Pump issues

As mentioned in one of my previous posts, I have agreed to try an insulin pump for 3 month. My diabetes nurse has tried for years to convince me about this, but it was a combination of several things that finally made me say, "okay, let get it over with then":

1. my boyfriend suddenly turned around, thinking it would be a good idea - so now the pressure was on me from several directions!
   
2. the fact that maybe, if pump therapy should really improve my daily regulation, now would be a good time to test that in order to finally be able to convince my boyfriend that going to Denver to do a Ph.D should not make him worry, if I deside to do that, even if he does not feel like going with me
3. I am going to a conference in Prague in the beginning of May, and this would enable me to test and compare the challenges of travelling with a pump vs. pens

The reasons why I have been reluctant to try the pump were not that I could not see some advantages and posibilities of this sort of therapy, but mainly the fact that I could also see some disadvantages and difficulties of it, which didn't really excite me. A few of the latter mentioned have turned out to just be prejustices, now that have been pumping for almost 3 weeks. However, yesterday reinforced another of my pump prejustices: The one about the need to test frequently and ALWAYS have a back-up plan at hand. Yesterday started out okay. I was 7.8 (140) before breakfast, and I used the bolus wizard to estimate the breakfast bolus of 5.6 U. Because I have not come to trust this wizard function completely yet, and because I had a suspicion about being too high later that morning, I tested again about 2.5 h after breakfast: 17.1 (308)! WTF!!??? Although I suspected that I was high, I did not imagine I would be that high. While evaluating posible reasons for this, I took a correction. I inspected the site, wondering that it looked a bit moist, but maybe that was because I had been sweating a bit on my bike ride to the university earlier that morning. When the pump had given the correction I inspected the site again, though, and I wasn't pleased with what I saw! Now it was clearly wet and the smell of it let no doubt that the site was somehow leaking! Great, just one of my precausions about pump therapy had been confirmed. I did not have another infusion site at my desk, but fortunately the pen that I used to use beforehand was still in its place, so I turned to that instead. However, I had no idea how much, or how little insulin had actually been delivered by the pump, so I would have to guess on the correction and the bolus for lunch later. That went fairly well, though, despite going low before lunch (3.0 [54]). The rest of the day I debated with myself about whether to insert a new site when I got home, just prior to leaving again for soccer practise, or just leave the pump off until this morning. I was seriously tempted to do the latter, but I ended up inserting a new site when I got home anyway, and fortunately it seems to work as it is supposed to (*7-9-13*). I can't help wondering about how sane it actually is to miss injections!! You woundn't think that would be a posibility, having cursed the inconvenience of them on and off during the last 16 years ;-) Still, the experience confirms that the pharmacy that you have to bring along when on the run will be even more voluminous when using a pump, and I must admit that I think that I will rather carry the pens along with me than having to carry extra infusion sites, syringes, insulin bottles and so on. After all the pens easily fit in a pocket or a bag, while the pump supplies will require cargo pants with multiple large pocket or a bag with a compartment dedicated to the supplies to cover prospective issues of insulin delivery :-)

Copenhagen trip

Monday I went to Copenhagen. At a career fair at the university a couple of month ago, I took part in a competition at the stand of my labor union - and I won! The prize was a 2 h appointment with a career/competence counselor. This appointment took place at the union's headquarter in Copenhagen on Monday. I didn't really knew what to expect from it, but it was quite interesting. I had talked to the counselor on the phone prior to our appointment because he would like a test as starting point for our conversation. So I took this test akin to those that some employers use at interviews with new possible candidates for a job. This was done on the Internet, and the counselor had then printed the result which we could then discus. Although I find that most of these tests generally want you to choose between cholera and the plague, I could actually recognize myself and my way of being in the test result, so I guess that was good. I tried another test like that on a job portal on the Net a while ago, and the result of that implied that I was the same type of person as Charles Darwin, Albert Einstein and Marie Curie, and thus would fit well in a job in science. The test of the union also showed that I have some personal qualifications that almost only fits with what is wanted for scientists :-) This actually please my, because I would really want to be a scientist!

Because I do not go to Copenhagen very often (I don't really like moving around in the centre of Copenhagen with all the noise and traffic), I had made sure that I would be able to meet with my best friend, who have been living overthere for almost 7 or 8 years now. We went out for lunch and spend about 4 h together until we had to split up for her to catch an appointment with her chiropractor, and me to catch a train back to Odense. We both agreed that we ought to meet more often than we do, usually we only mail each other or talk on the phone for hours, but it is certainly more enjoyable to meet! We got to now each other on the hospital of Holbaek more than 16 years ago. A the time of her diagnosis of Addison's disease and mine of diabetes. Ever since we have kept contact, frequently discussing the inability of some doctors and other health personnel to understand such chronic ailments at the level of the patient, you now, the fact that theory and practice does not always match as perfect as most doctors seem to believe.

