Tuesday, November 20, 2007

Tagged for 7

Though I was thinking that I should take advantage of the fact that our little puppy is not at my lap while I'm typing, I wasn't really planning on posting a meme. However, Chrissie tagged me so here I go - I figure I better do it quick, or it will be even more difficult to find people to tag that haven't already been tagged by others :-)

Apparently this meme is about 7 random things about myself with 5 rules to follow doing this:

  1. You've got to link to the blog of the person who tagged you
  2. You need to post these rules on your blog
  3. You have to list seven random and/or weird facts about yourself
  4. By the end of your post you have to tag 7 random people and include links to their posts (do I sense some sort of advertising purpose - i.e. spreading the word of the host of blogs available to dedicated readers and writers - of this meme? ;-))
  5. You have to let the people you tag know that they have been tagged by posting a comment on their blog
Alright, rules set, and now Nemo made a jump into my lap - she seems to have a need to be tugged in - so I better get down to business:
  1. I am not very good at prioritising my time for regular postings on my blog, hence my participation in NaBloPoMo is probably never going to happen :-)
  2. I am now officially a PhD-student at the University of Strathclyde, Glasgow, Scotland - or so it seems, yet I cannot help wondering when new administrative and/or bureaucratic issues concerning this will show up whether from Scotland or from Denmark ;-)
  3. Starting this Monday and 2 weeks ahead, Jimmi and I have no kitchen, which makes storing as well as cooking of decent food a challenge (did anyone say Nemo? :-))
  4. I have a thing with high blood sugars! I don't like seeing high numbers on my meter, which sometimes makes me take actions that will get me into trouble later. I am trying hard to limit myself in this context, but it is hard
  5. Yesterday I experienced my first bad site with a site change. I was a my parents because I had business to do in my hometown, and like I alway do I changed my infusion site in the morning. My fasting BG was 3.1 (56), and breakfast was a little lighter than usually, because I had plans to go visit my grandparents a couple of hours later, probably going to have a little something to eat there. When I got there I tested and found myself at 15.5 (279). I found that quite odd giving the low fasting value and light breakfast, so I did think about a possible bad site. However, I had just been to the dentist, and while I like my dentist very much (that is one of the reasons why I haven't found one here in Odense yet) and usually don't have any dental problems, I have a very hard time coping with the high-frequency spinning noice of her instruments used to remove the tartar. Therefore, I was also considering a possible stress-effect. I corrected the high, both with the pump and a small bolus by pen, just to be on the safe side, yet 90 min. later when I had just boarded the train back to Odense, I clocked in at 20.4 (367). I cannot remember the last time I saw a number like that, but it convinced me that something was not right with the new site. I don't usually remove my old site until I am sure that the new one is working, so I hooked back up to the old site and entered a bolus to "flush" it. I took a larger correction by pen, and by the time I reached Odense I could see that at least I wasn't rising anymore. I was 19.3 (347). After the bike ride home I felt quite exhaused and figured that it was probably the hours of ridiculously high sugars now taking effect, but it turned out that the corrections were now finally working and I was actually going low. Just an hour after being 19.3 I was 68! When I removed the bad infusion set I could see that the catheter was bend at a 90 degrees angel, so no wonder the insulin didn't seem to work!
  6. I tend to have a rather messy workplace, both at home and in the lab. However, I usually know where to find the things I need, and so even if it might seem chaotic to other people, I am on top of it :-)
  7. I need to take Nemo for her late night walk now, so I gotta stop now :-)
I tag Doris, Scott, Adjoa, Super G, Kathy, Sandra, and Aliya. I don't know if any of you have already been tagged, or if you want to take part, so don't feel obliged to do it :-)

Monday, November 12, 2007

The adventures of Nemo

This is just a short up-date to keep you posted on our adventures with Nemo (I still haven't found a way to transfer the pictures from my phone to the computer, and one of our friends has borrowed our digital camera for his awesome trip to some exotic island. Sorry!). Right now Nemo is pushing around behind me in the couch, battling one of Jimmi's socks, and I think that it is about time that I take her out for a walk :-)

Nemo is adjusting well to us and our home, and Jimmi and I are adjusting to her as well. She is very playful, but also very good at obeying our calls, so we have had her leash-free several times already without any problems. She has started to sleep in her basket after being very sad the first couple of nights, forcing Jimmi to get up and tuck her in on the couch (we don't want her in our bed). Now she will usually run around just as we are getting ready for bed, but then, once the ligths are off, she will settle down and go to sleep.

Jimmi is home with her most of the daytime and has taught her to sit on command today - whether it is still coincidental or not, I am not quite sure, but at least it worked when he wanted to show me :-)

We haven't started any specific training with her yet, but are planning on taking her to some puppy courses in the near future. Jimmi was very positive one morning, when I was low - when I'm low while sleeping I tend not to hear the alarm clock - because he was sure that Nemo could feel that something was not quite right. I bet she could, but I think it might just be due to Jimmi's reaction - at least I haven't noticed any change in her behaviour what so ever on times during the day, where I have treated lows myself :-)

On the Scotland front not much have happened since last week. I still haven't seen any money, so I think that if there is still no sign on them in my account tomorrow morning, I will write the lady, who said that the money transferred would be arranged Wednesday last week to hear if "arrange" was just another word for deferring thing further ;-) I think that I have been very patient so far, actually more than should be expected, so I think I am more than entitled to push for answers and not least my salary!

Now Nemo has fallen asleep on my lap, paws resting just besides the computer and her head between my arm and the table - puppies are so damn cute, and like Chrissie said in a comment this is probably the reason we put up with them despite their misbehaviour :-)

Wednesday, November 07, 2007

Found: Nemo

The title of this post is double-sided in references. I finally - or so I thought (see the next paragraph) - was registered at the Scottish university last week as I received the registration to sign as well as information about my e-mail account, user name and password for the different IT services. Nemo is the name of the exchange mail service at the university (the ability to check your university e-mails outside the university network).

