Thursday, December 28, 2006

Miscellaneous Christmas rants

Hope you all had a joyful Christmas! Mine was okay.

The evening before Christmas, we spend with Jimmi’s mother and her boyfriend, a very relaxed evening - despite the intensity of the rolling-dices-for-presents-game (everyone brings some small presents specifically to this game. You role a dice, and every time you get a 6, you are entitled to pick a present on the table. When all presents have been picked, a timer is set and the game continues, only now, when you get a 6, you pick a present from one of the other players).

Christmas morning Jimmi and I went to the local zoo, as entry was free between 10:00 AM and noon. When leaving, we talked to one of the inspectors at the entry, and she said that in these two hours more than 5,200 people had entered the zoo. The weather was nice, so it was actually a great opportunity, especially to families with younger children, to get out and use a bit of time and energy walking around the park.

We spend Christmas eve at Jimmi’s father’s house with his wife, Jimmi’s younger brother, S (11 years old), and their sweet little dog, Fido. We had a three-course dinner (split into two, because S was too excited about lighting the Christmas tree and getting presents). Appetizer: Rice porridge with cinnamon. Main course: Duck and roast pork with potatoes, potatoes in caramel coat (they are called “brunkartofler” in Danish, and are essentially small potatoes that are coated with a mixture of warm, liquid sugar and butter in a frying pan until they are warm and coated with this brown sugary stuff. Yum!!), red cabbage, prunes, and apples and jelly – a typical Danish Christmas dinner. Due to the excitement of S, we then danced around the Christmas three – Fido joined us, not really knowing what this was all about, but she definitely did not want to be left out of it, much to our joy – singing a few song and then S was allowed to distribute presents. When everybody had opened their presents, we went back to the table for dessert: Ris a la mande (the dictionary says it should be called rice pudding, although I don’t think that is quite the same) with cherry sauce. There was a bit discussion about who actually got the whole almond hidden in the dessert, and therefore, who was entitled to the almond-price, but as the dispute was between S and his father the price stayed in the family :-)

Christmas day (Dec. 25) my parents stopped by as they had taken my sister back to see her new apartment. Otherwise the day was used to relax.

The second Christmas day (Dec. 26) was used on Christmas lunch – again at Jimmi’s father’s house – allowing us to also say hello to Jimmi’s younger sister and her boyfriend. They live in Copenhagen so we don’t see them too often.

My BG-levels behaved very well during the Christmas days. Almost all readings was in range, only a few outliers – 2.0 (36) being the lowest and 9.8 (176) being the highest. I have been experimenting a little with the use of the dual wave bolus for more meals, and it does actually seem to smooth sugars out even more.

Overall this would make a very nice Christmas if it wasn’t for the early “Christmas present” that I got just 4 days before Christmas, and people, of course, couldn’t help asking about – explanation follows!

December 20 was the big clean-up-and-Christmas-lunch-day at work. Everyone had been assigned to an area, in order to keep everyone busy and make sure that every inch of the lab and mass spec-rooms would be cleaned. It worked very well. After a common breakfast in the coffee-room – to make sure that everyone had energy to use for the clean-up ;-) – we swirled through the labs leaving them clean as ever. I worked with a couple of post-docs in the back part of the main lab. We worked pretty effectively, so by 11:30 AM we were done, and since the lunch was not until 1:00 PM, we took a round to make sure no one else needed help before we drifted back to our offices to clean up there.

I share my office with 3 master students, none of them being there for the clean-up. One of them was excused, though – she went into labor that day, and by the end of the day she had given birth to a beautiful baby girl :-) Being the only one in my office, I could of course be tough and throw out everything that didn’t have a name on it, but I refrained from doing that and just focused on my own stuff (which, by the way, takes up most space in our small office). When I could actually see my desk again, I checked my mail. I was excited to see a mail regarding the PhD-application I just managed to send in before deadline end of November. I knew that the assessment committee was to meet at December 18, and I was told that they expected to be able to give answers to the applicants before end of December. To receive a mail regarding the application less than 2 days after the assessment committee meeting, what could that mean? Was it rejected or accepted?

I opened the mail, and was referred to an attachment. I opened the attachment and couldn’t help scanning it quickly – only to find out that I had not been chosen to receive a stipend :-( I then carefully read the letter. They had found my application to the specific project very qualified (no kidding – the project was about mass spectrometric quantitative phosphoproteomics in mitochondria from T2 diabetic muscles, and I have worked with quantitative proteomics in my Master’s and am currently working with phosphoprotein analyses, having 6 years of mass spectrometry experience plus a lot of knowledge about diabetes!), but they had found another candidate to be better qualified! My initial thought – besides disappointment – was “Who the hell could that be?”

I ranted a bit about this rejection to a couple of people, including Jimmi of course, and decided that I would question my supervisor, who happens to be one of the supervisors on that project too, about what qualifications I was missing. Just before the lunch I ran into him in the hallway, asking him: “So, I heard that someone but me was better qualified for the project….?”

“Yeah, I had the chance to place both Z and you in Ph.D-positions, and we (as in you and I) have this meeting with W from Hamburg in January, so Z was given this one – but I would like to discuss this with you”, he replied.

“Sure” I said, while inside me anger was starting to build – in close contact with the aforementioned disappointment!

I didn’t enjoy the lunch as much as I had wished to, and really just wanted to go home early. Before going home however, I wanted to discuss the issues with my supervisor, since I wasn’t sure when he would leave for the Holidays (turned out that this was actually his last day and he wouldn’t be back until beginning of January). Fortunately, he had the time to talk that afternoon.

“I didn’t know that you had applied for that stipend” he said, closing the door to his office.

I told him that I saw the advertisement just 3 days before deadline, and he was out of the house at that time so I didn’t have the possibility to discuss it with him, but as he had mentioned it to me earlier in the fall, before it was announced, and because the deal with this guy from Hamburg is far from settled yet, I saw no reason not to apply for this.

He could understand that. He then told me that he had encouraged Z – one of his Master’s student, who just graduated the week before - to apply for this stipend, and that we were both very qualified for this project, but he thought that it might be good for me to get away from our lab for a while – once again mentioning the up-coming meeting with W from Hamburg.

I told him that I of course do not intend to never leave the university, but that I was beginning to loose patience a bit, and therefore saw nothing wrong in applying for whatever possible positions and project of my interest.

