Thursday, May 25, 2006

Off to Kos

I don't feel that I have been at home much this month. When I got back from Prague, I was told that I was hired for two projects in the lab, so I just started a one year full-time position. However, tomorrow, Jimmi and I will be leaving for Kos, a small Greak island for a one week holiday :-)

I am looking forward to a holiday. The weather down there is hot and sunny at the moment with temperatures cruising around 30 degrees Celcius. I wonder how this will impact the insulin in the pump, since I probably will not wear too much close to cover it... I have brought my insulin pens too, though, so if it doesn't work with the pump, then I can just go back to MDI.

I will be back in the beginning of June - with a nice tan :-)

Monday, May 22, 2006

BG's to piss me off

While the week in Prague generally went very well BG-wise, this last week has been a struggle of keeping a steady, and not too low level through the day. I have had too many values below 70, but even when such a value occur before a soccer game, and is treated accordingly, I have not solved the problem about high BG's afterwards. I find it incredible annoying, not to be able to keep it in range even when it's fine after the game. Mostly, I will be a little high afterwards, probably due to being disconnected for more than 1 ½ hour. For instance, we had a game in the weekend. I was low (2.9 [52]) before going out, so I had a four glucose tabs and a dried fruit snack to cover that (it was only about 1 ½ hour after lunch, so the bolus for that was still active in my system). After thoroughgh warm-up, I got the first half (45 min) of the game on the field. When being substituted at half, I reconnected and watched the rest of the game from the side - with the rain soaking us and temperatures around 12 C with a good wind to make sure we would cool down quickly! After the game I tested 12.3 (221), which I did not really get, but anyway, I took 6 units - something that would normally drop me almost 18 mmol (320), but when I retested before dinner an hour later I was up to 14.6 (263). Grrr! Why?? Being quite angry with this apparent "insuliresistancecsyndromeom-following soccer-games", I bolused 9 units for the dinner, which of course send me down in the 4 (70)-range later in the evening, but it appeared to work because I went to bed with a BG of 5.5 mmol/l (99) and woke up at 7.2 (130). Anyway, I have tried different alternatives to deal with the usually higher BG's after a game (I have managed to land at 6.3 (113) after a game, only to sky-rocket to more than 17 (306) only a couple of hours later), but so far it hasn't really worked satisfactory. I must admit that I am a bit puzzled about it, becauspracticese (1 ½ h) is usually no problem at all. Because of this I don't really think that it is just a matter of hormones (adrenaline) with the games. I have tried using Lantus like in the un-tethered regimen, but that did not really do the trick, so now I am actually considering involving Actrapid (Regular) before games, because I am used to handle that, but it does annoy me to have to grope through the darkness in order to find a stable solution, not to mention the reluctance of my diabetes nurse to the fact of involving other types of insulin than the NovoRapid given by the pump. So any ideas, comments or experiences on how to deal with sports when disconnecting, would be highly appreciated.

Thursday, May 18, 2006

Tour de Prague

Walk on Charles Bridge in daylight

The trip to Prague was not all business. We did have time to enjoy the beautiful city. Wednesday we spend the whole day sightseeing. We started out heading for Charles Bridge (Karlov Most in Czech), to see it by daylight. On our way, we encountered an exhibition of sculptures in one of the city squares (see pictures).

Me at a sculpture outside a historical building

Some of the sculptures of one of Pragues squares

Charles Bridge and its surroundinggs are totally different in daylight. The bridge is crowded with tourist, street vendors, and beggars. We crossed the bridge to go to the other part of town with the castle and president palace. It took a lot of steps to get up to the castle, and at the top we stopped at a stand with a sign encouraging people to contribute to a project that should give mentally ill people of Prague better homes than the hospital they are currently staying at. For 100 Czech koruna (equals approximately 25 Danish kroner or 4 dollars), you would by a clay brick that would be used for the chimney or stone tracks at the building. We bought 2 bricks, decorating them for others to see that delegates of KMEB, Odense, Denmark contributed to the project ;-)

We visited a couple of churches on our tour, and here we experienced how groups of tourist, sometimes young people, other times older ones, would suddenly arrange themselves in rows with a conductor in front of them and start singing, testing the acoustics of the church. As soon as they finished their great performance they would disassemble as quickly as they assembled in the first place, looking like a group of tourists and not an awesome choir. Amazing!

In afternoon we headed back to our hotels to prepare for the welcoming ceremony of the congress that we were attending. We wanted to put up our posters at that time too, and as the others had posters printed on fabric, these needed to be ironed. My poster was printed on photo paper, and when the other posters had been ironed, we rolled these up around my poster to carry them all in the tube mine was kept in. The welcoming ceremony was about an hour in length, followed by a reception. Having walked a lot that day, all of us could feel our feeds at the reception, but it did not stop us from going out for a late dinner afterwards - only using the metro to get from the congress center to the center of the city, otherwise walking :-). The next day we were gifted with pedometres from one of the companies in the exhibition area of the congress. The company had a competition where delegates wearing the pedometres could come to their stand to show how many steps they had walked in a day, and if enough win a price. Learning this, we couldn't help being a bit annoyed that we had not had these pedometres when we went sightseeing the day before :-)

Tuesday, May 16, 2006

Back again

It has been a while since my last post now, due to the conference that I had to attend in Prague, but this just means that there is so much more to blog about now :-) The last days up to our departure was rather busy with meetings, poster finishing and printing and so on, which is why I didn't get to post anything during those days. We set off for Prague last Tuesday, having to catch a train at 7.30 AM in order to get to the airport in time. We arrived in Prague in sunshine and 23 C, and managed to find the right bus, to take us to the metro to get to the center of the city where our hotels were located. Now, even though the bus departed from the airport carrying many tourists, the information given through its loudspeakers were in Czech, which neither of us had any knowledge about. We knew where we had to get of, but because that was at the end station, and both the information about where the bus was heading as well as the name of the next stop was given through the loudspeakers, we misinterpreted the information and got off to early. Standing at the bus stop, we quickly realized that and luckily the next bus would arrive 10 minutes later, so in the meantime we laughed a bit of ourselves while we "synchronized" our mobile phones, so that if we were to get away from each other later on, we could send an SMS or call. We joked about picking up our boss, Moustapha, and his assistant research professor, Basem, who would arrive the next day, and getting them off the bus at the same stop to "synchronize" their mobile phones as well :-) We didn't do that though.

