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 :-)


Scott K. Johnson said...

Great to hear from you Heidi!

Sounds like quite an experience after practice that day! Sometimes we get sick just for being sick - not diabetes related too. I wonder if it was anything like that?

Sounds like it passed relatively quickly though, which is good.

Good luck with all that you have going on - don't worry about posting unless you have time and feel like writing. We'll be around whenever!

Chrissie in Belgium said...

Hi Heidi,

SO GOOD TO HEAR FROM YOU! I guessed you were super busy! I can imagine all the hassle you have to wade through!

That sick episode you had - yuck! You know me, I am just sondering how much the ketones were the cause of your feling so terrible?! Maybe you can join the club with me and Lili?! Do you think the hypo was caused by the insulin for the meal you never ate? If you look at the parameters, how much of the insulin was still working when you had the hypo? You know that I have noted that when ketones disappear I really have to be careful for hypos. Or was this "just" a stomach flu thing? Did you eat something bad? What are you guesses? So will you be travelling to Germany June first?! Gosh you sound terribly busy not only with the new position but also with all your other projects! Isn't it typical that people always load things on you when one is closing shop..... Sounds like you and jimmi really enjoy Fido's company! Dogs are the greatest - could never live without them!

Heidi said...

Scott and Chrissie - thanks for welcoming me back :-)

It was truly a sick episode after practice last week, and while I am perfectly aware that the nausea and vomiting may have other causes, I must admit that I tend to blame the high BG and the ketones - despite their low level - for this one. The reason for this is that I have had a similar experience once before (after a soccer game last spring), and in my experience stomach flu, food poisoning or what ever else can lead to these symptoms never come and go that fast. The time course last week was 90 minutes, from the first high reading to vomiting and feeling better with a BG of 7.9 (142). It seemed a lot longer though!

By the time I was aware of the ensuing low it has been another hour or so - i.e., still well within the hours where the load of insulin was active, so I have no doubt that the meal bolus for the meal I never ate contributed to this. With the benefit of hindsight, sure I should have had something to eat/drink in order to get some carbs into the system, when I tested 7.9. At the time I just didn't feel like challenging the nausea once again, even if it has disappeared when vomiting.

I can't really point out what is making the difference between feeling so bad or hardly noticing it with high sugars and even low amounts of ketones. High sugars don't always seem to result in ketones, yet if connected to exercise ketones seem to be the rule rather than the exception :-/

And yes, as far as the plan is right now, I will be going to Germany by June 1st. Hopefully I will be able to round off all the projects that I am currently struggling with, and help our collaborators learn how to deal with the data themselves in the future, so that their samples can still be analysed by mass spec in our lab without putting too much work on other peoples shoulders :-)

Chrissie in Belgium said...

Well Heidi - I guess we can call it maybe a threesome. You me and Lili. I am just wondering if there aren't more out there. Did your ketones totally disappear when you got down to 7.9. I was instructed that when the ketones diasappear and the bg gets below 200mg/dl i should eat something b/c the liver has to replenish its sugar and will take it from the blood. This will make the bg drop even more quickly. When you felt terrible could you think clearly? Were you shaking? I AM GLAD YOU DIDN'T END UP IN THE HOSPITAL!

Bernard said...


I just found your blog for the first time this evening. I'll have to add you to my blogroll.

I hope you're doing well.