Diabetic dane

22 years

2012-01-16T18:33:00.002+01:00

Twenty two years ago today, I was admitted to hospital with a Type 1 diabetes diagnosis. I'm pleased to have survived all these years, virtually complication-free (i.e., if one doesn't count in the occasional hypo-unawareness), yet I'm also saddened by the fact that the promised cure still seem far away. The more I've learn, especially from my education in biomedicine, I've come to think that we will not see a cure until we learn to manage the immune system as well as replace the beta cells that the former mentioned immune system has killed off. This is tricky, and although I hope that it will happen some day, I'm not holding my breath. Instead, I enjoy life despite of diabetes - something which has become far more easy with the technologies of current time, such as insulin pumps, smaller and faster BG-meters, not to forget continuous glucose monitoring systems (CGMs).

Cheers to the first 22 years - I'm off to "celebrate" by working late in the MS-lab :-/

I wonder.....

2011-10-12T19:51:00.003+02:00

....if different pumps, even of identical model and brand, deliver slightly different amounts of insulin when set at the same rates?

I'm not thinking differences in the range of entire units, but maybe 0.01-0.02 unit differences in delivery when set at the same rates, due to minute differences in the mechanics.

The reason I even ask this question is that when I changed my infusion set first thing Monday morning this week, I also switched to the pump replacing my old, cracked one, and ever since I've had way more hypos than usual. Actually to the point where there are almost as many readings below 4.0 mmol/l as there are between 4.0 mmol/l (72 mg/dl) and 8.5 mmol/l (154 mg/dl) (my desired range). I've only had one high reading Tuesday morning after overtreating a pre-bed hypo in fear of more hypos after a day with no less than 10 readings of 2.1-3.3 mmol/l (38-60 mg/dl)!

I'd entered all my settings with my old pump in one hand and the new one in the other, reviewing them all multiple times to be sure that there were no discrepancies. The significant number of lows could of course be caused by something else and in this sense be totally coincidental, but I do find it strange that it's been like this since Monday. I'll await how the numbers behave after my next site change before I start tweaking basal rates and ins:carb-ratios. Until then I'm wondering about pumps, precision and performance - as well as how I avoid the next hypo :-)

Replacement of an injured pump

2011-10-08T15:40:00.007+02:00

A couple of months ago or so, I noticed that my pump had some cracks on each side of the reservoir window. I made a mental note to inquire about this the next time I saw my D-nurse, and then forgot about it again - well at least until the next time I saw a crazy number that called for inspection of tubing and reservoir for air bubbles :-)

The cracks are visible as thin white lines on the above pictures, my apologies for the poor quality of these, but close-up detail coverage isn't a force of our camera ;-) The cracks actually go all the way into the reservoir window, which on more than one occasion has made me question whether the reservoir was damaged, even if it was bright new and I hadn't noticed anything when filling it up.

Last week, I had an appointment with my D-nurse and showed her the cracks (in Denmark, insulin pumps as well as the supplies are paid for by the hospital treating you, hence I had to ask whether they would want to just replace it or if I should contact the pump company rep about it). Turned out, the decision and way of replacement would depend on whether the warranty period had expired or not - neither of us could recall exactly when I had gotten the now cracked pump.

A call to the company rep revealed that my current pump was still under warranty and so the company would send an identical replacement model (if the warranty period had expired, the hospital would have provided me with the newer Paradigm Veo). So now I have a replacement pump to set up before I retire the old one by direct mail to the company :-)

Tough diabetes gear

2011-09-06T19:51:00.003+02:00

Last night I'd made the second site change of the day, this time nesting the set on my left thigh. In this process, I'd just binned the new tubing as I already had a new and insulin-filled tubing from the site change I did in the morning. Getting ready for bed, I heard a cracking sound when I pulled up my Pj bottoms. The source of said cracking sound is visible in the picture: One site of the tubing connection had snapped off.

I was suprised though, to find that the set still works - the tubing still sticks properly to the set and it's still possible to disconnect with no issues. I guess our diabetes gear is just as tough as we're stubborn in exchanging them :-)

It requires a lot of time and effort....

2011-08-02T12:56:00.003+02:00

Denmark has very high tax rates - don't know if they're still the highest in the world or if the current government's tax stop has changed that. Our high taxes pay for free education, unless you choose private schools, free medical care (there are some exemptions here as well) and many other services for the benefit of the population.