Today, another chapter in the seemingly never-ending story of the registration hassle was written - in e-mails I received from my supervisor over there. I'm actually glad that at the time his first mail - a long correspondence between several department and registration employees - I was attending the biweekly group-meeting in our research group here in Odense, otherwise I think that I might have send a couple of upset mails to several of the people involved ;-) Here is what it was all about: We have applied for a fee waiver, which was approved with starting date August 1st this year and ending date July 31st 2010. However, in terms of the finance office at the university, the fee waiver is only valid for the study year 2007-08, i.e. from October 1st this year until June 2008, and so the waiver didn't cover August and September because I have only been registered as a student from October 1st. Sigh!! However, apparently things have now been worked out by them registering me for the 2006/07-session, applying only August and September of the current year. Bureaucracy!! From the last messages that I got today, it seems like they are now finally starting to arrange the transfer of my salary for August and September - October wasn't mentioned, I don't know what to think of that :-/

Back to Nemo. Nemo is the name of our new puppy that we got this weekend :-) On Saturday Jimmi received a call from a guy who had seen his announcement of our search for a puppy on the Internet. The guy had a dog with a litter of 4 puppies that they were looking to sell off. We went out to see them, and of course fell in love with one in particular. When we got home we discussed it a bit, but decided that to be totally sure, we would sleep on it. We decided to get the pup, and Jimmi got his father to take him to the little farm where the dogs lived. I thought it was a bit hasty to go get it on Sunday night, but Jimmi would rather do that than waiting to one of the weekdays where I probably wouldn't be home at the time he would get there with the puppy, and he didn't want to wait a whole week. The poor little puppy was a bit frightened by the car ride in the dark, though; it threw up all over Jimmi :-(

Now it has been a few days with the puppy in the house, and it seems like it is settling down nicely. The first couple of nights Jimmi had to get up to go the couch to sleep with it in his arms because it was crying for company, but last night we could both stay in bed. We don't want the dog to get use to our bed, which is why Jimmi got up to sleep with it on the couch instead. It is allowed to lye on the couch, although it is still not big enough to get up there by itself, even though it tries hard :-) The picture below is our pup, when we went to see it on Saturday. I have some pictures of it in our home, but they are on my mobile phone, and I haven't taken the time to transfer them to the computer yet.

Sunday, October 28, 2007

A perfect day

Is there such a thing in D-life? I don’t know, but looking at the readings at least it sometimes seems so :-) I had such a day Thursday this week. All of my reading were in target, from 4.2 (76) to 6.7 (121). Go me!

Actually this week has been rather good BG-wise. When I look at the pie charts in Kevin’s logsheet that I use for logging, I can see that so far 72% of my readings have been in range and only 5% above. The part of readings below target could be smaller, but at least when looking at those values, only a minor part of them are really low (I must admit, I don’t really regard readings of 3.5-3.9 (63-70) fasting or just before a meal as low, or at least I don’t treat them with anything but the meal that I’m about to have). When I left work Friday afternoon the statistics were even better with 81% of the readings in range and only 3% above, but weekends generally have a tendency to mess things up a bit.

I wish there could be more such days, preferrably weeks! :-)

Today I went for one of my “marathon” bike rides (little more than 43 km (just short of 70 miles), so actually it is longer than a traditional marathon ;-)). My experience tells me that I better do these rides in the morning to have least possible BG-issues. Today, however, the weather was a bit rainy all morning, and I must admit that I prefer to make these rides in dry weather, so I postponed it, hoping for better weather in the afternoon. Around noon it seemed like the rain had subsided, and I decided to go for the ride in the afternoon. I reduced my basal by 50% 1.5 hours before starting, and my BG was 10.3 (185) when I started my ride. The weather was quite windy, which usually is very effective in lowering my BG when I ride my bike. Riding my mountain bike also increases the resistance when riding on paved roads, which I – unfortunately – do most of the way, even though I go off-road every where I possibly can :-) Since I started out at a good level, and also felt quite good riding, I didn’t make a “pit-stop” for testing until half way through my trip. Little more than an hour of MTB-riding had dropped my almost 8 mmol/L down to 2.6 (47)! Although I usually have a little snack midways on my trips, the aim of these rides are NOT to be able to indulge in sugary snacks while riding. Today’s trip however, caused me to ingest a total of 64 g of carbs as the halfway through low, was rather resistant to treatment, and reared its ugly face again halfway through the last half of my trip :-(

This week Jimmi and I went for another visit with the dog that we were going to have. I say “were” because yesterday Jimmi got a txt-message from the owner, who apparently had gotten surprising news about the father of the pups. It seems that the father is actually a Smaller Münsterländer, and as these dogs grows to about 50-60 cm (shoulder height), our pup would likely get a lot bigger than anticipated. Also the owner, who we’ve had long, honest conversations with about our wishes for our coming dog, said that she actually didn’t really like the father dog and didn’t see it as a smart dog, so she could understand if we wanted to back out on this deal. After a lot of information search and talking back and forth, we did decide not to get Trille anyway, even though we were actually now really looking forward to getting her home :’-( However, the prospect of her getting that big (I know it could be a lot worse), doesn’t really fit our settings. If we lived in a bigger house with a bigger garden, then a bigger dog wouldn’t be a problem, but given the fact that we don’t live in that big a house, and our garden/terrace is only the size of our living room, to us doesn’t seem ideal for a dog this size, so now we need to look for a replacement. When you see the picture below, you’ll know that this is not going to be easy :-(

Jimmi with a sleeping Trille in his arms

Trille awake on my lap

Mayby she already knew that she wouldn't come home with us? She does look sad here. Bye Trille, we hope that you find another good home!

On the Scotland front I just heard from my supervisor over there that the German research fund’s money have finally arrived on the right account at the Scottish university, and that the registry office are pushing hard to get the registration through as soon as possible. I am looking forward to see if this will then cause the missing salary from the past three months to enter my account!