What a week!

This week I haven't had time to up-date my blog or to read other blogs. Tuesday I had a meeting with the guy whom I though was my employer to be. The meeting went well, and we both expected that I could start up on May 1. However, it turned out that the agreement on jobs with wage subsidy should be approved not only by the employer and the employment exhange agency, but also by the head of department and the trade union representative. The head of department was pleased with the agreement, but the trade union representative was not. He would not support this kind of underpayment of highly qualified young workers as he said. If I could be employed as a research assistant on regular terms and conditions, he would support it, but he would generally - because apparently it was the policy of the faculty - not accept jobs with wage subsidy unless the applicant had been unemployed for a long time due to missing qualifications. I can see the situation from his point of view, but I don't think that he quite understands how it works in the scientific community. There is just not an unlimited amount of money to be spend on hiring new people, and when there are money for hiring then the leaders will usually look around in their own group of students or research assistants before taking in one from the outside. I know of at least a hand full of people who would not be in a Ph.D-position in the groups where they are not, if it had not been for the wage subsidy offer. One of my supervisors from my Master's, Ole, was quite baffled about the attitude of the trade union representative too. Although the trade union representative's position on the issue meant that Ole would then have me as a candidate for two part-time positions as research assistant that two of his collaborators would want to pay for, he still felt an urgent need to react upon it - and I think that he will do just that very strongly! The conclusion for me now is that I am still unemployed, although Ole may be able to hire me again if his collaborators agree to it. Thus, I still have to look out for new possible jobs while finishing the paper that I need to write for us to publish some important results from my Master thesis, and the poster that I am to present on a big conference in Prague in the beginning of May. To make situation even more comical complete, I have actually been assigned a Young Investigator Award for the abstract behind my poster, which I will collect at the conference in Prague! How can you be about to publish something, be awarded with a Young Investigator Award and still have such difficulties in getting a permanent job and preferably a Ph.D-position?

This week I also had an appointment with on of the diabetes nurses out on the hospital to evaluate my first two weeks of pumping. The appointment was mainly focused on approving the changes I had made myself in the basal rates and the settings of the bolus wizard. I guess I must be a pain in the ass to some doctors and nurses because I tend to react when I am not satisfied with the regimen, and I hardly ever consult with the team until afterwards, but I am almost always correct in the changes that I make, so I can't help it. This time the nurse asked me if I had calculated the new carb-to-insulin ratio and insulin sensitivity that I had entered into the pump after being very unsuccessful in using the original settings that the nurses had calculated when I started on the pump. I had not, because do not know how they usually do that, but when she sat down to do the math, it turned out that my perceptions about these numbers were pretty darn close to her results - actually the variations were confined to decimal points! I am still not completely satisfied with pump therapy, but it is not fair to conclude anything based on only 2 weeks, so I will continue trying to get a grip on it. I am to do a series of evening-to-lunch fasts before my next appointment in 1½ weeks, something that I find quite hard partly because I cannot go back to sleep immediately after having been awake to measure at 3 AM and thus will be cranky if I have to get up early the next morning, but also because I am usually very active on a daily basis so I am hungry. I am half way through the 4 of these fasts that I need to do, but I certainly look forward to get them over with. Next Friday I also have an appointment with the dietician - actually the first appointment that I have had with a dietician since diagnosis, so maybe it is about time. I hope that she can help me with this new thing of counting carbs - carb counting is not mandatory in the general Danish way of diabetes treatment, only for those 0.5 % of the Danish diabetics who are in pump therapy it should be. We will see how it goes. I will try to post a bit more frequently in the week to come, but I dare not to make any promises about that ;-)