I guess this actually requires a bit more background for you to understand my reaction. You see, when I graduated in October 2005, I clearly stated to my supervisors that I would like to obtain a PhD-position, in case they came across something. Back in the beginning of summer my supervisor at the university was contacted by this guy, W, in Hamburg, who would like to set up a cooperation with our group. He was also looking for a candidate to a PhD position linked to the anticipated cooperation, and thus asked my supervisor if he happened to have any candidates at hand. My supervisor asked me if I might be interested, otherwise he had thought about Z for this. I said that I might be interested, but that I would like to learn a bit more about the given project before I made my decision. My supervisor fully realized that and agreed that we would need a meeting with W before we made any decisions about the cooperation and PhD position. Unfortunately, my supervisor had a very busy fall, so he and W didn’t manage to find a date that fit both of them until November 7. W would come to Odense, and plans were made for him to give a talk and for a subsequent meeting discussing the project plans. However, shortly before the meeting was to take place, W sent us a mail that he would have to cancel our appointment as he was set to go to a job interview that he could not re-schedule. He would like to re-schedule our meeting as soon as possible. Again, my supervisor’s calendar made the call – a new meeting will not be until January 17. Because of this unsettled Hamburg-deal, and the fact that a possible future supervisor might be looking for another job (that is not very reassuring in my point of view!), I of course did not stop looking for alternative answers to my PhD-wish. One of them could have been this project within the PhD school of Molecular Metabolism. Just my bad luck that this project was almost assigned to another candidate before being advertised. Z is an exchange student, who has just completed her Master’s in our group (a week before Christmas this year). She had a wish to stay, but without work or further studies on hand she would have to leave by January 2007, so of course this stipend was a golden possibility for her. However, it does leave me a let down, seeing this stipend go to a newly graduated candidate, when I graduated 15 months ago and have worked with protein and mass spectrometric analysis in this group for the past 6 years. When I was preparing to leave after having discussed the issue with my supervisor, I heard him bring Z the good news (she hadn't heard yet that she had got the stipend). Z replied that this was the best Christmas present she could get this year. I didn't really feel like stepping by her office to congratulate her. Sorry for that, I just needed to vent!

My supervisor and I agreed that we would have to get clear-cut answers from W regarding his search for other working places, as well as the exact project plans before agreeing to anything. I believe I got my point about impatience through, as my supervisor continued to say that if we could agree to start the project, then he wouldn’t mind aiming for a start in March, or whenever it would fit W, relieving me from my current contract, which otherwise does not terminate until May. So far so good. Still, I just have a feeling that I need to be prepared for something else, if this Hamburg-deal doesn’t work out. Therefore I am currently signing up for the competition about other PhD stipends other places too, so that I will have something to fall back on, just in case.

In hope of a Happy New Year fellow bloggers!

Friday, December 15, 2006

Christmas lunches

Today is probably the major day of Christmas lunches in DK. On work we have the department Christmas lunch this afternoon, followed by the entire faculty Christmas party in the evening. I miss both of these though, as Jimmi and I have other Christmas lunch-plans.

Next week the research group that I work within will have a local Christmas lunch. We have this every year, the last couple of years combined with a thorough cleaning of the lab, mass spec-rooms and offices. So on Wednesday next week we will start at 8:30 AM with joint breakfast and planning of the cleaning. When we are all done around noon, we will gather in the newly cleaned, and now decorated, coffee room for the last group meeting of the year and, not least, the Christmas lunch :-) It is usually very enjoyable so I look forward to it.

Christmas and Christmas lunches have always been a challenge for me since the D entered my life, so I am also looking forward to see, how it will work with the pump in stead of injections. So far (2 Christmas lunches/parties) the results have been satisfying, but that could just as well be “beginner’s luck” ;-)

I had an appointment with Alice earlier this week, and once again we concluded that those late afternoon basals need to be tweaked just a bit more, as I still has a tendency to run low during those hours. Alice has just been to Cape Town for a diabetes conference, where she had heard/seen results on studies of augmented use of the combined bolus even for ordinary meal that we usually do not consider to be fatty. According to Alice, it seemed like the use of the combined bolus could smoothen the BG level even more if also used for ordinary meals. She suggested me trying it, something like 80%/20% or 90%/10% for 1-2 hours, on some of my meals to see what the effect would be. As it is now I virtually only use the combined bolus for pizza and lasagne. I was planning on using it for the traditional Christmas dishes though, but maybe I should broaden my use of it even more? I haven’t decided how to go about it yet. If I am to try it, I need to do it in a “controlled” fashion, so that I do not have to take too many variables into account when evaluating the result.

Thursday, December 07, 2006

Busy days and hypos

Why do these always seem to go together? I have been quite busy lately: Application to finish before Nov. 30, numerous samples to prepare for mass spectrometry now that our instruments are finally up running again (work), seminars to attend (work), different arrangements of the Christmas months, preparation of a talk to 140+ students that I am to give this afternoon…….

This pace obviously does not pair up well with low BG’s, but that is what always seems to happen when I am busy: Chances of getting low increase.

During the last months or so, I have noticed a tendency to go low late in the afternoon. I have decreased my basals as well as my insulin:carb-ratio (i.e., less insulin for a given amount of carb than otherwise needed during the day) in these hours. I haven’t completely solved the issues yet, though, so I am looking forward to my appointment with Alice next week, to discuss this with her.

I am most annoyed with the fact that these lows always seem to interfere with my indoor soccer practice sessions on Tuesdays – preventing me to start practice on time, mind you! This week was another brilliant example of this. I had to finish my talk for today as much as possible, because I had to hand in the presentation to the organizers on yesterday. However, I also had to attend a seminar for the Danish Proteomics Society (DAPSOC), starting at 9:30 AM on Tuesday. Fortunately, the seminar contained rather long breaks for posters and exhibition, and they were most welcome for me to retrieve the samples I expected by mail that day as well as start some experiments to be continued the next day. I had decided that I would skip the last session of the seminar anyway, in order to be able to make it to soccer practice in time, but also to take care of these experiments, and as we were much too many people in a much too small seminar room, it was actually nice to get out of there :-)

At 3:10 PM, after a 2 h seminar session, and successive questioning about my poster, my brain felt pretty crushed, but testing revealed I was at 9.0 (162), so my bolus guestimate for the served lunch hadn’t been that much off after all. I had my usual afternoon snack along with 1.8 U of insulin to cover it. Before leaving for practice at 4:30 PM I was 6.3 (113) and had the pump going at 60% basal (0.15 U/h). I had a 4.5 km (approximately 7 miles) bike ride to the sports facility, fortunately with the strong wind in my back most of the ride. Anyway, after having changed, preparing to test before starting soccer practice, I noticed I was sweating a lot more than I thought was fair, even after the bike ride. Sure enough, the test gave me a 1.3 (23). Damn!! That’s a pretty hard drop in less than 30 min! I didn’t want to miss out on most of the practice, like I have had to before, so I downed a full bottle of OJ (33 ml), a couple of glucose tabs and some m&m’s, only waiting 10 min before re-testing. At that time I was 2.1 (38), so I just waited another 10 min until taking part in the game.

By the end of our session (6:25 PM), I noticed the symptoms of a low re-appearing, but as one of the others twisted her ankle just before, we were only 6 players left, 3 on each team, and we had decided to stop at 6:30 anyway, so I thought I could just pull it off by taking it easy, watching the goal for our team. I managed, and when I tested afterwards I was at 2.9 (52), so I had to have yet another snack in order to be able to make it the 8 km back home in head wind. I felt like crap when leaving anyway, and the weather didn’t make that better. Besides the strong wind, it was also raining. At the beginning of the trip the rain wasn’t too bad, but soon it was pouring and by the time I got home, I was soaked and could literally pour water out of my shoes. After a nice hot shower, while my dinner prepared itself in the oven, I tested again, now getting a decent 5.8 (104), and I was fortunate enough to maintain in-range levels the rest of the evening.

Today I am to give that presentation to 140+ students at 5:15 PM in the afternoon. While I have ample lab work to do today, I also have to take a break to prepare my talk (only the slides are done, and I haven’t had time to test whether what I want to say fits with the slides and the amount of time available, so I might have to make some last minute adjustments). I just hope that, despite me being busy today too, the BG will behave this late afternoon!

