Monday, January 29, 2007

New design

Finally, I got around to give my blog a needed facelift. I'm not completely done yet, but a least I have tried to up-date my links, so if I should have forgotten any of you, please let me know (Chrissie, you are now on my list ;-)).

Sunday, January 28, 2007


Why does it have to be so difficult? Not swimming in itself, but the part about managing the BG.

From I was 6 years old, I have been swimming once a week. Just for fun and exercise, never competition-minded (except for the personal competition you would have with yourself :-)). I continued this routine until I moved to Odense 6 years ago. When I began my university studies, I even went swimming twice a week sometimes. This was because I would sometimes use an hour in between classes to go swimming with some of my fellow students. There are swimming facilities at the university, and they are of course used by the sport students, but the “holes” in the timetable are free for other students, as well as employees, to use.

Those of you having read my blog from the beginning – or at least the recent post of January 16 – will probably, with some quick mental calculation, have realized that the D was introduced during the years that I have been practicing swimming. Besides the swims at the university, we would always go swimming on Saturday afternoons, usually shortly after lunch. Only once did this routine cause me a severe low afterwards. I could have slightly lower sugars (2.5-3.5 [45-63]), but never really posing any problems, except for that single one some 13 years ago.

The last couple of years I haven’t gone swimming. There is really no good excuse for that, just plain laziness in working it into my lab-routine. I took it up again in the fall, though. This time, being on the pump in stead of injections, I thought a lot about how to tackle this workout. The time in the swimming facilities specifically allotted for employees at the university is Fridays 12:00-1:00 PM. Being a bit annoyed with the time being just around the time where I will usually eat my lunch, I decided that I would work it in anyway.

My initial approach was similar to the one I used for soccer practice in the spring, where I would also disconnect my pump during the activity. I worked a lot with the timing of the snack and the amount of insulin to cover it before going swimming. However, only once have I succeeded in avoiding a low afterwards, despite the fact that I, of course, copied my approach from this successful day to the following Fridays. I have a goal of 30 laps (40 m each), or 24 laps (50 m each) when the pool is not split in two, within approximately 35 minutes. I have only fulfilled my goal a couple of times so far, because usually I will begin feeling this special fatigue and missing coordination in my motion, clearly telling me that I am low, at about 24-26 short or 20-22 long laps. I leave the pool, shower and get dressed, and usually get a reading of 2.5-3.5 (45-63). That I can handle without a problem. Sometimes I don’t even bother to chew more than a couple of glucose tabs (which is about half the amount that I will actually need to correct this if only treating with glucose tabs), while walking back to the lab (approximately 600 m) to get my lunch.

Since being on the pump I have had a fare greater share of readings below 2.0 (36) than I ever had with MDI. I believe the lowest reading after swimming have been 1.8 (32) or so. Until last week, that is.

Last Friday the pool was divided into two, and thus my goal was 30 laps. I had reduced my basal to 60 % a couple of hours before, and at 10:30 AM I had a snack of ½ slice of rye bread, a banana, and a few M&M’s. I bloused conservatively for this, using a combined bolus where a fraction of the bolus (0.3 U or so) was delivered during the course of an hour. Before heading for the swimming facilities I tested 6.9 (124), which I thought would be okay as I knew I would be disconnected from the pump for approximately 1 hour. However, once again I felt a low creeping up on me when I reached 26 laps. The symptoms weren’t too bad and I actually debated a little with myself, whether I would do 2-4 more laps before stopping. I didn’t though. I capitulated and headed for the shower. I didn’t feel too bad so I didn’t head for my locker right away to test and correct. I remember some music being turned on and one of a technician, who sometimes comes to perform experiments in our lab and whom I occasionally run into in the swimming facility, commenting on it, but I wasn’t really listening. Once I was dressed and sat down to test I got a reading of 1.2 (22). Damn! Just seeing such a reading automatically can make me feel bad. I was able to treat it myself, but I must admit that I felt a bit run-over when I made my way back to the lab to get my lunch. It scares me that sometimes I am apparently capable of functioning quite normally despite such a dangerously low BG. It also makes me seriously consider getting a medical ID that I can wear when going swimming too (I know, I know, I should wear one at all times, but the truth is that I never really have. I have a talisman-type ID, but never wear it because I am annoyed with it. It swings too much around my neck if I move just a little faster than slow walking, and I cannot tolerate that).

This scary post-swimming low was one of the things that I discussed with my favourite nurse, Alice, at my appointment with her this past Thursday. She suggested that I simply turned off the pump/set the temp basal to 0 % an hour or more before going swimming, as she believed that not only the swimming, but also my morning bike ride getting to work, is affecting my BG during this 30 min swimming work out. Also, to prevent those significant drops in BG that I still tend to see in the late afternoons around my bike ride going back home from work, she encouraged me to try to turn the pump of approximately 1 hour before my anticipated departure from work.