Monday, October 22, 2007


I cannot say that patience is one of my strongest assets, though it does somewhat depend on the context (if that was not the case I think I wouldn't be able to work in science ;-)). When it comes to my education and carreer, however, I have been rather impatient to move on ever since I graduated two years ago. I wanted to pursue my wish to optain a PhD-degree sooner rather than later. Thus, I was very annoyed by the fact that no positions seemed to be available within the areas I had the most interest, and when finally one was, I was overlooked by my supervisor because "we do have a meeting coming up about a potential project next month" (this meeting had already been postponed causing me to seek other opportunies) and the newly graduated, who got the position, needed to have employment in order to extent her visa.

Because of this, I wasn't expecting too much w
hen the day of the planned meeting arose back in January. I hoped that the project would be a good one, and that the main supervisor of it would be someone that I could see myself working with. Fortunately, this was the case, and though I had about 5 months left of my contract as a research assistant at the time, my former supervisor, who would also be a co-supervisor of the project, my coming supervisor, and I all agreed to start up the project as soon as possible. There was a lot of formalities and paperwork to be taken care of beforehand, though, so I was actually able to finish my contract before starting on the new project.

Back in the first months after our initial meeting I had several e-mail correspondances with my new supervisor, and among other things asked him about the application for registration at the Scottish university where he would move his research group to by August. At that time I was told that we should wait with that until he had had some more information from his superiours-to-be in Scotland. That seemed reasonable at the time, and also in June when I spend a few weeks at his laboratory in Germany - at the latter time there were still some issues about the transfer of the German research fund's money that should pay my salary in the next couple of years. We also had to search for a fee waiver as there wasn't room for tuition fees in the research fund money pool, and it became clear that this waiver would by no means take effect before October 1st, leaving August and September as a couple of months surrounded by uncertainties. For June and July I was employed by the German research lab, but we could not register me as a PhD-student at the university in Scotland until the fee waiver could take effect. We discussed the possibilities of employing me as something else, e.g. visiting scientist, research assistant or whatever would solve the problem of me continuing to work on my project AND being payed by the German fund's money through the Scottish university. However, no aggreement was settled, and because my supervisor was super busy moving both his own family and the lab in late July and August plus having to get use the different administrative standards, time just went without anything happening.

Thursday last week I finally received the offer letter that I should sign in order to get the registration rolling. It seems that until the registration is settled, the fact that the money that shall pay my salary is German and not Scottish is immaterial because it still needs to go through the university's finance department.
By now it has been almost 3 months since the last salary entered my account. I don't think it is fun anymore :-( I feel sorry for my German supervisor also having to struggle with this, but most of all I feel screwed by the ridiculous bureaucracy that prevent the money in coming my way. I certainly hope - almost expect - some kind of compensation once this issue is finally solved. Until then I'm actually only working for my own sake, keeping myself up on the beet of biotechnology, but keeping my results and struggles with my samples to myself. I will not give anything away for free!

Well, that was a bit of a rant, but I needed that. I will finish this entry somewhat more positively. Jimmi and I have decided to buy a puppy. Jimmi is hoping to be able to somehow train it into recognising my lows by time. The pictures below is "our" new puppy at 4 weeks of age, on the lower picture, mommy-dog gets a lick :-) We get the dog in a couple of weeks, and have yet to decide on a name for her. The owner calls her "Trille", which in Danish means "to roll" or "trundle". I don't really know if I like that name for a dog, so if you have any good ideas, let us know :-)

Monday, October 15, 2007

I'm still here

It has, once again, been quite a while since my last post, but I’m still here!

There have been an awful lot to do the past months, and thus I’ve had to prioritize, and doing that, blogging as well as reading and commenting on other peoples’ blogs didn’t make it into my top 10 to-do list. I’m a bit sad about that actually, because I do enjoy and appreciate the DOC a lot, and I hope that even though I will probably be busy with various things in the future as well, I will still be able to stop by here once in a while :-)

My last entry was a question about hypothyroidism and diabetes, and I guess I better give an up-date on that side, as well as a very belated THANK YOU to everyone who responded to my questions.

The blood samples, of course dare I say, showed TPO-antibodies, along with a TSH-value of 7.43 (as far as I remember). This ensured me yet another appointment with a doc at the hospital. The appointment was rather useless in my opinion, though, but summa summarum the doc wrote me a script for Eltroxin (the Danish version of Syntroid), 50 mg/day and set me up for a follow-up appointment 6 weeks later. The follow-up appointment was almost just as useless, and I was the one having to ask questions in order to find out what the status actually was, and how treatment should continue. I was told to increase the dose to 75 mg/day by taking 2 50 mg pills on even dates and only one on uneven dates (I will not even mention the fact that the pills can actually be split nor that this instruction, if followed literally would actually only work due to the long half-time of this medication, as there are actually several times years when there are two uneven dates following each other ;-)). I was also told that in the future the control of my metabolism would pass to my regular endo. There are a few issues about this, but I will not go into those here. Some of you will know what I’m talking about anyway.

I had an appointment with my endo last week, just short of a month after the follow-up appointment for the metabolism issue, and thus not really ideal for evaluation of the upped Eltroxin-dose. My endo, however, hadn’t even realised that treatment was initiated, though, as he told me, when commenting on my lab-results, that it still wasn’t necessary to start treatment! I had a little chat with him about that fact, and had it not been for a hypo during the appointment, I had probably asked to switch to another doctor. While I like my current endo, he doesn’t seem to be the ideal choice for issues like pump treatment and hypothyroidism (again, some of you know more about the background of this). Anyway, I think that my endo actually realised a few things during our last appointment. We were discussing the number of tests needed to be performed on a daily basis (I am not sure if we will ever agree on this, but that’s another matter), as well as my efforts in avoiding really low sugars, when he asked me what I though my sugar was at the moment. I told him that I had a feeling that it was on a down-slide, if not already low, and he said that he thought that he could see as well as hear it on me, so he ventured off to get me some juice. I was rather calm, though a bit annoyed, about it and just got out my meter to test. I had assumed that I would be around 3.0 (54) or something like that (I was 9.2 (166) before my bike ride (5.5 km = 8.8 miles) to the hospital about an hour earlier). The result that my meter showed just as my endo re-entered the office with a glass of OJ and an apple was much lower though: 1.8 (32). While I hate readings below 2.0 (36), I don’t panic too much about them anymore, as least not when I don’t feel too bad, but my endo was baffled and immediately ran out of the office to get more juice + some rye bread with cheese to follow up. While I was consuming all these carbs he was all, “I’m right here with you, just take your time”, and “can you feel it rising?” It was actually nice that he took the time, even though I wasn’t feeling that bad, also because it was a real show off of the fact that I have been trying to make him clear that sometimes I seem to function rather well, even when incredibly low, and I will actually feel the worst “symptoms” when the BG is rising again afterwards. He could hardly believe that it had been possible for me to be part of our dialogue seemingly problem-free, even though he did note that I had slowed down a bit, i.e. was talking a bit slower than I usually do (I didn’t even notice that myself, but I don’t doubt that it could be true). In general, I think this little episode scared him the most, but then I have been there before, and he probably hasn’t :-)