The whole KMEB delegation at a late dinner Friday. From the left is Jorge, me, Basem, Sijranke, Pernille, Moustapha (our boss), and Moustapha's wife, Mette. Amer is behind the camera.

Standing in the center of Prague with all our luggage, our first quest was to get hold of a city map to help us locate our hotels. We were 5 people, two guys and 3 girls, but we had not managed to get the same hotel for our stay, so the guys would be in one apartment hotel, while Pernille, Sijranke and I would be in another apartment hotel. It took us a while to actually get hold of a map, and still we had to ask for the way to our hotel. Because we were approaching 3 o'clock in the afternoon, not having had lunch yet, we decided to drop the luggage in our hotel, go get some lunch and then find the guys' hotel afterwards. After this late lunch, we went shopping for breakfast the next days (breakfast was not included at any of our hotels, but as both of them were apartment hotels that didn't matter much, because we had kitchens to prepare our own breakfast in), and located the guys' hotel, which turned out not be very far away from our hotel. After getting settled in our hotels we went out to look at the beautiful city of Prague by night.

Sijranke, Amer, Jorge, and Pernille standing on the Charles Bridge of Prague

Me, Jorge, Pernille, and Sijranke at Charles Bridge the first night in Prague

The conference officially started on Wednesday 10 May, but having looked at the program, we decided that clinical lectures that were on, did not really have our interest, so we went sightseeing in Prague the whole day instead - I will tell you about this in another post. We registered at the conference in the evening to attend the welcoming ceremony and reception, though, as well as to put up the posters of our scientific work.

Me at my poster

With this I will end the first part of the "conference in Prague"-tale, stay tuned for the parts to follow :-)

Tuesday, May 02, 2006

Soccer and pumping

The past weekend was pretty busy. Saturday I had an away soccer game in the afternoon, and Sunday we had to go to the confirmation party of Jimmi's cousin. In this program I had to try to fit in at least 1 overnight-to-lunch fast for the nurse to evaluate my basals at the appointment today. I started a fast Friday night, but had to stop for "lunch" at 10 AM, because I started feeling really hungry and thus decided to test: 3.4 mmol/l (61). Despite eating well and cutting back insulin, the low trend continued and I was only 2.7 (48) when I tested before preparing for the game. Grrr...! Well, glucose tablets and my preferred carbohydrate-containing sports drink of orange juice and water 1:1 (I prefer to just drink water when I practice, but when needed I have found this combination of juice and water to be useful) in combination with the fact that I always disconnect when playing soccer did the trick and I landed at a satisfactory 6.4 (115) after the game. I didn't eat anything at that time because dinner was just about an hour away and I didn't want to spoil my appetite for Jimmi's chicken roast ;-) During dinner I started feeling uncomfortable, though. In the beginning just tired which I thought was just due to the game and bike ride, but then a subtle nausea started showing its ugly face. I didn't finish the meal that I had bolused for but hit the sofa instead. As I didn't feel better and also started feeling thirsty, I suspected that the BG was not where it ought to be. Surely not! At 7 PM, just 2 hours after being 6.4 upon more than 2 hours of soccer, I was 17.7 (318) with ketones starting to show up :-( Based on my experience with a leaky tubing earlier that week, I decided to do the correction with a pen, just in case this was a pump and/or tubing issue once again. I had just done the correction and tried to drink some water to quench my growing thirst when my dinner decided it was time to resurface! Why does such things always happen after you bolused/corrected? Needless to say, this meant that my BG's cruised rather low the rest of the evening, but luckily I managed to pull through without help from others. I discussed the episode with the nurse today, as this was exactly one of the precausions that I have had about pump therapy. She couldn't explain what had caused it, and I really have no idea either. I can't say that it couldn't have happened with MDI's, just that I have never in my more than 16 years with this experienced anything like it. It is my general experience that my BG will rise after soccer practice and games if not compensated with insulin, but I have never experienced such discomfort due to a BG that has only been high for a short amount of time. Only with continuous high BGs as at the time of my diagnosis and the end of my honeymoon period, did I feel that unwell.

Apart from the issues mentioned above and in previous posts, I am slowly adjusting to pump therapy. I actually enjoyed being able to go through the 3 course-menu lasting more than 4 hours at the confirmation party without having to either inject several times or risking to bottom out between courses. The next big test for me will be a trip to Prague next week. I am going to a conference on calcified tissues, presenting a poster with some of the results of my Master thesis - details will follow :-) The nurse provided me with a pump certificate today to circumvent problems at the detectors in the airports. They are actually still working on making this certificate more convenient. For now it is just a bunch of papers that can be cut into smaller pieces and fitted into plastic covers about twice the size of a credit card. Most of the pages are in Danish, though, being more like a short guide to the pump user. The language of the certificate written in English is quite poor and not that informative yet, but I guess that it does contain the most important information about the pump being a medical devise that is not to be taken away from me, and a referral to the Endocrinology Unit at the hospital in case of doubts.