Thursday, November 30, 2006

Endo appointment

Today I had my endo appointment. He thinks that my management is so good that we only need to set up appointments twice a year. I can live with that, as I get the appointments I need with Alice, my fabulous diabetes nurse in the day-hospital unit. In my eyes, Alice is the health care person in my D-team, who knows the most about me and my diabetes when it comes to management of this disease. She has done more trying to get my sugars in control, working with me to reduce the number of morning highs and subsequent severe lows (they were more or less an invariable rule for the last couple of years with Insulatard® [NPH] as basal insulin), assisting in the switches to Lantus and the pump, respectively. That she is the one to turn to when it comes to fine-tuning of insulin and use of the pump in general, was confirmed beyond everything else today.

I started seeing my current endo, when I moved to Odense almost 6 years ago and needed to find a new diabetes team here. My first impression of him was a bit mixed. He is Egyptian, and although he has been living in Denmark for many years, he still speak Danish with quite an accent, so I had to focus on every word he was saying to make sure I understood him right, which also caused me to doubt his medical capabilities a bit. This is not a problem any longer, as I have gotten use to his accent in both Danish and English (he was my co-supervisor during my master’s, and because his research unit is international, the common language in the lab and at meetings was English), and I have gained confidence in his medical capabilities too. Like many other doctors, however, he too has a tendency to focus on the overall results of diabetes care, i.e., the A1c-value. Thus, it took me quite some time to make him realise that a change in my regimen was needed 4 years ago, when I was having large issues with Insulatard® and BG-levels overnight. My A1c was around 6.0, so he couldn’t see any problem.

Sitting in his office today, I almost felt like back then. He asked about, whether I had decided to stick with the pump or not, and I told him that although I am still not convinced, I am being a bit more positive towards it than I was 6 month ago, so I felt I had to give it a bit more time to make it prove its worth. Jimmi and I do want to have kids within the next few years, and as much as I know that the hospital will not approve Lantus for use during pregnancy, I absolutely do not want to go back to Insulatard® and its unpredictability, so, as I told my doc, it will probably be wise to try to make pumping work. I told him about the issues I currently feel I have with it, but he didn’t really have any suggestions as how to solve those. As these issues are specifically related to the sports activities I like to join, he asked if the adhesive on the infusionsites would stay put when I was sweating. I told him that I would usually secure the site with an additional adhesive, because I had experienced unintentional detachment of sites due to sweating. I also mentioned that I had started swimming again, and he immediately asked me how I managed with the pump during swimming.

“I take it off”, I replied

Doc: “So you take out the whole thing?”

Me: “No, I just disconnect like this (showing him how to disconnect the pump), put a couple of pieces of Tegaderm® over the site to seal it, and go swimming”

Doc: “Let me see that again (referring to the disconnection procedure, carefully inspecting the infusionsite). It is so much smarter than those old butterfly-needles that were used with pumps 20 years ago.”

Me: “Yeah, I guess so….” (thinking to myself: Haven’t he kept himself informed about the new advances in diabetes treatment at all for 20 years?!!! He too recommended the pump 4 years ago, when he finally realised that we needed to exclude Insulatard® from my regimen if I was to regain decent control – and now he reveals that he actually knows nothing about pump therapy!!).


I am so happy that I got Alice to turn to in these matters. My endo is apparently helpless when it comes to pump therapy. What surprised me even more today was that he didn’t even wanted to look at my log sheets. Essentially, what he did today was to measure my blood pressure, hand me a lab-sheet for blood work to be done before the next appointment in 6 months, reminding me to schedule an appointment for eye check-up at the same time (the eye exams are done by specialists in the ambulatory too), and then ask me if there was anything else (not specifically related to pump therapy, as he stated that it was probably better to let Alice handle that) that I wanted to discus with him.

I've got an appointment with Alice in two weeks :-)

Friday, November 24, 2006

At long last!

I did it! It has taken me more than a handful of tries, but today I succeeded in completing my swimming session without going low :-) If I had had the time, I would have been able to reach my goal of 30 laps, but one of the ph.d-students of our group was to defend her thesis at 1:15 PM, and if I was to catch some lunch before the talk, I had to stop swimming by 12:30 PM.

I started swimming on Friday noons about a month ago, as we are able to use the university’s swimming facilities for free at these times, and I thought it would be a nice supplement to just biking to and from work and only playing soccer once a week during the winter. I can’t say that I am happy about the time of our free swimming sessions. The choices are Monday-Friday mornings 7:00 - 8:00 AM or Friday 12:00 – 1:00 PM. I am not much of a morning person, least of all during the darkness of winter, and as I have got a 9 km bike ride to get to the university, the morning hours are so out of question for me. The noon time on Fridays is not ideal either, because it is usually during that hour that I will have lunch, but I am stubborn so I wanted to make that work anyway. Until today, however, my swimming sessions (usually 30-35 min, 22-26 laps of 40 m) have always caused me to go low. On the last few lanes my movements are hardly coordinated, my muscles feel heavy, and I have to give in to that stupid low. My approach so far has been to eat a small snack, accompanied by a small bolus, about an hour before going into the water. I used the same approach for soccer practise in the spring where I would also disconnect during the session, so I figured that it would also work for swimming. Apparently it did not though and I have been quite annoyed with that fact.

Today I had a low of 2.9 (52) at 9:15 AM. I treated it with ½ slice of rye bread and didn’t bolus but 0.3 U for it at 10:00. At 11:00 I had another ½ slice of rye bread and some veggies for a pre-swim snack (I have used fruit or m├╝slibars for this beforehand). I bolused 1.3 U for this to cover for some of the carbs as well as the upcoming time off the pump. I tested at 11:45 AM before heading towards the swimming facilities: 10.5 (189). A little higher than I would like before disconnecting for 45-60 min, so I added an additional 1 U.

Due to my limited amount of time today I swam 26 laps in 35 min before having to stop if I was to attend the ph.d-talk. After showering and getting dressed, at 12:45 I tested: 5.9 (106)! When I got back to the office and P asked me how my swimming went today, I couldn’t help raising my arms in sign of victory. “Are you low?”, she asked, and I was happy to announce that for once I wasn’t. I had completed my swimming session in save range. Great! Heidi 1 – diabetes 0 :-) At least for now……;-)

Thursday, November 23, 2006

Chocolate is good for you :-)

Today I got chocolate at work :-) Two bars of dark chocolate, one with nuts and one just plain dark chocolate. Uhmm!!! Did I mention that I love chocolate? ;-) The reason for this chocolate coming my way – and I haven’t eaten it all yet, it will probably last me a few days, if I can restrain myself a bit ;-) – was an expression of gratitude.