Now that this is already a lengthy entry I might as well end it off by a little up-date on my PhD-project. Back in June, when I got back from my stay in the German lab, the plans were for me to re-join the group once they were settled in Glasgow by mid-August. There were some unsolved issues about my status in August and September, as the Scottish study year doesn’t start until October, and thus the fee waiver that we were to apply for wouldn’t either. These issues still haven’t been solved although we are now in mid-October. Actually, my registration at the Scottish university is still not settled despite the fact that I was promised to receive the offer letter Friday last week so that I could sign it and send it back in time of the next registration date, which is…….October 16th! I hope that all these issues will resolve soon enough. I think that it is about time to get some salary again – I haven’t gotten any for August or September yet, so things are getting a bit tight now.

Wednesday, July 18, 2007

Diabetes and hypothyroidism

I need some information the interaction between these two ailments, and what better forums to turn to than the DOC and TuDiabetes? ;-) I know you guys and gals have a lot of experience to share, so I will give you some background to support my specific questions.

When I moved to Odense more than 6 years ago, I needed another D-team. I had arranged with my former team that they would send my chart to the university hospital in Odense, but here they wanted to start their own chart, only keeping the chart from my former D-team as background reference. Therefore, I received a chart for blood sampling, and I have never before or after seen that many marks for analyses to be performed! It required 9 tubes of blood, almost leaving my arm drained ;-)

When I saw my new doctor at the hospital for the first time, I was informed about the results. Most of them were normal, but among those requiring attention was my TSH-level. It was marginally increased, 6.3 or something like that I believe – the normal range being 0.5-5.0 mU/L. The doc felt my thyroid gland being somewhat enlarged and referred me to an ultrasonic examination and a pin needle biopsy. The ultrasonic examination showed that my thyroid was indeed a bit enlarged, but the biopsy didn’t show any malignancy.

My D-doc (endo) has kept requesting thyroid analyses with most of my blood draws ever since, but otherwise there hasn’t been any follow-up on this. I have rarely seen the results of the analyses, but a couple of times within the past 2 years or so my doc has asked about my dose of Eltroxin (I believe it is called Syntroid in the States) – as if he shouldn’t be one of the first to know if I received any such treatment!

A months and a half ago I had my last appointment with my endo. When he showed me the paper with the most recent lab-result – for me to view my A1c – I noticed that the TSH-level was still off, having been as high as 9.37 in November last year. I was a bit shocked about this, but was told that treatment wasn’t initiated until the level was above 10 (so has my TSH been at this level the times he asked me about my dose of Eltroxin in the past?). He continued asking about my asthma, something that he has never done before, and I could tell him that I have had more problems during this spring when playing soccer. Still, he seemed to conclude that no immediate action needed to be taken, and just set me up for another appointment in 3 months (usually I go 6 months between appointments).

Ever since the realisation that my TSH-level apparently still isn’t normal, thoughts about the consequences of this have filled the back of my mind. I have searched the Internet about it, actually finding a site stating that with hypothyroidism diabetes could be hard to manage, but no case studies of the effect(s) of hypothyroidism on BG-management. I have found my old pathophysiology book, re-reading the section on hypothyroidism, and found some interesting information that put some things into perspective for me.

I’ve been diabetic for 17+ years, and the first 5-7 years were not much of a struggle. In contrast, the past 8 years or so have been very challenging BG-wise. I don’t know if my former D-team ever screened for other autoimmune disorders, but at least they didn’t tell me about it. With the initial result of my TSH-level 6 years ago, I cannot help but wonder if some of the problems I’ve had with maintaining a stabile BG, and not least avoid serious hypoglycaemic episodes, could somehow be related to the fact that an autoimmune attack has been taking place in my thyroid during the years as well. With swinging TSH-levels the levels of the important thyroid hormones have likely lingered around on the low side for the same amount of time as well, and since thyroid hormones among other actions increase the rate of carbohydrate absorption from the gut that may explain why it has sometimes taken “forever” to correct a low BG. As a side note, I can tell you that I have had a synacthen test performed to evaluate the functionality of my adrenals because for some time years ago, I had a lot of severe hypos, requiring a lot of ER visits as well as paramedics attending me in my apartment, at Jimmi’s place, at work – you name, it probably happened. The synacthen test came back perfectly normal, though.

What annoys me, though, is the fact that without saying – and not least doing – anything, I have apparently been “diagnosed” with “myxoedema without specification” and “autoimmune thyroiditis” years ago! Leafing through all my medical documents, ER- and paramedics notes, I found a piece of paper that I cannot really remember the context of, but the information in it seems clear (the diagnoses listed above). Looking at the date of this paper, I infer that it is from around the time where I switched from Insulatard (NPH) to Lantus, although I cannot really see, what the information about thyroiditis and the like has to do with this switch.

I have an appointment with my D-nurse again tomorrow, and I intend to bring the above-mentioned piece of paper, and ask her about it. She arranged for me to have another blood draw, so that she could discus the newest thyroid results with a doctor prior to our appointment. Although, I don’t like the idea of having to add yet another chronic illness to my chart, I don’t like the though of anything going untreated with the potential of causing additional problems either. I am not sure if any or which of the BG issues that I’ve experienced within the past 8 years have anything to do with a possibly wacky metabolism, because I haven’t found any specific cause-effect descriptions of the effect of untreated, low-grade, hypothyroidism on diabetes, but I would be surprised if there isn’t a DOC-blogger or two out there who has experienced this on their own body. So if any of you have been diagnosed with hypothyroidism – after being diagnosed with D – and can remember any D-related symptoms that subsided once the hypothyroidism was treated, I would like hear from you.