I set out to try this the following day. At 10:15 AM I set a temp basal to 0 % for 90 minutes, while getting my snack and a conservative bolus. I was busy in lab the whole morning, and just did a quick test before hurrying towards the swimming facility at 11:45 AM. I was 9.7 (175), and though about whether that was actually a little too high. I didn’t do anything about it though, just headed for the pool. This time the pool wasn’t split in two, so I was doing 50 m laps. I felt full of energy. Passing the 20 laps I began feeling a little tired, so I decided to end my session with just 2 more laps of slow, cooling down breast swimming. In the shower I ran into one of the technicians from our lab. We talked a bit, and I told her (she had heard the story of my scary low the Friday before, as I told the other technician about it one morning in the lab, where she told me that the music was folks music for a special team occupying the pool after us) that I felt a lot better today. I actually expected that I would be in the high 3’s (63-70) afterwards, but as you can see from my chart below, I wasn’t. 2.8 (50) was all it could be.

Why does it have to be so difficult to figure this out? Anybody have some experience with swimming and pumping that they would like to share with me? I would like to make it work, and even if I don’t, I am not the type to give up because that would that I let the D rule my decisions in this matter. Only I don’t want to risk going completely sugar cold because of my stubbornness, so inputs are more than welcome to help change this pattern of lows caused by swimming :-)

Monday, January 22, 2007

When D affects......

This afternoon I read Scott’s latest post about the negative feelings that D can impose upon us. While I was planning to post about the below-mentioned anyway, Scott’s post somehow inspired me to add a D-twist to my current report.

Last week I had a very long awaited meeting with my current supervisor and a German scientist, W, who contacted my supervisor last summer with the hope of setting up collaboration with our group, and if possible acquire a talented candidate for a PhD-position that he had funds to pay for. My supervisor found the request from W attractive, and he asked me if I might be interested in this possible PhD-position. I said that I might be, but that I would like to hear more about the project before I made my decision. This was also of interest to my supervisor, and as W had mentioned that he would be willing to meet us here in Odense to discus the possibilities, the two tried to set up such a meeting. My supervisor generally has a very busy schedule, and it took several months until they finally found a date. A meeting was set up for November 7. However, a week before this meeting W had to cancel his trip to Odense, because he had to go to a job interview elsewhere. He still wished to arrange a meeting, though, but at the time my supervisor didn’t have any openings in his calendar until January. A new meeting was then scheduled to January 17. I was a bit annoyed with this delay, which also caused a clash with my supervisor regarding an alternative PhD-position that I applied for. The fact that a possible supervisor for a PhD-project was looking for other work didn’t ease my mind either.

Maybe it was because of all these bumps on the road that my expectations to the meeting weren’t too high. When I was introduced to W, my first impression of him was good, though. He seemed very calm and relaxed. My supervisor had asked him to give a talk about his research, but only 6 people showed for the presentation! It was a shame, the talk was actually pretty interesting, but I think that the fact that we had already had a group meeting in the morning and this talk was scheduled at 3:00 PM, caused many people to opt it out in order to get just a little work done that day.

After the talk my supervisor, W, and I continued with a meeting regarding the possible PhD-project. My supervisor went to fetch some coffee, and while he was gone, W told me that he hoped that we would be able to establish the cooperation despite the fact that he would be moving his research group to Scotland in August! I was a bit surprised about this, as all that I had heard was that some of the work of course would have to be performed in W’s research lab in Hamburg. It turned out, though, that the institute, at which W is currently employed, had decided to focus on research into another parasite, sort of excluding W’s research. Therefore, he had been looking for other possibilities, and one had shown to be at University of Strathclyde in Glasgow, Scotland. Thus, he would be moving there together with his research group, and if I was to become his new PhD-student, I too would of course have to go there for some of the work. W assured me, however, that he would actually imagine that most of the work could be done here in Denmark, with only shorter stays in Hamburg and Glasgow, respectively, because the reason that he wished to establish this collaboration with us was our instruments for protein analyses (the project will focus on protein analyses).

We discussed the anticipated aim of the project, and I actually found it appealing. The funds that should pay my salary would come from the German Research Counsil, which posed some issues to be sorted out. W had funds for 2 years of salary, but he would only be allowed to bring them along when he moved to Scotland if the PhD-student had been employed at the institute in Hamburg prior to the departure. That shouldn’t be too problematic, at least not if there is no required time frame for the employment in Hamburg. W imagined that we could set it up so that I would be employed there from May to August, which would be okay with me. Now, a Danish PhD-education is 3 years, so we were missing funds to pay for the third year. In the light of this we discussed where I should be registered as a PhD-student: At the University of Southern Denmark here in Odense, at the institute in Hamburg, or at the University of Strathclyde. This also caused the discussion to turn to any advantages, tax-wise, for me moving my address out of the country.