I share my office (office may actually be a little too big a word for this 8-10 m2 room) at work with two master students. One of them hasn’t been around for the last couple of months as she is studying for an exam that she needs to pass in January in order to formally be able to finish her master's. The other student, P, is just about to finish her thesis. However, she is pregnant and due to give birth by the end of December, and all of the medical appointments she has to go to (she has Leri-Weill syndrome and Madelung’s deformity (see picture to the left), and during pregnancy her thyroid gland has been getting sloppy, requiring several tests and endocrinological follow-ups, and now medication too), means that she will not be able to hand in her thesis until after the baby is born. We have shared office for years, struggling with our different projects and thesis, and even when I finished my master’s last year and got employed as a research assistant within the group, I kept my desk in this office despite it officially being reserved for students (our group is very space-constrained with only 3 of our 6 principle investigators, as well as our secretary, not sharing their offices. Everybody else shares, usually 4-6 people in each office). P and I have helped each other a lot during the years, both in scientifically oriented issues and in personal issues. She has become quite skilled in spotting if I am heading towards a low, and know how to deal with it if I am not able to myself.

A couple of months ago P and her husband moved to Vejle, where her husband works. This causes P to have a 60-75 min commute to and from the university every day. The medical appointments she has to attend often causes her to take the whole day off because they may be situated in the middle of the day so that she would only be able to spend a couple of hours in the lab before or afterwards. This is of course not practical with this commute, so these days she will often be working at home, reading articles or analyzing spectra. Sometimes, though, these days away will interrupt the experiments that she needs to do in the lab, setting her back more than just the single day that she is actually off. Because of this we have an agreement that she just has to tell me and maybe leave a note on my table, if I am to take care of an experiment for her (e.g. dry down some samples, start or end an enzymatic digest, etc.), so that she can just continue the series of experiments when she is back in the following day. I don’t mind doing this. It usually doesn’t take much time for me, but it saves her at least a day, so I think that it is the least I can do. She is grateful for this, and because she knows that I am a chocolate lower, she usually gets me a piece of chocolate in thanks.

Handing me the chocolate this morning she told me that she just heard on TV last night that dark chocolate may actually be good for diabetics. Two different programs on two different TV channels had sent that message through. Dark chocolate should apparently be able to increase the insulin sensitivity of muscles, thereby assisting in lowering the BG. I have heart many good thinks about chocolate, and dark chocolate in particular, during the last few years, but never anything specifically related to diabetes, so I was a bit surprised though pleased that food research may actually justify my occasional craving for chocolate :-) I entered “diabetes + “dark chocolate”” into Google, and got an amazingly 261,000 hits! I didn’t really find anything new, though, but I did find a couple of sites that stated the link between dark chocolate and the proposed improvement of glucose metabolism although the main effect seems to be lowering of blood pressure and not blood sugar (ooh!). Amy at Diabetes Mine had a post about this about a year ago too where she also points out that the experiments leading to these conclusions were actually done on healthy, non-diabetic individuals with some degree of hypertension. Now I am just wondering why all of a sudden the possible positive effect of dark chocolate has reached the Danish media again more than a year after this research first made headlines (here in Denmark too), and now even focusing more on the effect for diabetes?

Monday, November 20, 2006

Severe diabetes

”You’ve got very severe diabetes, haven’t you?” Ever heard comments like that? I have several times, especially when I have been “stupid” enough to open-heartedly tell people about the challenges of this disease, and what can happen if a low BG is not caught in time. I have never really known what to respond to this type of question. The reasons for this are multiple. Sure, I have had my share of problems with diabetes during the last 12-13 years, but these problems have always come in waves, and not with equal intensity. The first 4 years of my D-life were quite an ease, so things haven’t always been that difficult D-wise. When the issues were most extreme (the last couple of years with Insulatard® (NPH) as the basal insulin), I had several severe hypoglycemic episodes causing several trips to the ER. I had to drastically increase the number of tests done pr day, but as this didn’t eliminate the trips to the ER, I guess it is only natural for third parties to think that I must suffer from severe diabetes. After all, people always seem to know another diabetic who “doesn’t test much, just take the shots, and never has any problems”. I cannot help but think – and thinking back on my trouble-free years too – that when you do not test much, chances are that you don’t notice those highs or lows that ought to have been corrected, e.g. by change in your general insulin regime, thus generally you are a bit on the high side some times and on the low side at others.

I guess it all points down to the eyes that see in the given situations. The reason I am ranting about this today is that I was asked the above mentioned question during the weekend. On Saturday we had our soccer team’s end-of-the-year-/Christmas party, and at some point I got to chat about diabetes with one of my team mates, getting this question (I cannot remember the exact context, but that doesn’t really matter anyway). She is a teacher and one of her students was diagnosed a couple of years ago. A recent change in his medicine had also caused his levels to fluctuate greatly. I told her about some of the difficulties I have had with diabetes, and answered some of her questions about diabetes in general. Having talked for a while, she suddenly said in a serious tone: “It is quite a difficult condition to handle, isn’t it?” Apparently, she had come to realize that with diabetes thing aren’t always plain black and white, and just to follow some “simple” rules to avoid problems is not the way it works. If this was really what happened, then all I can say is: Mission accomplished! :-) It is not always easy to manage diabetes, and the more people are aware of this the better, especially for the sake of the diabetic children who may not be able to “defend” themselves against the verbal attacks and judgments that ignorant people can come up with (I still remember being told: “Ah, you’ve probably been sinning (not religiously meant), haven’t you?” if I had a high reading, and regardless if the reason for that high was that I had had something sweet or not, I would always feel that I was being convicted for not taking proper care of myself).

Anyway, the party was great, and we were still able to perform pretty well in the indoor games that we had to play on Sunday. Most importantly we had a draw with one of our local rivals, 2-2 (the same result as last week, by the way), and a win of 2-0 against the other local rival, the Football Club of Odense (OB). Maybe it was because we had such strong support with us – despite the late night party, a “fan club” of ours of 7 people (team mates and coaches) had taken the 30 min drive to cheer on us :-) I don’t know. I just know that this past weekend seemed far too short, as one of my team mates put it when we were driving back towards Odense in the dark, rainy afternoon yesterday: “I wish tomorrow (i.e., today) would have been Sunday – but then again, I guess we would just have gotten around to do something else tonight that would make us feel just the same by the end of that day too :-)”.

Wednesday, November 15, 2006

A break

I just read Kerri’s post, ”An open letter to my Pancreas”. I need to join the pack of admirers of her writing style and sense of humor :-) Still, as always, she’s got a point, an important one: Things sure would be much easier if Mr. Pancreas would fulfil its job and not just part of it!

At the moment I am trying to figure out how to predict the effect of cycling on my BG. Usually, my cycling to and from work and activities do not pose any large challenges. Sure, the BG will be lowered a bit, but usually no more than 2-3.0 mM (26-54 mg/dl) on ride of 8-12 km, which does not necessarily pose any threat to my well-being. The last couple of days however, it seems like my bike rides, notably those in the afternoons will send my BG into an almost vertical decent.