Diabetes is no cheep acquaintance. Living in Denmark, and for the past few years also in Scotland, however has kept the costs of insulin, pump supplies and test materials low for me. In Scotland, NHS made sure that I got all my insulin and test supplies for free. In Denmark, the hospital I attend pays for my pump, its supplies (except personal pump accessories of course) and the CGM sensors that I may need to use. Insulin is not free of cost. It used to be, but years ago the rules were changed so that we've now got a central subsidy scheme where prescription only medication is subsidised by different rates. If your medicine costs less than 865 kr (approximately $160), you pay the full price, but above that you get 50% subsidised up to 1,410 kr (approximately $265), then 75% for costs between 1,410 kr and 3,045 kr (approximately $265-570), and for everything above the 3,045 kr mark you get 85% of the costs covered. There are different rates for children, but there is still something to pay. For every person, the subsidy scheme is reset 1 year after the first transaction. With the different meds I use, I generally spent most of each "subsidy year" at the higher subsidy rates, but I still find this system sub-optimal. Especially when I was a student, it meant a lot whether I had to pay 1,500 kr (approximately $282) or 15 kr (less than $3) for my medication. Now that I'm employed, I'm better able to cope with these greatly varying medical expenses. I know that this type of system is probably far easier to administrate so that most people can benefit from it, regardless how dependent they are of prescription only meds, but while the average monthly cost for me and other chronically ill people in general is affordable, it is a killer that in reality the costs are so unevenly distributed.

Coverage of test strips, lancets, meters, pen needles and syringes etc. have long been regulated, though mainly for type 2 PWDs, and the regulations have varied from council to council around the country. Most places, type 1 PWDs have access to unlimited amounts of test materials free of charge, while type 2 PWDs can only get a certain number (I believe it's some 150 test strips/month, but am not sure). Some councils have had restrictions on where you could get the supplies (i.e. pharmacy or private vendors), but for most parts you'd still have unlimited choice of products. This is now changing - at least where I happen to live. A couple of months ago I received a call from a representative of Danish diabetics asking me if I had any issues getting the test supplies and needles that I wanted now that my council had made a deal with a private vendor about the delivery of these products. I was rather uncomprehending as the council had used this vendor for years already, and I had never had any issues in the past. Mid-June, however, I received a message from the council that they had indeed made a new deal with said vendor, valid from March of this year and 3 years ahead, and that from now on only certain items would be covered. When I looked through the list of items now covered, I was surprised to see that most of the test strips that I use were no longer covered, especially as I had received my latest order in April and had not had to pay anything.

Annoyed and a bit confused I phoned the municipality services to inquire about this. I was told that the council had decided upon the selection of meters, test strips and lancets based on what was most often ordered. I was still puzzled by this answer, as I know that I order about 1,200 test strips every year for my main meter. These strips are included in the current deal, however only in 50 strips packages and not the 100 strips packages that I normally order. The response was that the pack size had been chosen to accomodate the restrictions on number of test strips covered for type 2 PWDs. Hmm, I guess I can live with this - twice the number of test strip cassettes will obviously take up more space in my closet, but it's the council who'll have to pay more for the higher number of 50 strips packs than for less 100 strips packs. What bothers me more is the fact that the selection of meters included in the deal is so narrow, and doesn't contain a single of the small, handy meeters. Most of the meters on the list are rather big/heavy, their main feature being big displays. Two of the meters that I use are on the list - my primary meter and a newer all-in-one solution that I find some use of when on the move where a single-hand operated device generating no waste is nice. The latter meter, however will probably never be my favourite due to its size and weight (it almost resembles a late 1980'es cell phone by size and weight). I'm of course pleased to find my primary meter on the list, but also greatly saddened to see that the FreeStyle Lite meter that I keep on my night stand for middle of the night/first thing in the morning tests is not. To my knowledge, the FreeStyle meters are the only ones (available to Danish PWDs) with a test strip light, which is why I heart this meter by my bed. I don't have to get up to turn on the light when I feel queasy from a middle of the night low, and most important, I can perform the test immediately instead of having to wait until my eyes have grown accustomed to the light, thus also making it much easier for me to go back to sleep afterwards. I don't even want to think about how little sleep I might get when having to deal with basal rate tests without a meter that I can use in the dark!