Hard work of Easter

Why is it that holidays are such "hard work"? You have to catch up on everything that you miss on working days, including family visits. It sometimes feels like you end up being more busy in the holidays than on working days. Thursday Jimmi and I went to see his mother. Jimmi's sister and her boyfriend as well as Jimmi's grandfather was there too. Jimmi's mother always make sure that nobody will leave the table hungry - i.e. she cook for a whole army despite only expecting 6 people for dinner! It is very enjoyable, though, although you are so full when you leave :-) We left quite early to drive Jimmi's grandfather to his house. He has been sick for nearly a year now, also loosing his wife in the middle of his illness, so he is dependent on in-home help on a daily basis, which means that he has to be in a certain times of the day, limiting his ability to go out for social events. I had to get up early on Friday, so I didn't really care that we had to leave early. I had the first soccer game of the spring season in my new club Friday morning, and as it was an away match we had to leave from the city center at 8.15 AM - about the time I would usually think about getting out of bed on weekends! I was quite excited about the game, mostly because I hadn't played one since October last year, but also because it would mean yet another new experience on how to handle thing with the pump, when I will not wear it on the field. I started as a substitute, so I could keep it on until the beginning of the second half of the match. It went quite well - no surprise as the pump was actually not even off as long as it has been during practice, so I still have no idea on how it will work when I am first choice as I would then take off the pump before warm-up and actually be off it for 1 h 30 min after that - a total of about 2 h.

Yesterday we had my sister, my parent, my grandparents and Jimmi's father, stepmother and younger brother over for Easter-lunch. It was a long day, but very nice indeed. It was actually the first time that my grandparent came to visit us. My sister and I moved to Funen more than 5 years ago, and ever since my grandma has wanted to get to see how we lived. It shouldn't be that difficult, because my father's youngest brother and his family lives in Southern Jutland and my grandparents go to visit them on a regular basis. Usually my father's older brother will drive them, which mean that they actually go right by Odense and should be able to take a quick turn off the highway for a short brake, but this have never happened, so yesterday my parents brought my grandparents here. My dad took them for a ride around Odense for a sight-seeing of the places where Maiken (my sister) and I have lived/are living and working before they arrived at Jimmi's and my place. They were very happy about it :-)

Today it is time to relax a bit. I haven't had time to read my newspaper the last couple of days, so I will sit down with them today. The weather is quite nice today too, so I will probably also want to go out for a bike ride to burn some of all the calories of the last days' Easter-lunches :-) In the afternoon, Jimmi and I have tickets for Circus Dannebrog. That should be nice too.

Plans for the future - part 2

Last week I had interviews with 6 different possible future employers. All of them went well, but three of them were more interesting than the other. I was very difficult to decide which of them to turn down, but I managed to inform all of them about my final decision just before Easter. I have chosen to start as a research assistant in a group out at MBC. This position won the race because the leader of the group, who is a very sympatic guy, offered me my own project to start on. The project would lean agains one of a newly started Ph.D-project, but deal with another protein. In general, I see great opportunities for future research, including a Ph.D-position, in this group. They work with different recognition molecules of the immune defense, some of which are involved in autoimmune disorders. They were actually in need for a person to assist the former mentioned Ph.D-student, because her project involves use of mass spectrometry - in corporation with my supervisor from my Master's in fact - but she did not know much about it. I look forward to start a project in this group, getting more experience in experiments with genetic manipulation and research animals as well as being able to contribute with my knowledge about protein chemistry and mass spectrometry. I haven't given up upon the Ph.D-offer from Denver yet. In fact I see the possibility to combine the project in MBC with that from Denver, thus even enabling mass spectrometry to be part of the thesis, which was not readily an option before :-) Of course I don't know if it will be that way, but anyway I hope to be able to go abroad during my Ph.D - not least to get back on Jimmi for not going along with it in the first place ;-) I love him but I cannot help being a bit disappointed that he hasn't been willing to a least give it a chance and go with me to Denver to look at it before a final decision is made.