I am tired of having to act as my own doctor, but apparently it is necessary, so the more facts I can collect the better my argumentation for and questioning about lab-results and/or treatment will be. After all, I cannot write the prescription myself, I need a licensed doc to do that :-)

Monday, June 25, 2007

To pay: 1779 kr

Last week I came home to find a couple of letters from Germany in my mail.

One was from the German insurance company that I had to pair up with to get a German health insurance. I thought that maybe they had finally gotten around to send me the insurance card that they promised me almost 2 months ago. However, it was just a second reminder of a questionary that I had to fill in and return (that I had actually done more than a week before, even though I have never seen the first questionary – only the reminder of it!).

The second letter contained some words on the envelope that immediately got me a bit worried – I smelled some kind of bill. I opened the letter and just as anticipated it was a bill – from a company representing the German ambulance service, Deutsches Rotes Kreuz. If you read my last entry you may guess what this bill was all about.

Being born and bred in Denmark, I have never been accustomed to much self-payment when it comes to health care. Every Dane has a civil registration number and a health insurance certificate issued by the municipality where he/she lives. This card entitles the holder to get free medical attention - except if you need medical statement or the like - by your PCP, treatment and admission on any public hospital and/or ER, and urgent paramedic assistance when needed. It is also possible to underwrite additional insurances to cover some or all of the expenses to dental care, physiotherapy, chiropractor treatment and the like.

I know that the abovementioned benefits are costly, and that is why we pay rather high taxes (40-60 % of our income), but it makes sure that no matter your income and insurance status you are able to get basal treatment at any time needed.

The Danish health insurance certificate also serves as a travel health insurance to some degree in some parts of the world. Therefore, I had this certificate along with me, when I went to Germany, as I hadn’t received any card to show my relation to the German health insurance company. On the night of June 12th when my parents, through the receptionist at the institute where I was living, required medical assistance to overcome the severe hypoglycaemic reaction I was caught in, the only “insurance card” that the paramedics could relate to was my Danish one.

The reason why I needed to establish a German health insurance when initiating my work in Germany was that my Danish insurance could not cover me when I was working abroad, being paid by a non-Danish employer – and it didn’t matter whether I would have the general yellow Danish health insurance certificate or the blue European one. Some of you may remember the difficulty I had finding out what insurance what needed and getting it settled. Therefore, there was no doubt in my mind that the bill from the German ambulance service sitting in my hands would not be covered by my Danish health insurance. I did have other Danish insurance alternatives, but I figured that the chances of getting them to cover this were equally small, given the fact that I was working abroad, not being on vacation. Left was the German health insurance. I had a letter from them, dated May 4th, that I had been accepted by their plan, stating an insurance number and a promise that I would receive an insurance card to show my membership within a few days. As mentioned, this had never happened.

I logged on to the Internet to investigate the actual terms of this German insurance (i.e. what is the actual coverage, and is it managed by reimbursement or directly, etc.). I didn’t get much wiser by searching their web-page, though – not only because it was in German ;-)

I decided to call them the next day in stead, in order to ask about the second reminder of the questionary that I had already handed in, the missing insurance card, and then whether they would cover the cost of the ambulance service and how.

I was lucky enough that the insurance worker answering my call was willing to try to get through the conversation in English. Essentially, I do understand quite a lot of German, but I have difficulty expressing myself (I haven’t used this language since public school 13 years ago), and in this situation I wanted to make sure that I understood everything right just as much as I wanted to be sure that got my message through. Still, I am a little worried about the latter :-/

I was told that the insurance company would reinitiate the process of issuing an insurance card to me, that I should just ignore the second reminder of the questionary given that I had obviously already filled it in, and that of course they would cover the ambulance service since it happened on June 12th and I was officially included in their member crowd as of June 1st. I was instructed not to pay the bill, but send it to the insurance company for them to take care of it. I did that immediately, including a letter of information about my conversation with the employee and the fact that I had never received an insurance card. Additionally, I included copies of the letters from the insurance company about my acceptance – for them to see the dates – as well as a copy of my Danish health insurance certificate to point out that even though this was what the paramedics had used to note information about me on their chart, they had managed to get my date of birth all wrong (my date of birth is 14.08.1977, but this somehow turned into 17.08.1977 on the paramedics’ chart and therefore also on the bill). In my letter of information I requested to be notified when the bill have been paid/if they for some reason are not able to pay it before July 2nd when it is due, so that I will not receive reminder fees. I hope that I do not have to worry about that, but I can’t help it. It is just something about foreign business partners, not least on the insurance side, that makes me very careful trusting them.

By the way, the bill amounted to 235.19 Euros (1779 Dkr or 315.3 $) for 30 min of work. Hypoglycaemia sure can be expensive!

Tuesday, June 19, 2007

Yet another comeback :-)

Once again I have been away for a while, not because I haven’t had anything to post about – on the contrary actually – I’ve just been to busy to do so. Therefore, this post will be a lengthy one, containing a little on many different issues, some of which I will – hopefully – find the time to elaborate on in subsequent posts :-)

The past months have been crazy work-wise. I finished my research assistant-contract by May 14th, without actually being done with all the different projects I had been involved in the past year, partly because the instruments needed for sample analyses had been out of order most of the spring. I had also received some samples from the German group that I have now joined for my PhD-study, and I had hoped for the analyses of these to be done before I went to Germany, so that I could bring along the results and explain them to my new colleagues. Unfortunately that wasn’t possible. When I returned to the Danish lab this week, I learned that only a few of the samples had been run and moreover the runs were unsuccessful :-/