Poking my fingers up to 15 times a day (when I'm not wearing a sensor), I have carefully chosen the lancets that I prefer, not to mention the lancing device. None of them are on the current list. It's not that I need to renew my lancing device that often, and it isn't even that expensive, but it bothers me that I can now only choose from thicker lancets than the ones I currently use, unless I pay for them myself. My fingertips definitely tells me that there's a huge difference between using lancets of 30G (a selection of which, as well as some 28G, are available from the current list) and the 33G ones that I've used ever since they came out. In Scotland I had the "pleasure" of getting the same brand of lancets in 30G instead of 33G once, and it was a painful month to get through, leaving numerous black dots on my otherwise dot-free fingertips!

My phone call to the council assured me that of course I could continue to order the supplies I wanted, but that I would be billed for those not included in the current deal. While promising myself that I wouldn't leave this without a fight, I accepted this message. Today I had to order new supplies and as usual I logged in to the vendor's web shop for this. My order contained both supplies included in the deal, a lot that are not, and some glucose gel. The glucose gel and other non-medical consumables (food, books, batteries, etc.) are usually paid for during the check-out process, and I had been told that billing for the supplies not included in the deal would be handled separately, so I just proceeded to check-out to pay for my gel. However, I wasn't able to proceed, just got an error message that I couldn't continue while running "Navision Application Server". I didn't really know what to make of that so I had to call their customer service, and was then told that this was because my order contained items not covered by my council's deal with the vendor, and that the vendor just had not yet managed to set up the online ordering system to deal with such orders! Sheesh!!!! I then had to give my order by phone, and time and time again assure the customer service assistant that, yes, I knew that I'd have to pay for part of my order, and indeed I would do so as well as fight the council separately.

Now I need to gather information about the legislation on this area to see what my options for arguing the council's decision are. My current order will cost me 1,700 kr ($320), and will probably last me for a couple of months, so if I have to pay for everything in the future, I need to revise my budget to include these significant additional expenses. Don't get me wrong, I don't see it as an obligation for everybody else to pay for my medical expenses, but I do find it wrong that I'm charged such high taxes without then being able to choose what I want these tax money spend on. If I and other PWDs pose too high costs for the council then I'd rather the council limit the total amount they'd be willing to pay for my D supplies than having them try to force me to use "medieval" remedies. I know it's all about budget cuts, and that some will probably see me and other Danes as spoiled kids when we complain about these types of restrictions, but it's probably because they have never been used to a tax-financed health care system, or if they have, then have never had to make as much use of it as chronically ill people have. In a country with high tax rates nobody will make equal use of all the services paid for over the taxes, it's a joint club and those who have no need for medical aids may have a host of school-aged kids who get free education, or spend hours every day on the roads and bridges that are also partly or fully financed by taxes.

It does indeed require a significant amount of time and effort to cope with the challenges presented to us in consequence of diabetes - especially when we don't only have to fight our own body but also municipal decisions affecting our health.

What kept me too busy to blog......

2011-07-26T16:04:00.015+02:00

As I mentioned in my post last week, I'd give you a review of what has kept me from blogging these past 3½ years, diabetes included. In short, I'd say that it has been a mixture of intensive work and everything around deciding to build the new house that we moved into in December last year. This has obviously all been seasoned with diabetes high and lows, but also with a final exam and subsequent unemployment on different levels, while trying to land either a job or funding for a research project that I want to carry out.

My leather-bound thesis - its contents kept me busy for the past 3½ years :-)

In my last post before my un-noticed hiatus, I was about to leave for Glasgow as part of my postgraduate studies, and part of the preparation for that trip involved getting my hands on a CGM. I had hoped to update you on my experience with the Minimed Paradigm CGM, but that didn't happen in a timely manner, and while every experience is individual, I'll definitely spare you a lengthy review on the pros and cons of this system :-) In short though, I can say that I have used Minimed's system on and off ever since. I say on and off because while I'd were it continuously whenever in Glasgow for extended periods of time, I'd typically take a break from it when back in DK, only using it for special occations (e.g. stressful weeks around deadlines, conferences, moving, etc.). While it definitely does have its flaws, I wouldn't have wanted to be without it over these years and I'll likely continue to use it in the future when need be. Even though my current system cannot provide predictive alarms, it saved me numerous times in Glasgow. However, I've never found it to be good with sudden, drastic changes, and as these do occur - sometimes not even giving me enough time to actually feel them - I have experienced the impressive helpfulness of the Scots and their emergency services. These episodes were fortunately far in between, and only one had other consequences than my pride and D-self confidence getting knocked down:
My laptop screen didn't survive a "dance" with a lamppost during a severe and sudden-onset hypo. My laptop was in my backpack and as I tried to stay on my feet with a BG well below 2 - the EMT arriving a few minutes later tested me at 1.2 (approximately 22 in American measures) - I stepped/fell backwards against a lamppost one or more times before settling on the sidewalk. It's never fun when lows affect anything but yourself, yet fortunately I came back up without being too hurt and the laptop screen could easily be replaced.

