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The feasibility has been investigated of a physician in a district general hospital implementing an assessment and treatment service for male erectile impotence. Over an 8-month period a questionnaire was given to 200 men attending a diabetes review clinic. There were 50 replies declaring a problem of impotence, 34 of whom expressed interest in discussing treatment. These men and 17 others who spontaneously mentioned an impotence problem were further assessed with a view to treatment. After a full assessment and discussion the following treatments were agreed and successfully implemented: no treatment 30 (59%), self-injection of papaverine 12 (24%), urology referral 4 (8%), psychosexual clinic referral 2 (4%), vacuum devices 2 (4%), adjustment of drug therapy 1 (2%). Only 18% of questionnaire respondents ultimately opted for active treatment compared with 88% of the spontaneous complaints. A successful impotence assessment and treatment service, including self-injection of vasoactive drugs, can be provided by a physician as part of the diabetes care service. Active treatment is gratefully accepted. The numbers involved are manageable if resources are concentrated on those spontaneously mentioning the problem. Our experience suggested self-injection of vasoactive drugs to be the most successful treatment option.

A survey of district facilities and staffing for diabetes care in the South East Thames Region of England (population 3.58 million) is reported, and compared with the recommendations of the Royal College of Physicians and British Diabetic Association. Hospital Activity Analysis for diabetic patients in the Region for the year 1985 is also reported and costs assessed. Compared with recommended staffing levels there was a deficit of 12.8 Consultant Physicians with a weekly deficit of 109 sessions, and of 49.6 whole time equivalent Specialist Nurses. There were 11,857 admissions of diabetic patients, 4185 with diabetes as a primary cause. Seventy-six per cent of these were for diabetes without mention of complications and were therefore theoretically and potentially preventable. Total cost of diabetes care was estimated to be pounds 21.6 million p.a. for the Region of pounds 1.44 million per District Health Authority. We suggest it is time every Regional and District Health Authority gave some priority to diabetes care and established formal care strategies. To provide adequate staffing and facilities would improve standards of care, reduce morbidity and hospital admission rates, and be cost effective.

Ethanol concentrations were assayed in urine samples obtained from 10 newly presenting diabetic patients (aged 50-69 years) with glycosuria and symptoms suggesting genito-urinary candidiasis. No alcohol was detected initially with diabetic urine samples, but when stored at room temperature 8 out of 10 samples showed increasing levels of ethanol from day 3 to day 20. Peak levels were more than 10,000 mg/l in three samples and more than 1500 mg/l in six samples. Studies were also performed using normal urine and urine to which was added glucose and/or Candida. Samples were kept at either room temperature or 4 degrees C for up to 21 days and ethanol assays performed at regular intervals. Studies with non-diabetic urine showed a maximum ethanol level of 500 mg/l after 11 days only in samples containing both glucose and Candida and kept at room temperature.