After I finished my contract I had a few days to prepare for the holiday that Jimmi and I had planned. We went to Rhodes for a week, and just by chance one of my father’s colleagues, who is married to a native Rhodean (is that what people from Rhodes are called?) were also at Rhodes at that time, so we arranged for some meetings down there, experiencing some alternative sight-seeing as well. There is so much to tell about this vacation that I think I need to reserve a post for that – I just don’t know when I will get to that so I will just give you a few pictures :-)

Our return from Rhodes turned out to be quite an experience as well. Our flight was to depart 9:50 PM local time, meaning that we should land in Denmark at 00:30 AM (there is a time difference of +1 h from Denmark to Greece). The boarding began on schedule, but because passengers are to be transported to the plane by busses, this already caused a delay – maybe because 2 flights were scheduled to depart for 2 different Danish airports within 5 minutes. Anyway, once all the passengers had finally boarded the plane, approximately 30 min late, we were told that they had a problem with the plane: It wouldn’t take in fuel! We were told that the crew was trouble-shooting, and that they would provide further information when available. Another 45 min or so past before the captain provided further information: They had been through the whole repertoire of possible sources of this error, without seeing any improvement, so now they would turn to the last possibility, which according to the captain usually cured even the most severe of these types of errors. They would shot the plane down completely and then restart it just like rebooting your computer when nothing else works. So the plane went dark, only for a minute or so, though, and another half hour passed until we were finally told that now the problem seemed to be fixed and we would depart shortly. We landed safely in DK at 02:20 AM, feeling very sorry for one of Jimmi’s theatre colleagues who had agreed to pick us up from the airport – it is a 75 min ride from Odense. Thus, we were back home and in bed by 4 o’clock in the morning – and for those of you not familiar with the Danish summer, I can tell you that by that time the birds have started their morning singing ritual, and the sun is beginning to rise!

Due to the late arrival at home after our trip to Rhodes of course the better part of that day was used for sleeping and taking care of a lot of laundry, because I was to leave for Hamburg just a couple of days later.

Just before leaving for Hamburg, actually on the morning of the day I left, I had an appointment with my endo. He had a lot of questions about my going to Hamburg, the PhD-project I was starting, and the article that he wanted me to write (my doc was also co-supervising my Master’s thesis, and after my graduation he wanted for us to publish the results, even though the most important of these actually derived from one single experiment, because the back-up samples were lost due to instrument-related issues) – but there were also time for to discuss diabetes issues. He gave me the results of the blood samples, my A1c being 5.0 this time, all the other values being okay, except for the thyroid levels which are still a bit off, but not yet at levels were they usually start treatment. Although I do appreciate the low A1c I made it clear to my endo that while in general I think things have been good/improving the past 6 months, I still think that there are too many readings below 2.0 (36) which I do not like, but he told me to discuss this in detail with my D-nurse, because he is not much into the pump managing himself. It is fair to admit one’s lack of experience, but in this case it seems like it is making my endo-visits rather useless….

The readings below 2.0 (36) are not only a worry to me but just as much to Jimmi, who of course has been deeply concerned about me going to Germany by myself. I do understand his concern, however, I have lived by myself before, and I have been confident that I would be able to do so again and after all it was only for little more than 2 weeks. I thought of it as a chance to prove to him that it could be managed before having to leave for Glasgow sometime in August, probably having to stay there for a bit longer (i.e. months).

Unfortunately, my stay in Hamburg wasn’t all that successful as I had hoped for diabetes-wise. At home I am fairly active, riding my bike close to 20 km (32 miles) a day if not more, playing soccer 2-3 times a week, and swimming – whenever possible – once a week (the swimming facilities at the university are closed during the summer due to maintenance work, though). In Hamburg, my accommodation was at the very same building as the lab, meaning that I only had some hundred meters of hallway and some stairs to force to back and forth to work. Shopping was close by as well, and as the working hours in the lab was typically long, I didn’t have the time for long walks/runs if I was also to chat with Jimmi, and sometimes my parents as well, before going to bed. Therefore, my exercise regimen was deeply impaired, something that – as anticipated – greatly affected my BG-readings. I struggled a lot during the first 1½ week to adjust the basal rates, trying out many different combinations. Approaching the second week, very warm summer weather hit us. Outside temperatures hovered around 30 °C (86 degrees Fahrenheit) and as the lab didn’t have air conditioning, but did have large windows turning south, especially the afternoons were almost unbearable hot – especially when you have to wear a lab coat and cloves to protect yourself! Very warm weather has always seemed to cause me problems, usually with increased chances of lows, and this time was no different.

Tuesday was a real rollercoaster-day, where high readings caused corrections that would then send me low. In the evening I went out for a walk, but didn’t get far before I could feel my legs not willing to support me anymore. I had to stop in the middle of a square along Reeperbahn, sit down and wait for half a package of glucose tabs to do their job. After that I completed my errands, and returned to my room around 8:20 PM. My intension was to test right away, and I had actually prepared both meter and lancer for this, I just never got around doing so, apparently already being low enough for my brain not to function properly.

I barely remember talking to Jimmi on my mobile phone, because I had problems logging on to my computer (we usually would use Skype to talk to each other in the evenings, in stead of spending a lot of money by using our mobile phones). I do remember glancing at my wrist watch at 9:30 and 9:45 PM, but after that and until about an hour later I only have flashes of memory – which I don’t even know if to trust – about what I was doing or what happened around me. What I do remember, though, when slowly coming out of this nasty low, is my room being crowded with people I did not know, the only familiar face being my neighbour, who also happened to be a diploma student in the lab. He was generously handing me cola (the sugared variant), and assured the paramedics – and whoever else was in the room – that they didn’t have to do more, when they had gotten a reading of 53 (in my foggy brain it took some time to realize that the result was not 5.3, when they showed me the meter, and subsequently do the math to convert this value into one that I could relate to, i.e. 2.9 mmol/l). He would stay with me until I had safely recovered. So he sat with me and told me what had happened, and that I should probably call my boyfriend because he was worried. Before I had a chance to do so, however, my dad called as it was apparently my parents who had alarmed the institute that I needed help. Jimmi had called them because I failed to answer his calls 10-20 min after he had called the first time and noticed that I was low (he told me afterwards that he called back several times before he proceeded to alarm my parents because I had told him that I had eaten some glucose tabs and so he wanted to give these a chance to take effect). Talking to my parents afterwards they also encouraged me to contact Jimmi as soon as possible, because when he called my parents he was apparently already in the process of arranging some transportation to get him to Hamburg ASAP.

