, my daily insulin requirement has fallen some 10%-15% since I left the City and started as a (rather mature) research student at Oxford. Stress hormones raise blood glucose levels, and so more insulin is needed to keep to, or restore, normal levels. That said, being a lawyer in the City is a fairly stressful life - the insulin changes are just something else you have to deal with if you have type 1 diabetes.

My advice to those with the condition who are looking to start their careers is that there's no reason why they shouldn't be a City, or any other, lawyer. Managing type 1 diabetes is not easy, but nor is it rocket science - and if from time to time your blood levels are less than perfect you just get on with it - work out the causes and try to do better next time. You may be unlucky enough to become ill and need medical treatment, but this applies whether or not you have diabetes - and research does show the better you manage your condition the better your chances of avoiding complications in the short, medium and long term.

The supportive technology for those with type 1 diabetes, including insulin pumps and continuous glucose monitors, has improved dramatically since my diagnosis and there is no reason why this should not continue. It is now almost a decade since I moved from injections to an insulin pump, which is attached to my stomach almost constantly. It is difficult to describe what a difference this made - but it certainly made coping with legal life much easier, even for someone as unmechanical as me.

Following retirement I joined the board of JDRF and am hoping to do more to raise funds for medical research into type 1 diabetes. I am starting with a trek up Mount Kilimanjoro this June with 19 other type 1 walkers and a support team.

There have been, and continue to be, great advances in the treatment of type 1 and JDRF has a proud record supporting research. It nevertheless remains a chronic and incurable condition. My hope, long term, is for medical research to discover the cure and herald a world without type 1 diabetes.

In the short term I particularly want the 'artificial pancreas' project - funded by JDRF and currently in human clinical trials - to become a reality. This will provide a continuous measure of blood glucose levels linked to an insulin pump which will automatically provide the required level of insulin 24/7. It will not be a cure, but it will allow those with type 1 diabetes to live life with less interruption and a reduced risk of the long-term complications, including eye-disease and nerve damage, that accompany the condition.

If you are interested in sharing skills with JDRF please contact corporate development fundraiser Ruth Caulfield on 0207 8413658 or email rcaulfield@jdrf.org.uk.

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