For most people moving your address out of the country may not be that big a deal. I don’t know if it is to me either, yet I have some reservations about it. First of all Jimmi and I have not shared our current address for 2 years until October this year. Because it is a rental house, this means that if I move my address out of the country, Jimmi will not be allowed to stay in the house by himself, even though I may be here living there with him for up to 2/3 of the 3 years of my PhD-education. Second, moving my address out of the country also leads to some considerations regarding my health (D, asthma and allergies) and the cost of the needed meds and supplies. The taxes in DK are quite high (40-60 % of your salary, depending on your income, are paid as taxes), but this also means that we have rather low costs when it comes to meds and supplies. I pay for my medicine myself, but great deals of the costs are covered by grant aids. My diabetes supplies (test strips, needles and the like) are free of cost for me. The home-municipality pays for that. When it comes to insulin pumps and supplies for these, the costs are covered by the hospital treating the patient.

I had a note from W today, stating the answer about funding and registration that he had gotten from his future employer. Apparently PhD-salaries are free of tax in the UK, and thus W’s coming manager would recommend that I’d be registered at Strathclyde. That would imply a registration fee that we needed to find coverage for, and of course it would require my stay at Strathclyde at least for part of my PhD. I like the idea of avoiding tax by being registered and receiving my salary in another country. However, I need to find out whether it will be advantageous, if I need to stay in Glasgow for an extended period of time, not being able to bring all the supplies and meds that I need with me from DK. If I would have to pay it all out of my own pocket, it seems questionable whether it will actually be advantageous to arrange it this was (the tax saving might be eaten by the costs of meds and supplies).

I have an appointment with my wonderful diabetes nurse on Thursday, so I will discuss these medical issues with her. It annoys me, however, that my decision about the PhD- and address registration has to be affected by the D in such a way. I am not going to let the D get in the way of this position, but I still wish that it wouldn’t have to take up so many thoughts in the decision making and arrangement of the course.

D actually also plays another part in this. Jimmi was okay with the fact that I would be staying in Hamburg and Glasgow occasionally - as long as these stays wouldn’t be too long – but he did have one mandatory condition to accept it: I should make some arrangement for other people to be able to keep an eye with me, to make sure that I got up in the morning, and be able gain access to my accommodation in case of an emergency. It is actually a fair condition to make, but I am annoyed by the fact that it should be necessary. Why does the D have to play these games with us, causing us to sometime need the assistance of our love ones to handle scary or night time lows, and causing our love ones to be worried about our well being? Why does the D has to affect us and our love ones in this way?

Tuesday, January 16, 2007


”You are no different than any of your peers despite this!” I still remember this statement made by one of the nurses at the hospital when I was diagnosed. Although I am confident that she told me so in the best sense, even now I can’t help thinking how wrong it is in certain contexts.

Today is my 17th D-anniversary - actually I believe that the week day was also Tuesday back then. Neither I nor my family has ever done anything special to commemorate this day, just noted that yet another year had passed. Each time, however, I cannot help to think back to that day when I was diagnosed as well as the years past since then.

This year, since I now have a blog, I will share some of these thoughts with you guys.

In one of my first blog posts, I described my diagnosis , so I will not go through that again. Suffice it is to say I don’t remember the 2 weeks of stay in the hospital as very joyful – except for the fun with my roomies, one of whom is still one of my best friends :-) Most of you who have had this disease as long as I, or even longer, will probably remember that those early days were not the most flexible ones regarding diabetes management and treatment plans.

My family has always been very supportive with my D, which is great. In addition, my dad has always been very protective toward both me and my sister – I would actually say overly protective much of the time. Maybe I will understand this wish to protect your children against everything, even just scratches and falls during play, when I have kids myself, but so far I can’t say that I agree with all the protection that my dad offered – and still offers - me and my sister. This protection meant that even though I had wished to try to play soccer in a club for years, I wasn’t allowed because I could get hurt (that was my dad’s typical reasoning with me, along with the fact that the strains on the muscles, tendons and skeleton that soccer would mean, would cause problems when you were still growing). The fact that I had asthma and allergies (grass pollen allergy is one of them) didn’t help either, so when diabetes came along I almost thought I would never get to play soccer in a club until I turned 18 and would be of legal age.

