Nineteen of the 22 were sleeping alone at the time of death and 20 were found lying in an undisturbed bed. The most puzzling group were 22, aged 12–43 years, most of whom had gone to bed in apparently good health and been found dead in the morning. Of the other 24 cases, two patients had been found with irreversible hypoglycaemic brain damage and died after a period of artificial ventilation. Of the 50 cases we excluded five with a definite cause of death, 11 suicides or self-poisonings, six cases of ketoacidosis, and four in which there was insufficient information about the circumstances of death to drawn any conclusions. An autopsy had been done in all cases and we supplemented this with detailed clinical information from relatives and case records. In total we were notified of 50 deaths of people with Type 1 diabetes under age 50 years in the UK in 1989 which our informants (relatives, physicians, and pathologists) considered sudden and unexpected. It was suggested that such deaths were due to hypoglycaemia and related to the increasing use of human insulin. It was an exciting time to be in diabetes.The suggestion of an increase in the number of sudden deaths of young people with Type 1 diabetes in the UK has been investigated. This, he said, “may go some way to explaining my interest in the psychological aspects of diabetes and the hinterland between medicine and psychiatry.” He studied at Cambridge and St Thomas’ Hospital and did a senior house officer job at Nottingham General Hospital before joining David Pyke in London. Robert was born to two psychiatrists and went on to marry one. It opened up a whole new field of research, which continues to yield a dividend both for science and for those who carry the genes involved. This simple clinical observation and some intensive sleuth work led to the discovery of maturity onset diabetes of the young (MODY), the first single gene variant of diabetes to be described. David Pyke-Robert’s mentor-recalled the same phenomenon in another family.

The young Robert Tattersall was working on a study of long term diabetes at King’s College London, when he came across a woman with a 40 year history of diabetes who had stopped taking insulin.

Diabetes by Robert Tattersall