I spent 30-45 min talking to Jimmi trying to make him reconsider his decision about coming to Hamburg. It was difficult – and I am sure that I would have been just as difficult to turn around if it had been the other way around – but I finally managed to make him turn around (fortunately he was just outside Odense, so he hadn’t gotten too far away). He wasn’t happy about it, and didn’t at all feel comfortable with the fact that I was alone in my room with no one to notice if I got low, but at least he agreed to give it a night’s sleep and thoughts before continuing.

I hate the fact that it happens, especially because it had actually been a long time since paramedics was needed, and I felt confident that I could handle it. That it did happen, however, makes me think that maybe I ought to pursue the Paradigm real-time system more, even though I don’t know if it is available in DK yet. Though this system is certainly not perfect yet – as can be seen from all the comment and suggestions that Will received after posting about Medtronics wish to gain input from the (potential) users of their system – it could perhaps provide me, and not least Jimmi, with a little more trust in the ability to prevent severe lows. I don’t know. I will discuss it with my D-nurse, and find out what else can be done during the coming 2 months before I am likely to be off for Glasgow. Test more often, many may say, but during my stay in Hamburg, I actually tested 10-18 time a day, so I don’t think that there is much more to win there. Other types of actions need to be taken, because I will not allow, least of all accept, the D to prevent me from following my dreams!

Sunday, April 15, 2007

Back to blogging

I haven’t been around here for quite a while now. Not because I’m tired of blogging, but because I have been busy. To busy to even read fellow bloggers’ posts – sad but true.

As some of you may remember, I am to start a PhD-study by June 1st. This has required quite a lot of planning as well as a great deal of patience with the health insurance issues that employment in another country brings along. The issues have yet to be solved, and it has been enough of a hazzle to fill an entire post by itself :-)

I have one month left of my current contract as a research assistant, and I guess that most of our collaborators have realized that as well, because I have been receiving samples and assignments like never before. I’m involved in 8 different projects (PhD and Master’s projects) and currently (and actually this has been the case for the last couple of months) 4-6 of them are active, as in me having experiments and/or data analyses to perform. Thus, I don’t have a chance to finish one assignment before having to start the next one, and consequently I’m trying to alternate between the assignments and prioritize them according to the order in which I have received them, but it is not that easy because I sometimes have samples in queue for a specific instrument for several weeks/months, and then is often busy with other assignment by the time the data from these samples are finally ready. Because of difficulty with some of the data analyses, I have also had to learn how to use 3 new programs – all of which have no or only rather sparse manuals to help you get started!

On the diabetes front things have been relatively steady. Beginning of April I started soccer practice again – I had participated in a practice match in the middle of March, actually playing most of the game and 4 different positions, without having played any soccer but the indoor form this year (the indoor practice ended by the end of January!). We have had magnificent spring weather the last couple of weeks, culminating this weekend with temperatures of 20 degrees Celcius, and this of course have had a great impact on the motivation for soccer practice :-)

Despite the fact that soccer practice has been relatively problem-free even after I got the pump, this week I had my first real bad experience with practice and diabetes. The practice is from 5:00 PM to 6:30 PM, so I usually have a small snack about half an hour before starting and then dinner is postponed until after practice. This Tuesday I got home from work at 4:20 PM, had a banana while taking care of a few practical things before leaving for practice at 4:55 PM (the field is just across the street where I live, so I usually get changed at home). Before leaving I checked my BG, getting a 4.2 (76). I was a bit nervous that was too low, but on the other hand, I had eaten a banana without bolusing for it, so I just decreased the basal to 60 % and thought nothing more about it. When practice was over I felt a bit tired, but put that down to the fact that it was just my second practice of this season. Back home, before hitting the shower, I tested: 15.2 (274) WTF?!!! I thought that maybe I had not been drinking enough during practice so while shooting up 4 U of NovoRapid by pen I also drank about 0.5 l of water. While in the shower I started feeling a bit nausea, and when I checked the BG again afterwards it had risen to 16.0 (288) – 25 min after the correction bolus taken by pen! Because of the nausea, I also tested for ketones, getting a 0.4 mmol/l result – theoretically that should not be enough to make me feel this bad, but then again theory and practice often tend to differ quite a lot, especially when diabetes-related. I wasn’t really hungry, but I decided to prepare dinner anyway to see if I could just get a little something down. I couldn’t really, however, so Jimmi ate it instead as he came home just about then. I had bolused for the meal that I ended up never eating (7.4 U), so I actually anticipated a rather quick drop in BG. It didn’t really happen though. At 7:40 PM, an hour after the initial correction bolus and half an hour after the meal-correction bolus, I was still 15.1 (272) and feeling nausea as ever. I lied down on the couch, having a bucket placed besides me just in case. The bucket was needed about an hour later, returning most of the fluids (approximately 1 l, I think) that I had consumed since getting the initial high reading – or so it seemed anyway. I felt a lot better afterwards – maybe a BG finally back in range at 7.9 (142) also deserves some credit for that? However, I still really didn’t feel like eating anything, I was just too exhausted, so I decided that I would just relax on the couch for another 30 minutes or so to hopefully not having the nausea return, and then I would have some kind of snack. I fell asleep, though, and only woke up almost an hour later at 2.7 (49), after Jimmi had fed me glucose tabs and juice, as I – of course – had slipped into a hypo while sleeping (no wonder with all that insulin and no food!). The nausea was gone, and finally I was able to eat something. I still cannot really figure out what went wrong that day for practice to result in such an elevated BG and consequently feeling sick. It has never happened before, and I certainly hope that it never will again!