My postgraduate study obviously took a lot of my time over the past years. It's been super-exciting and super-tough at the same time. While I was a registered PhD-student with a Glasgow-based university, my project had me spent just as much time at a Danish university, carrying out specialised analyses in the research group where I did my graduate work years before. A combination of lab-work, data analysis and extensive progress reports made for the typical work weeks to hover around 50-70 hours - certainly not healthy to anyone, let alone PWDs. I'm fairly convinced that all this work on top of all the "life" things that I had to fit into my schedule played a big role in the difficulties of managing D that would sometimes be manifested by hard crashes - of course almost always while asleep when I'm least likely to cooperate with Jimmi's suggestions or demands. Especially the last part of the project work was tough as I not only had to finish a lot of experiments and write up a monster thesis of 200-250 pages (I'd have preferred the Danish version of just 50-60 pages along with publications ;-)), but at the same time also had to take part in all the preparations for becoming house owners. There were a lot of issues around the handing over of our house, so we ended up getting it just a few days before I had to leave for Glasgow to hand in my thesis. I was beyond stressed at that time, but somehow managed to hand in my work, register as unemployed, pack down our old home and move into our new house in just about a week's time! This was, however, after several bad nighttime hypos on those nights where I actually made it to bed in stead of working on my thesis.

The beginning of 2011 was a combination of getting used to our new house, and the fact that its location generally meant longer bike rides for me (insulin adjustments required), as well as trying to sort out future work plans and possibilities. I had hoped to have at least the work part sorted rater soon as I was given the impression that we might find a bit of money to continue the collaboration from my postgraduate study, at least on a temporary basis. My supervisor in Glasgow and I had prepared project plans to further explore my work and findings. Both of us applied for money to support different versions of this work, but neither of us had any luck with our applications. When I was back in Glasgow for my viva in February, we managed to get things sorted for a temporary research position, though only part-time. My contract would have me mainly working in Denmark, and when it ended in June it was perfectly matched for yet another trip to Glasgow for graduation. When I returned from Glasgow, I started a new position in my old DK-lab. This is also a temporary position, but it's full time and hopefully it will provide me enough time to have at least one of my research manuscripts submitted for publication in order to increase my chances of attracting funding in the future :-)

My parents, me and my supervisor at the graduation reception

Graduates and their families filling the graduation garden

"Life"......

2011-07-20T15:34:00.009+02:00

Those of you who used to read my blog will know that it has been very long since the last update here. It’s not that I’ve been cured from diabetes and therefore have had nothing D-related to write about. There have been plenty of blogable events involving diabetes in the past 3½ years, but there just hasn’t been time – or energy – from my side to consistently blog while working 40-70 hours a week on my postgraduate studies.

Last week, I read a blog post by Alexis over at I Run on Insulin. In essence, her entry was about how that little thing called “life” sometimes makes it difficult to do all you the things you want/need/have to do, online as well as in person, when there’s just 24 hours in a day. I had to comment on this, and that lead to a comment for me from another blogger that my updating my blog was missed. Even if just one or very few people think this, I’m very honoured by it :-)

So here I am with the first update since January 2008, but whether this entails a full revival of this blog, I dare not promise. If “life” allows, I’ll continue to try to check in here once in a while, maybe even try to do the required amount of dusting on my blog settings (layout, about me info, blog role etc.). I’ll also try to post again in the very near future to answer a couple of questions related to what I’ve been doing since 2008.

To end this, I’d like to repeat my statement in my comment for Alexis’ post last week: I know that the DOC is a very tolerant creature that will just appreciate those few times when I actually manage to contribute – and thank you all for that, and for being such an incredible source of advice and support when we need it!