My dad surprised me, though. He signed both me and my sister up for a soccer club in the nearest larger town. There was a soccer club in our village too, but apparently my dad chose the larger one, because he knew some of the people in that club. I was thrilled to finally be allowed to enter a team, although I was a bit annoyed by the fact that the distance to the club was so that one of our parents had to drive us for practice and games.

While my dad would usually attend all the away-games (to be sure that we got there safely!), he wouldn’t stay and watch practice. I had been diabetic for little over a year when I started playing soccer in the club, and although I had only been on injections for half a year or so, I felt fully competent in recognizing and treating lows. I also felt that I understood the principles behind the treatment and the effect of it pretty well, having educated myself through a lot of reading and noticing how my body reacted in different situations. However, I clearly remember a couple of times, where soccer and diabetes collided, and where my dad particularly didn’t show much of the understanding that otherwise characterized my family.

At the time I had a meter that required half a liter (or so it felt like ;-)) of blood, after one minute drying off the blood from the strip before inserting it to the meter, and then wait another 60 sec. to get a result based on the colorimetric changes of test area on the strip. In the hospital I was introduced to a lancing devise (much like this one posted by Art-Sweet to Diabetes made visible) that didn’t hide the lancet nor bothered to just poke half way through your finger. Needless to say I wasn’t happy about this, and despite the fact that I got another lancing devise with my meter, I just could not get myself to use it. Pressing the lancing button, I would simultaneously move the finger that was targeted to take the prick. Because of this, my parents assisted with my testing, drawing the blood from my earlobe in stead. Testing was not done that regularly back then, so I didn’t test before, during, or immediately after soccer, as I do today.

In the first season of soccer I remember feeling low during practice. I had glucose tabs with me and treated accordingly, quickly joining the others again. When my dad came to pick me up afterwards, he asked how practice had been, and I told him that I had a reaction that I needed to treat. I remember him turning his head to look at me, asking: “Are you sure that you were low, that it was not just the excitement of playing?” I was stunned and angry that he would even doubt it. I didn’t say anything, just nodded, thinking to myself that well, it is my body, and I know how a low feels like, and then hoped that the test at home afterwards would not give a high reading. Thinking back though, I actually believe that my dad’s reaction to this episode was due him being worries, and maybe even blaming himself for not having been around to make sure that I was okay.

The other example is from one of those rare away-games, where we didn’t have parent to drive us. Because we were going to suburban Copenhagen, and both junior teams had to play in that area at approximately the same time, the club had arranged for a bus to drive us. Thus, it was almost a whole-day excursion, and I remember discussing with my parents what to do with injections. I did my own injections, at that time before breakfast, before an afternoon snack, before dinner and before bedtime. The game was around noon, and because I would be playing soccer my dad insisted that I should not bring my insulin pen and just skip the afternoon shot – still having the snack though. I did not feel confident about that, but I couldn’t say anything to change his mind. Because it was slow and inconvenient (using an ear lobe, I needed a mirror and much fiddling around to actually land the drop of blood at the test area of the strip, if I were to test my BG myself), I didn’t have the meter with me either. The away-game in suburban Copenhagen was played in a warm and sunny day. I drank a lot of water, playing the whole match. I had some dried fruit snacks in the break and my packed lunch after the game. Sitting in the bus going back home, I remember that we stopped on a gas station because some of the other girls wanted to get some soft drinks and something to eat. I didn’t have any money with me so I just sat in my seat, dreaming about a nice ice cold coke :-)

When I got home it was just before dinner, and my dad thought we should just do a test to see how the day had passed off. I was suspecting a high, but my dad didn’t think that was likely if I hadn’t eaten anything I wasn’t supposed to (read: besides my packed lunch and snack). After all, I had played a full match of soccer, and “exercise lowers your BG”. I was high. I cannot remember how high, but I think somewhere around 12.8-15.8 (230-284). My dad was blaming me for not having taken proper care of myself, while I tried to defend myself with the fact that I was not the one, who said that the afternoon shoot should be skipped.

I guess what I am trying to illustrate with these short stories is two things: 1) While family and friends can be very understanding and supportive, they just don’t always get it; 2) Although we still need to see the promised cure, diabetes management has become so much easier during the years. Although I haven’t been in this game as long as some of my fellow-bloggers, I still feel how research and development have increased our ability to live a normal life with the flexibility and control needed. Just comparing the first insulin pen I was handed (I did do injections with syringes while in the hospital, but that was just until my pen arrived. Use of syringes for insulin in DK is almost not heard of, the different pen devises are used extensively) with the ones that I have now is amazing. And of course, the fact that a BG test gives you the result within 5 sec today compared to 120 sec 17 years ago is hard to dodge!

Lets just hope that the next 17 years will show just as much progress – hopefully letting us get rid of all our pens, syringes, pumps, BG-meters and other paraphernalia all together :-)