Yesterday, I tested at 4:15 PM and got a 6.2 (112) reading. This seemed reasonable. I had a slight bolus from a bun that I ate at 3:00 PM, and because I was heading for indoor soccer practise at 5 PM, the basal was reduced to 60 % at 4:00 PM. The trip to the sports facility where we practise is little more than 4 km. I didn’t have a head wind or anything. I was in a hurry, though, because I had been busy at work (needed to finish a presentation I was to do today), so I was a little late. When I arrived the others were ready to start warm up, and I just thought I would quickly change my close and join them. I did feel a bit light headed, but thought it was just the stress of the still unfinished presentation and me being late. It wasn’t. When I tested just before joining the others, I was 1.7 (31)!! Quite a drop in just 45 min I think! I took me an additional 45 min to get back up in safe range to play, which I of course was rather annoyed with. I didn’t go to the sports facility just to sit around and watch the others play and have fun, I wanted to play myself, but couldn’t because of my BG. I only got to play for about 30 min – we stopped early because we were only 7 people and indoor soccer is quite strenuous when you are constantly involved (the others had been playing 3 against 3 while I had tried to get my BG back up, and once I joined we started a rotating substitution where each player would get 5 min break, thus continuously changing the constitution of the teams to allow every one play with as well as against each other). Fortunately, the anticipated rebound of this low wasn’t too bad. I was 12.1 (218) by bed time, not having been higher – at least what I know of ;-)

Today I went to Glostrup (near Copenhagen) to do the presentation that I had finished during the train ride. Everything went well. I felt - and was indeed - low at lunch, 2.2 (40), probably because I had lunch a little later than usual and having had a busy program all morning, without thinking about where the BG might be at. When I got back to work in Odense in the middle of the afternoon, I had a snack, covered by an appropriate small bolus, worked for a couple of hours and then prepared to head home. I did a test before heading home: 8.6 (155) at 4:30 PM, so this should be enough to get me home without any problems. It takes me approximately 30 min to ride home on my bike, today with a little head wind, but not too much. On my way home I noticed that I started yarning. Not because I felt particularly tired, just because I needed to. To me that is a sign of a BG not being where it is supposed to. Usually it is going low, but sometimes high – why does some symptoms have to be ambiguous? Anyway, I got home and because we were due to eat within 30 min, I didn’t got to do a test right away. I just took part in the preparation of our dinner and then tested at 5:45 PM: 2.8 (50). Dropping 5.8 (104) in just 75 min seems a bit drastic, I think, considering that I didn’t have much insulin in the system (last bolus of 0.8 U at 3:00 PM and basal only being 0.3 U/h from 3:00 PM to 6:00 PM). I would just love a break from this!

Sunday, November 12, 2006

Rebound highs

Today we had the first games of the indoor soccer tournament. The first game was at 10:59 AM in a sports hall not too far away from Odense, so we were to depart at 10:00 AM. Because I had a few things I would like to do before taking off towards our meeting point at 9:30 AM, without being too busy, I had set the alarm clock for 8:00 AM.

I didn’t hear the alarm clock. It showed 8:20 AM when I first opened my eyes because Jimmi came into the bedroom to see how I was doing. A morning low :-( I still got around the things that I wanted to do before taking off for soccer, but in addition I got the joy of rebound highs during the rest of the morning. Before the warm up I was 13.6 (245). The pump didn’t think a correction was necessary. I overruled that decision, though, and sent 2 U into the system. When I checked again about 45 minutes and two games later, I was 15.6 (281). Great! The adrenalin from the games combined with the other hormones of a typical rebound swirling around in my body. I took an additional 4 U, because I don’t play too well when I am high either, and we still had 3 games to play. When we had finished our 5 games about an hour later, I was down to 12.4 (223), and it was time for lunch and another aggressive bolus.

Back home a couple of hours later all the insulin finally seemed to take effect, and I had a reading of 3.0 (54), but except from that I have been steady in target since then, enjoying the effect of exercise on the BG-level too.

Next Sunday the second round of indoor games are on. I hope that I will be able to start the day without a low then. There are enough of other challenges for our team this day as we have our team’s end-of-season-/Christmas-party on Saturday night ;-) I am pretty sure that this will cause as least some to suffer a bit from a hangover. Fortunately, we should be 7 people, and as only 4 will be on the field at a time, the ability to make substitutions should be good. We have a few games to revenge ourselves next time as well as repeat the victories we had today :-) The best of our games today, we won 5-1. In all the games I was responsible for guarding our goal, but because of the rules in indoor soccer (each team has to have at least 1 player on the opponents half at all time – unless they are in minority due to a suspension), the goal-keeper usually take part in the attacking play to create a “power play” situation. Therefore, I was on our opponent’s half in the end of this particular game. From the side line I heard one of our substitutes cheering for a goal in the final 10 sec. of the game. I had just passed the ball to one of the others and turned my head to look at the clock, seeing a “4 sec” left of the game. A fraction of a second later I got the ball back again. I made a short, quick move and took a shot towards the goal. The ball hit the net just as the final whistle sounded :-) Our substitutes were thrilled, they told me that they had actually just been joking when they cheered for a final goal 10 sec. before time, because they didn’t really think we would make it. I just told them that I saw no reason to give our opponents any last chances, thus I took the shot as late as possible! It gave us a good laugh, but I guess that we were too high on our performance in this game, because we weren’t quite as focused in the two final games, both of which we lost. We’ll make that up next weekend!

Thursday, November 09, 2006

Power out

Yesterday Jimmi and I were perfectly rested in our sofa, watching soccer on TV – first a cup game between the local heroes, OB (short for Odense Boldklub), and Broendby, and then F.C. Zulu (a soccer team created by the Danish TV station TV2 Zulu, constituting a bunch of guys who have never played soccer, or any other sports for that matter, before being enrolled in this project, where a former top-player has been their coach :-)) and their Spanish equivalents, with the Danish team targeting revenge for our real national team’s loss of a game to Spain at the World Cup back in 1986. Check out some pictures of the Zulu-boys here.

Watching the Zulu-boys play is always amusing, but yesterday the entertainment was abruptly interrupted: At 9:05 PM there was a complete power out in our area! The whole neighborhood was dark, although we didn’t realize that at first. We thought that maybe it was just our own cut-out relay playing tricks with us, but after having groped for a flash light in the dark, we could see this was not the case, so we looked out the window and couldn’t see any lights around our house either. We then had to find some matches and candles – this was actually very cozy :-)

As today apparently is officially D-blog day, you may wonder what this episode has to do with diabetes. Last night, when we were done lighting candles, Jimmi asked: “What do we do now? I want to take a shower and go to bed with a book. Only, I will not have enough light to read by in my bed”. His question made me think about how dependent our daily living and activities are on electrical equipment (TV, computers, powerful light to read and work in, freezers and fridges, etc.). We don’t think much of these facilities until we aren’t able to use them. On the other hand, it is commendable that at least the stuff needed to manage the D on a daily basis (meters, pumps, pens/syringes etc.), if anything, are battery-driven. We do not live in an area where natural calamities may cause power outs and/or other emergency situations very often, thus we have never really thought about having a plan for such situations. We usually have matches and candles (although mostly tea-light candles with a limitted number of burning hours) on stock, but batteries for flash lights and bike lamps are not something we always have in the house, because we primarily use rechargeable batteries for these devices – and once they are flat, they need electricity and a couple of hours to get back to work :-) I don’t even have an emergency kit of supplies and other D-related stuff packed for me to quickly grab if we for some reason or another would have to evacuate our home someday (luckily, I think chances are very slim that this scenario should ever arise). Anyway, I guess I actually ought to have such a kit, regardless.