Anyway, this weekend has been rather perfect. Jimmi and I, once again, have had the pleasure to take care of his dad’s dog, so we have had plenty of opportunities to enjoy the great weather while walking with Fido (the dog). Today I had a morning soccer game on the other side of the island, so I was up early – and so was Fido, forcing Jimmi to get up too and take her for a walk (he had no intentions of getting up at that time, but Fido thought otherwise ;-)). As for the soccer game, I played only the second half of it, but actually managed to keep the BG rather steady. With a 1 U bolus when the game started, as well as increasing the basal rate by 25 %, I had a 7.6 (137) before the game, a 6.1 (110) just before I entered the game, and an 8.4 (151) afterwards. This is one of the most constant BG-courses I have seen around a soccer game since I started pumping :-)

By the way, we won the game 5-4 :-)

Thursday, March 15, 2007

Very belated 7

I am very, very late to this one. I know. I just haven’t had the 48 h a day that I would need to just get through half of all the things I want/have to do these days. Anyway, here it goes, the 7x7:

7 things to do before I die:

1. Realize at least one of my dreams

2. Learn to master French – two years in high school clearly wasn’t enough, but it is such a beautiful language so I really want to give it another go

3. Visit Australia

4. Carry out at least one research project where the result(s) benefit diseased people – preferably diabetics, but others will do too :-)

5. Have kids

6. Experience at least 1 day as a non-diabetic once again

7. Meet as many fellow D-bloggers as possible in person :-)

7 things I CANNOT do:

1. I cannot help being a perfectionist in many aspects of live, including D!

2. Go to work by car when it rains because I don’t have a car, only a bike

3. Avoid being curious and wanting to expand my knowledge

4. Safe the world - but if I can change it just a little bit to the better, if only for a few people, through my work in research, I will be satisfied with that

5. Get my sugars right when swimming or playing soccer (games only, practice is usually not a problem)

6. Go to sleep instantly – especially not if I have had to test during the night!

7. Execute doctors’ (or any other medical personnel for that matter) orders without a bit of scepticism. I just don’t feel like I can always blindly trust that it will work as supposed for me.

7 things that attract me to …. Jimmi:

1. His kindness

2. His sense of humour

3. His honesty

4. Him being so straightforward

5. The BIG child he hosts that usually express itself by him lying on the couch watching cartoons – preferring not to be disturbed, and knowing all the characters in the different cartoons – or reading Jumbo-books (booklets with different comics about the inhabitants of Duckburg), but also when he pretends to be whiny (always in a joking mode, though) when I am leaving or wants him to do something :-)

6. Him being serious and cutting right through when needed

7) His urge to help people, both his immediate family, but also everybody else who have problems (e.g. computer problems, problems with flying ants inside their houses (this is why we are now running a case with the building association that owns our row house – see #6 below), want to learn how to speak/improve their English without having to attend classes to do so – he is continuously working on a website (only Danish-English so far, but his intentions are far wider – and did I mention that he is actually somewhat dyslectic, and thus needs to work even harder with foreign languages?) for people to associate English words with pictures as well as their Danish relatives, both in reading, writing and pronunciation - practical issues at the theatre he is a part of, etc)

7 things I say:

This one will primarily be in Danish (this is also why you may only see funny signs instead of letters in certain words, we have 3 additional letters that are not internationally common), but I will try to translate the best I can :-)

1. Hva’ så? (What’s up?)

2. Så pakker jeg sammen (I will be packing up now – to let Jimmi know that I am finally about to leave work)

3. How much longer? – to whoever is occupying an MS-instrument that I’m next on the list to use, just to know when the instrument will be available and decide whether I need to make an additional instrument booking in order to finish analyses so that I don’t take too much time from the next person on the list

4. Will you put my target in when you are done, and let me know? – in connection to #3, and here target is not associated to desirable BG-values, but a term for the specific metal sample plates that we use for MALDI-MS :-)

5. Jeg skal se, hvad jeg kan gøre (I’ll see what I can do – when new samples with associated analyses and deadlines are pushed to me when my hands are already full from other analyses/when people want to get special information out of their samples, despite not giving me all the information I need to assess whether this information is actually retrievable)

6. Nej, nu må den/de/det lige ta’ sig sammen! (C’mon, please get your act together – said to or about any machine/instrument/person, whose action(s) get on my nerves! Lately this phrase has been used frequently when discussing with Jimmi the issues around his approval for daily allowances, as well as the case we are running with the building association that owns our row house, regarding the rules and responsibilities concerning ants as pests)

7. Det ved jeg ikke… (I don’t know…)

7 Books that I recommend

1. “Sofies verden” (“Sophie’s world”) by Jostein Gaarder – The only thing we require to be good philosophers is the faculty of wonder”

2. “Out of the Sun” by Robert Goddard – how insulin is used in the act of a crime

3. “Prey” by Michael Crichton - I’m a great fan of Michael Crichton

4. “Cruel and unusual” by Patricia Cornwell – she is a great crime writer

5. “The Dante Club” by Matthew Pearl

6. “Deception Point” by Dan Brown

7. “Løgnhalsen fra Umbrien” (“The Liar from Umbria”) by the Danish writer Bjarne Reuter – I don’t know if this book has been translated into any other languages, and thus the English title is a just a proposed translation of the Danish one. The book is brilliant, though, so I hope that it is/will be available in other languages for you to read about “the shopkeeper Giuseppe Emanuele Pagamino, who set off from the kingdom of Naples to the bishop’s dominance of Lucca to find the recipe of eternal life, upset the church and incurred the attention of Satan”

7 Movies that I like

1. “Forrest Gump”

2. “De grønne slagtere” (“The green butchers”) – a fabulous Danish comedy

3. “Beverly Hills Cop” – I love Eddie Murphy (except when dubbed on German television - that just sounds awful!)

4. “Drømmen” (“The Dream”) – another great Danish movie

5. “Ice Age 2” – I am still into animated films, and I love Scrat :-)

6. “The Lord of the Rings” – all three movies, need I say more?

7. “Philadelphia” – another great performance by Tom Hanks

7 People that I tag:

1. If you

2. haven’t

3. done

4. this yet,

5. go ahead

6. and

7. do so! :-)