Today was the first day of the Easter holidays. This afternoon Jimmi and I took Jimmi's younger brother to the movies for Ice Age 2. That was great fun! Well until the last 5-10 minutes of the movie where I started feeling very tired. I acknowledged this as a symptom of hypoglycemia although I didn't quite see the reason for it with all the popcorn we had consumed during the movie. The movie theatre is located in the central train station of Odense, so before I went for my bike to go home I found a bench to check my bg. 1.8 mmol/l (32 mg/dl)! Ups! Down with 5 glucose tablets and a cracker waiting for it to work before getting on my bike for the 4.5 km ride home - with the wind very much against me! The bg is now back up on a nice 4.7 (85) and I am ready for this evening's Easter get-together at Jimmi's mother's. I am still a bit annoyed about that low, though. A couple of weeks ago my diabetes nurse along with Jimmi managed to talk me into giving the insulin pump a try. The nurse has tried hard to convince me the last 4 years, and it is not that I don't see the advantages of the pump, but I also see some disadvantages, so I am not that fond of it. Last week I was then started on the pump for a 3 month trial. I know that it takes time to adjust the basals and other routines when switching insulin regimen, but seriously, I feel like I have had more hills and valleys of my bg this last week than the last half a year on shots! That is very frustrating, but I have to be strong and go through with this, comforting myself with the fact that if I cannot adjust to this, I can go back to shots in 3 months and my nurse promised that she would then stop mentioning the pump for another year or so. I guess to understand why I talk about this as a trial, I need to inform you a bit about the Danish medical system. Danes, who needs medication, are covered by an "ingenious" grant system. The more medicine you need the less you have to pay yourself, but the system restarts itself once a year making you start all over paying the full price yourself again. Anyway, as for supplies for diabetes, all type 1 diabetics gets their testing supplies, needles, lancettes and so on for free. Most Danish diabetics on insulin use insulin pens to deliver the insulin, and since pens to be used with insulin pen-fills are free, so are the pump - at least for the diabetic. The costs of the pump and all its supplies are covered by the hospital ordering it, so I only have to pay for the insulin in a different form to use the pump. So far I am not convinced that the pump is the ideal solution for me, but maybe I will change my mind once the insulin doses have been adjusted to fit my daily routines.

That's it for now, I am of to the Easter get-together!

Plans for the future?

This is always a difficult question to answer. To understand why I blog about this, I should mention that just finished my Master's last fall so I am in the beginning of my career. I finished with top grade (13 on the Danish scale), which made everybody assume that I would be able to pick and choose between jobs or Ph.D-positions. Sure I was appointed as a research assistant two weeks after my exam, but the position was time-limited - only 3 month. There was a chance that it could be prolonged, but this has not happened due to financial issues. Though of course it was sad to exchange salaries for daily allowance, I can't say that I am sorry that I could not continue with the work, because it was not that inspiring or challenging. When the 3 month was almost out, I got an unexpected mail from a scientist at the Barbara Davis Center for Childhood Diabetes. He is Danish but has been working as assistant professor at UCHSC in Denver. He is the head of a small research group working with developmental biology in the hunt for a cure of type 1 diabetes. He mailed me because he had read a popular paper for which I was awarded the Herbert Price 2005 of the Faculty of Natural sciences, University of Southern Denmark (SDU), and wanted to give me some credit for it. At the same time he wanted to tell me a bit about the research that he and his group were doing, as it might be of my interest. It was, and so was his open offer to maybe do a Ph.D in his lab. I have been in contact with him on a regular basis the last couple of month. It is a big decision to go the US for 3 years, and my boyfriend certainly does not share my enthusiasm about getting such an offer thrown at you. Jimmi (my boyfriend) is not willing to move nor will he fully accept the possibility that I would go by myself and then follow the courses of the Ph.D program here in Denmark whenever possible. He has changed his mind about it regularly, getting a little bit closer to a compromise, but not enough, and it kind of disappoints me that he cannot support whatever decision I will get to, trying to make things work as smoothly as possible. I do not think he quite realizes how big this opportunity actually is, and how deep impact it will have on my future career to get a Ph.D, and especially one obtained away from Denmark. With this you will have both a Ph.D and experience from living in a foreing country, which is what many employers like to see. It would make it so much easier to get a job in a private company or in the academic society when returning to Denmark. I must admit, I was not so sure about going away for 3 years when I first got the offer, but the more against it Jimmi is, the more I want to make it happen, despite the difficulties it will entail.

It would be easier to say no the offer from USA if I had an equal or even better one from home. I do not at this point, but of course I have been seeking for it. I have applied to several position, but I must admit that it has mostly been because I need to be able to prove that I am actively seeking employment rather than because interest. Last week a friend of mine from the lab told me about the possibility of getting into a research lab or a company by wage subsidy with the possibility to continue in a Ph.D. position afterwards. She did that herself, and I know of a couple of other people who have also used that trick, but I was not aware of the actual offer and the rule about it. We sat down and made a list of more than 20 scientists and companies that might benefit from getting a skilled cand. scient in biomedicine with experience in mass spectrometry into their house at low costs. I mailed all of them Friday, receiving the first answer only 10 minutes later, and over the weekend I got positive feedback from a total of 6 people and companies who would like me to come by for an interview. Thus, the first three days of this week has been very busy with 3 interviews Monday, 2 yesterday and 1 today. 3 of the interviews are of particular interest to me, so now I have to sit down and make a decision on where to place my bet: 3 years in USA, employment as research assistant with open possibilities to obtain fundings for a Ph.D in two different groups at the Medical Biotechnology Center, Odense or in a small private company. It is going to be tough!