Power came back on at 9:37 PM yesterday, so it wasn’t that long we were without power. Despite the cozy atmosphere created by the lit candles, I actually appreciated being able to test and treat that bed-time hypoglycemia (2.0 [36]) having sneaked up on me, without having to carry a torch around the kitchen to find the needed snacks in the fridge and cupboards. Although, maybe being a bit inconvenient, a torch-search for food might actually keep one from returning to the cupboards and fridge, over-treating the low? ;-)

Monday, November 06, 2006

".....your result sure embellishes the statistics...."

As I wrote in my last post, I wasn’t sure how my diabetes nurse, Alice, would react to the result of my last HbA1c. I haven’t had time to post about it until now, although my appointment with her was Thursday last week.

The appointment started out with us discussing some things related to the “insulin pump” that the hospital is working together with a company to develop. Alice told me that they had just had another meeting with the company the day before, this time with patients using insulin pens. These patients had, as expected, been far more positive in their evaluation of the product than us pumpers had been. She also had to tell me that the company seemed to have realized that perhaps they ought to work a little bit closer with the caregivers, i.e. the nurses, on some of the dosing issues that had come up during the meetings. One of the representatives had done some calculations the night before the last meeting, and although he couldn’t recall exactly how he reached the results, he was proud to announce that based on his calculations, the typical daily dose of insulin for a type 2 diabetic would be around 15 U! No need to say, the nurses’ reaction to this statement was utter surprise that was not to hide behind a tolerant smile :-) Anyway that is another story; I just think it perfectly illustrates the need for companies working with diabetes remedies to work closely with patients as well as caregivers to obtain the best results.

Proceeding to talk about my management with the pump, we got to HbA1C result. Alice’ reaction to the results just illustrates why you got to love her as a nurse and a person! With a sincere smile upon her face this was her comment to it: “Well, I don’t know how I should reward you, if I ever manage to see a 6.0 on your chart. On the other hand, I must admit that your result sure embellishes the statistics of the A1c of our pumpers!” No hard words, just a smile and this comment along with the “as it is now, I still think we should aim as getting you a bit higher, though”.

I think Alice is the only caregiver I have been seeing through all of my years with the D, who acknowledges the facts that she can say as much as she like, but there is no guarantee that the patients will comply, and that the changes to be made need to be realistic from the patients point of view too. This is also why the conclusion to this appointment was that I would start out cutting 0.05 U of all the basals during the day, so far not touching those in effect during the night, because night time lows do not seem to be an issue. The aim still is to slowly elevate my general BG level just a bit, but at a pace that I am confident with (I do confess not to like seeing numbers above 11.1 (200) in general, many times having a hard time confining my desire to correct it). She understands that, and tries to work with me to find satisfactory solutions. She really is great, and I wish that all of you could be seen by someone like her, when you need to make adjustments that cannot just be made by a few words from the endo in his consultation (no many adjustments can, by the way!).

Tuesday, October 31, 2006

5.3

The last HbA1c I had before starting on the pump was 5.8 % (Nov. 14 2005). In April this year, when I started pumping, the aim of my diabetes nurse and I was to try to increase this just a little (to 6.0 %) to see if this would also eliminate some of the nasty lows that had experienced. While these nasty lows were not that numerous after the switch to Lantus 3 years ago, they would occasionally show their ugly face, usually leading to a trip to the ER or a visit from the paramedics in our home, so I sure would like to get rid of those.

As described in previous posts, the switch to the pump still has to prove its worth in relation to lows. Because of that I wasn't too surprised to see a slight decrease in my HbA1c at my endo appointment in the end of June, almost 3 month after pump start. At that time it was 5.7 %, which would be great if it wasn't because of all the lows it included.

Last week I mailed another sample for HbA1c-analysis. Sunday evening I went into my web health portal to see if the result was back yet. It was. I have an appointment with my diabetes nurse this Thursday, and I am looking forward to see her reaction to the result. 5.3 % it said, which is the lowest it has been since I moved to Odense in the beginning of 2001.
My HbA1c results the past 2 years

Before that I had results as low as 5.1 %, which at that time was more a concern to my doctors than to me, because I didn't had that many low, and certainly not as many requiring assistance in their treatments as I have had afterwards, even with higher A1c's.


I will have to admit that the perfectionist inside me most certainly aims for an A1c that is normal, i.e. in non-diabetic range (4.6-6.4 % as far as I remember from patophysiology classes). Not at any costs though. The current 5.3 % result, while in this range, stores too many low lows. I cannot remember ever having tested, or even being able to test, at 1.1 (20) or lower (my meter just reads LO for values of 1.1 and below) in all the years I was on MDI. I have already lost count on the number of times this has happened while on the pump, but it is at least a handful of times. Of course these lows are somehow outweighed by the highs that has also been present, especially after soccer games, but that just shows that the BG-curve has not leveled out as much as anticipated. Hopefully this will happen with time, but it is a bit difficult to be patient, when you were promised results, potentially within 3 months.


It may sound like I am all negative about the pump and the promises that comes with it. That is not the case. I certainly see advantages with this therapy as well. I am probably just, still, a bit frustrated by the fact that I cannot seem to get a hold of things with CSII, and that it regularly causes issues that are not only troublesome but also scaring at times. I hope that my next A1c will be as great as this one, only without the hypoglycemic backside of the result :-)

Sunday, October 29, 2006

Winter is coming

The past night we changed from summer time to winter time. While it is lovely to have your weekend extended by 1h – especially when you have attended a party (soccer season winding-up party) on Saturday night – and I am looking forward to be able to go to work in daylight, at least for a couple of weeks, it is getting darker and colder outside. Winter is coming. The weather forecast for the week to come had sleet in it. Like the roads and bike tracks aren’t slippery enough as they are now with all the wet, fallen leaves lying around!

I don’t know about you, but for me there has always been a good correlation between required insulin doses and season of the year. I tend to need more insulin during the winter months, probably because I am not as active as in summer. I still ride my bike to work every day during the winter, and this year I have also, besides the weekly indoor soccer practise, resumed swimming again, so it is not like I am totally inactive. Still, compared to the summer, where I usually have two soccer practises, 1 game, and extra bike rides “for fun” on the program, winter does not entail as much physical activity. When on MDI I would usually have to increase my Actrapid (Regular) doses by a couple of units with each meal, the Lantus dose in general staying the same.

The past night we changed from summer time to winter time. While it is lovely to have your weekend extended by 1h – especially when you have attended a party (soccer season winding-up party) on Saturday night – and I am looking forward to be able to go to work in daylight, at least for a couple of weeks, it is getting darker and colder outside. Winter is coming. The weather forecast for the week to come had sleet in it. Like the roads and bike tracks aren’t slippery enough as they are now with all the wet, fallen leaves lying around!

I don’t know about you, but for me there has always been a good correlation between required insulin doses and season of the year. I tend to need more insulin during the winter months, probably because I am not as active as in summer. I still ride my bike to work every day during the winter, and this year I have also, besides the weekly indoor soccer practise, resumed swimming again, so it is not like I am totally inactive. Still, compared to the summer, where I usually have two soccer practises, 1 game, and extra bike rides “for fun” on the program, winter does not entail as much physical activity. When on MDI I would usually have to increase my Actrapid (Regular) doses by a couple of units with each meal, the Lantus dose in general staying the same.

Approaching the first winter with the pump, I am looking forward to see, whether the tendencies noticed on MDI do also apply to CSII, or if that is just another set of experiences that I can forget all about in relation to diabetes management. Starting on the pump was like starting from base once again. Of course, some of the experiences that I had build through 16+ years of diabetes would still apply, but the vast majority of them had to be modified.

Resuming swimming has been a challenge. I have about 18 years of swimming experience, 12 of these with diabetes, but the last 3 or 4 years I haven’t really made it to the swimming facilities. This winter I have decided to give it another try, though. I work on the University, and students as well as staff are allowed to use its swimming facilities for free at hours when no teaching takes place there. For the staff, Mon-Fri from 7:00-8:00 AM and Fridays between 12:00 and 1:00 PM are available. The morning hours are a no-go for me. When it is dark outside, I cannot get myself out of bed before absolutely necessary, and as I have a 30 minutes bike ride to reach the University, I would have leave home at 6:30 AM or something like that to take advantage of the morning swimming hours. The hour on Friday noon is not ideal either, but I am working at getting into a routine that allows it. So far (3 attempts) I haven’t had too much success. I thought I could use the same strategy that I used for soccer practise in the spring: I would have a small snack, accompanied by a small bolus (<>r at 12:35). Hmm, another indication that I was low. I did not expect to see the number I did on the meter, though. Sure I felt the weakness you do when you are low, but other than that I didn’t feel too impeded by it. Until I saw the number, that is! 1.6 (29)! Damn, grab glucose tabs and M&M’s in my back and start chewing. Slowly made the 700 m walk back to my office, cursing and wondering whether I should make a stop at the canteen. I decided not to stop at the canteen - my hypoglycaemic brain couldn’t handle that challenge - and headed straight to my office and my lunch box and sugary cola. It took me a good 45 minutes to get back to my normal self. Why does it have to be so difficult to succeed? With 3 failed attempts, I am now considering not to do the extra snack-bolus thing before swimming. My guess is that it may prevent me from going low, but is also likely to leave my above 11 (200) when I finish, and that is really not in my interest either, as by that time I am usually hungry because I will normally have lunch around 12:00-12:30 PM. Maybe this is just another one of the choices between cholera and the plague that diabetes offers you?

Tuesday, October 24, 2006

Up front on diabetes research and development

A couple of weeks ago I got a call from my diabetes nurse. She told me that the hospital had started an innovative collaboration with a private company. The “aim” of this collaboration was to develop a sort of a “single use pump”, a device to be put onto the skin to deliver insulin for 3 days, after which it should be replaced. The company was not really into diabetes and insulin treatment, and thus they would like to discuss the features and possibilities of this device with patients and caretakers. Therefore the company had asked the hospital to arrange for a meeting with a host of diabetics, half being pen-users and half being pumpers. If I was interested, I was invited to participate in this meeting. I thought that sounded interesting, and figured that I would be able to make arrangements in order to leave work a little earlier on the day of the meeting, so I accepted the invitation. “Great, you will receive a letter from H (chief physician on the endocrinology ward of the hospital, and apparently consultant for the company on this project) with more information about the meeting”.

The letter informed us that apart from us as patients, the three diabetes nurses that are involved in pumping and H himself would participate in the meeting. Apparently the company, in collaboration with the hospital, had developed a new insulin pump that would go into clinical trials at the hospital next year. As the company was new on this field, without much experience with insulin treatment, they would like diabetics to advise them about views on pumps in general, as well as evaluate their prototype regarding the idea behind the concept, the design, and other wishes or needs in connection to pump treatment. They would want to present the prototype and get a patient to try it. That sure sounded interesting!

Yesterday was the day for the meeting. This was the first meeting in Odense that the company and hospital would host. We were 8 diabetics on pumps, the three nurses, H – attending another meeting simultaneously, and two representatives from the company. H opened the meeting by welcoming the company representatives and us, describing us as part of the elite of diabetics, people who were on top of their diabetes management (nice to know :-) although I am not sure how much insight he actually has on this, as I don’t think that he is a consulting doctor anymore). By the company representatives request we introduced ourselves to them and each other, on camera because they needed to be able to take our opinion back to their engineers. It turned out I was among people, who had been diabetics for as long as 50 years! A few had lived with this disease for 35+ years, one of them having had a pump for more than 20 years (several different types along the way).

When the representatives presented this new “single use insulin pump” to us, they soon learned that some parts of the concept/design was not ideal. We also had to turn our minds into not seeing this new product as an insulin pump in line with the pumps that we use, but rather sort of an insulin pen based infusion-device. It is an oval-shaped, wireless, plastic device with an electronic part that is reused when the “pump” is replaced. It is filled with insulin from an ordinary insulin pen – a very smart feature in my opinion. On its backside it is covered with an adhesive, and to insert the devise, you attach it to your skin, pres a button to introduce the needle into your skin, and remove said button, so that you are left with only this 7.5 x 5 cm (2.95 x 1.97 inches) and about 0.7 cm (0.3 inches) thick oval shaped devise. 20 minutes after insertion the “pump” will start infusion of insulin at a pre-set basal rate. A button on the devise allows you to administer boluses, each press on the button will release 1 U of insulin. The “pump” will continue working until empty, or about 3 days, at which time it will alarm you by vibrations, sound and light, to make you replace it. As you might have guessed by now, said presentation (of which I have only reported the most essential parts) led to quite a few points of criticism and comments. The devise did not enable you to change the basal rate, nor did it allow administration of “odd” numbers of units for boluses. This of course should be seen in the light of the target group of patients for this devise: Diabetics currently on a pen regimen, who may not yet be fit to take the full step into pumping, or who attends a hospital without the economic potential to pay for a pump (in DK, pumps and pumping supplies are financed by the hospital treating the patient) – this devise is supposedly cheaper than regular pumps although, of course, more expensive than traditional pen-treatment, and otherwise might benefit from a “near-pumping” regimen.

I tried the prototype on, without a needle in it, and it was actually surprisingly comfortable to wear, despite its size. I would like to show you a picture of it, but I will refrain from that as I am not sure whether the company has otherwise gone public with their new concept yet – and I wouldn’t want to give their idea away now, would I :-) We all filled a questionnaire about our own way of treating our D as well as our thoughts about the new devise, its advantages and limitations. The company representatives expressed that they had greatly benefited from the meeting, being a bit surprised about our main point of criticism (the lack of the possibility to change the basal rate as needed), and they would take our response into consideration in the ongoing development of the devise.

H returned to close the meeting by handing us another questionnaire, this one being related to his own project on developing a sensor to alarm diabetics about hypoglycaemia – also an interesting project indeed. The nurses handed out envelopes containing a tube to sample blood for an HbA1C and a question about our quality of life before and after the pump. This is for their continual specification on the regulation of pump users. Thus, this was an afternoon of multiple questionnaires as well as a demonstration that the hospital, and especially H, is up front in research and development when it comes to diabetes :-)

Monday, October 16, 2006

Damn diabetes

I guess the title of this post eloquently expresses what I, along with all other members of the OC, feel about this disease from time to time! My need to express myself in this way now emanates from its interference with my plans and performance this weekend.

I hate when an out-of-range BG-reading requires me to change or postpone my plans! Yesterday we had the final game of the fall season. It was a morning game starting at 10 o’clock (very wet grass and temperatures slowly creeping up from 5 degrees Celsius – something like 41 degrees Fahrenheit – but actually it wasn’t that bad playing in shorts!). My fasting BG at 7:45 AM was a little higher than I like it to be: 9.9 (178). I didn’t correct for that though, as I knew I had a hard game coming up. However, when I tested 1.5 h later, getting ready to go out to the field to start the warm-up, I had dropped to 2.9 (52). I changed the temp basal rate from 60 % to 0 % for 90 minutes, while I chewed down glucose tabs and banana. Out on the field we got the line-up. I was to start as left defender. Certainly not a favorite position for me, but to the long line of injuries, especially among our regular defenders, our coach apparently saw no other option than to place me there. So, I started warming up, not feeling too fit due to the low start, but hoping that it would improve before the game started. It didn’t. My legs felt more and more heavy, my passes were generally off, and 10 minutes before game start I capitulated and found my meter again: 2.4 (43). Not good! There was no way I would be able to get it up to 6.0 (108), where I like to be during soccer, before the game started :-( Our coach changed the line-up and I sat down, exhausted and pissed at the D, finding more glucose tabs, juice and m├╝slibars to elevate the BG, while wondering what the hell had happened to my solid breakfast that should definitely have had time to take its effects before I left the house 5 minutes before our time of meeting prior to the game (it was a home game, being played just across the street where I live, so there are only about 1.3 km [0.8 miles] from my front door the locker room where we meet before games). About a quarter of an hour into the match, after having consumed an additional 40 grams of CHO or so, I was slowly climbing to 3.2 (58). By the end of the first half I could start my warm-up for the second time that morning, so that I could replace one of our wings at the break.

The damn diabetes precluded me from playing a full match of soccer! More than anything, I hate when diabetes prevents me from doing things that I like to do, e.g. play soccer. Also it is frustrating that hypos or hypers occurring before or during a game affects your performance negatively. I ended yesterdays game on a fair 8.0 (144) at 12 o’clock, but I sure didn’t play the best I could. By the way we lost the game 2-1 despite having had our opponents very well matched during most of the game :-( I got myself a strained inner ligament in my left ankle, but because it was only minutes after I had finally made my entrance to the game, I continued playing and the pain went away, but as you may guess it returned once the joint cooled down after the game. Today it is sore, but there has hardly been any swelling, and I can move around although it hurts like hell if I have been sitting too long ;-)

I guess the winter break for soccer has come on an appropriate time point. The current situation for our team is 5 knee injuries, 1 hand injury (soccer induced!) and then at least a handful of “minor” injuries of fibers in thighs, groin issues, inflamed toes and strained ligaments. That is actually a whole team out with injuries - we are a poor crowd! Anyway we don’t start practicing indoor until next week, so my ankle has a couple of weeks to recover – hopefully :-) Hopefully the D will not interfere as much with my performance in the indoor games either!

Friday, October 13, 2006

Reflection

The soccer season is coming to an end. We play the final game this Sunday. If we win, we end third and collect a cash prize to make our ending-party even better :-) Approaching the end of the out door soccer year makes me reflect upon the seasons (spring and fall) as a whole.

I entered a new club in the spring and felt welcome there from the first minute. A couple of team mates from my former club are in this new club too, and that made the transfer a bit easier – at least I only had to learn about 20 new names in stead of 22 ;-) I am proud of the fact that I fairly quickly entered the team for the games, having only missed 4 games or so (of 20) over the two seasons in total, and three of these were due to me having other appointments on game days. Given that we are more than 20 players, occasionally our coach have had to drop players, so being picked for the team on those occasion feels extra good.

This year was also my first of combining CSII management of my diabetes with soccer. Before that I had about 15 years of experience in handling insulin dosing with injections around practise and games. I was comfortable with that, and although it did not always work out quite as would have liked it too, it usually did not cause too many problems. Exchanging Insulatard for Lantus as my basal insulin three years ago didn’t cause any changes around soccer, other than making it a bit easier to manage in some situations. Starting pumping back in April this year, however, is another story! I felt quite helpless not really knowing how to handle things around soccer. This of course was due to lack of experience, but also because I knew the theory behind pumping, the pharmacokinetics of NovoLog that I was now totally dependent upon and needed to learn my response to, and not least the fact that I did not feel like wearing the pump while playing soccer. Practise quickly turned out not to pose any problems, as my theory about giving a small bolus along with a snack about an hour before starting practise worked very nicely, without causing too many lows during practise or highs post practise. Games turned out to be a tough challenge, though. It was, and actually still is, not at all an easy task to make things work without too large fluctuations in BG levels, and I have expressed my frustration about this several times on this blog. In the summer break my diabetes nurse and I agreed that I should try to wear the pump while playing. That prompted finding a way to wear the pump in order to protect it against the hits of close encounters with the field, ball and other players that occurs in the heat of competition, without affecting my free movability. After a few unsuccessful attempts, the sports pack entered the scene and solved the problem in an acceptable way. I must admit, though, that I would still prefer to play without wearing this. Anyway, the next challenge was to find out how to regulate basals around games. This challenge has yet to be solved completely. For the first game of the fall season I was able to wear the Guardian RT sensor, which provided me with very useful information about BG trends during games, and gave me some ideas on how to fit the basals to counteract large fluctuations. Still, theory and actual occurrences are not always the same. I have only had a few successful game days BG-wise in the current season, and it bothers me because even though I may not see the high BG until after the game, being too high or too low surely affects my performance. The issue have mostly been high BG’s, especially towards the end of the game and immediately after. I am annoyed by the fact that I still haven’t been able to figure out how to avoid the spikes towards the end and immediately after games, without having to battle low blood sugars during warm-up and the first part of the games. It is not that I had perfect sugars for games when I was doing MDIs, but the post-game highs never really went above 13.0 (234), whereas with the pump 15-18.0 (270-324) are the typical results. An example of this is from one of the games this fall. I played most of the game, being replaced about 15 minutes before the end of the game. At that time I tested and got a perfect 6.3 (113). Knowing that it was likely to rise, but also wanting to risk going low, I entered a small bolus, 0.8 U (1U will usually drop me 2.7-3.0 mmol/l [49-54 points]). The game ended, we did a short evaluation of it and then headed for the showers and victory beers. Out of the shower, I did a quick test just to be sure I wasn’t too low. About 45 minutes after the perfect 6.3 (113) and 0.8 U bolus, I was at….. 15.7 (283)! Where did that come from? I had not had anything to eat or drink other than lots of water, and the result had me turn down the beer offer outside the locker room, as I did not want to make it even harder to get back into range again.

The series of examples of severe BG changes in relation to soccer while being on the pump is already long. Why is it that I can start out with a 4.7 (85), just a little lower than I would like, thus eating a couple of glucose tabs and a small banana, and then two hours later, after a full warm-up and only 15 minutes break during the 90 minutes game, landing at 16.8 (302)? I just don’t get it!

Anyway, now the indoor soccer season is coming up, and I look forward to that. Not only because I like the technical aspect of indoor soccer, but I also anticipate that it will be somewhat easier to manage BG-levels for this, as the games usually are no more than 7-15 minutes each. Thus, disconnecting for games should not be an issue, and as for practise I may wear the pump or disconnect by the same procedure as I used for outdoor practise back in spring. Time will tell which it will be :-)