Jimmi and I in front of the Famous Grouse at Glenturret Distillery in Scotland this summer

Getting everything settled

2008-01-27T20:22:00.000+01:00

Friday next week I will leave for Glasgow, spending 5 weeks over there. 5 weeks – with only a week to get everything settled for my departure!

Before Christmas my supervisor and I agreed that it would be good if I could come to Glasgow in the beginning of this year, but even so I don’t feel like I have had enough time to actually plan my trip. The reasons for this are that work has been crazy during January. My Danish supervisor expected me to assist and train a foreign post-doc coming here for a short visit end of January in order to learn how to analyse some samples that our lab had run for her. This was planned even before Christmas, and as I knew she would be here the last 2 weeks of January, I figured that I probably wouldn’t be able to leave for Glasgow until beginning of February. In the first days of January, I did start to make a draft plan for my trip, as well as the experiments that I would want to conclude before leaving. I had a plan for my experiments all set to start January 7^th, and figuring that I could use the breaks in between the experiments to make the final arrangements for my Glasgow trip. However, as I wrote in my last post, my plans got messed up by an e-mail I received on January 7^th, and because I have a short-term visitor that I need to help with data analysis this past week has been more than stress-full.

I managed to have a very decent draft of my review done last Sunday, and have used whatever few minutes I would have during the week to proof-read and refine it, while having to use the majority of my time to trouble-shoot data processing and software installation issues. At the same time I also had to get my trip to Glasgow arranged, ordering the tickets, so that I would be able to participate in a lab meeting over there at the 5^th of February – a lab meeting I have to prepare a 20-25 min presentation for as well!

Being busy for me usually means an increased frequency of hypos and as my regulation haven’t been the best the past couple of months I have had even more issues with this. Just before this crazy schedule started I had an appointment with my D-nurse and we agreed that some basal testing was needed. Thus, on top of all the work/study related stuff, I have also tried to fit in some attention to basal testing. It has been very difficult, and it is probably not the most optimal to combine busy schedules with basal testing, but I felt I had no choice as I have had far to many hypos in general lately. I have been making some changes to my basals during this period of basal testing, but the changes don’t seem consistent – as in one day they appear to work, the next they don’t – and I still have too many hypos to actually not worry about my coming trip to Glasgow.

I went for a blood draw Friday morning to get some thyroid results, and at the same time I had an A1c done. The result was in my file on the Funen Diabetes Database later that day: 4.9%! That is a 0.4 drop from beginning of November, and the lowest A1c result I have ever had. Aside from the fact that Alice will probably “kill” me when I call her on Tuesday ;-) I don’t think I have even been that frustrated with a low A1c result before. Had this results been achieved without all the hypos then of course I would be thrilled, but fact is it has been achieved due to daily hypos, at least for the past month or so. That is utterly frustrating, especially when the changes you try to employ do not seem to help!

I have been thinking a lot about what to do about my stay in Glasgow. Even though I know from experience that changing my setting, even if it is just for a couple days at my parents, will generally elevate my sugar levels - the extent of the elevation depending on the actual “new” setting – I am worried about the risk of being alone with a hypo in Glasgow. Not to mention the fact that Jimmi has also been close to the past months’ low sugars and is of course worried too, because he cannot be there to help me. He will come for a short visit, but the majority of the time I will be on my own. I much hope that I worry without reason, but it is difficult, especially with the events from Hamburg this summer in mind. I plan on asking Alice if there is any chance in the world that I would be able to borrow a sensor to bring to Glasgow, but given the short notice and the length of my stay I don’t expect it. Anyway, I hope that the accommodation will enable me to notify someone about my condition and how they should react if I act strange or don’t show in the morning, and I will probably also make a deal with my colleagues in the lab about calling me if I’m not in at a set time and have them contact someone who can get into my room should I not answer. Otherwise I just hope and pray for my sugars to behave while I’m over there, so that none of the emergency contacts needs to get involved!

Wish me luck, and I will try to post about my adventures in Glasgow, if not during my stay then at least afterwards :-)

18 years, hypos, and busy schedules

2008-01-16T16:51:00.000+01:00

In Denmark 18 is the legal age, allowing you to get a drivers license, vote, and officially take care of your self etc. Today, D and me turn 18 together, but somehow it doesn’t seem quite as big and important as when I turned 18 twelve years ago :-) Still, I cannot help to think about the progress within D research and treatment the past 18 years have shown. Although the cure that was also promised me within a few years when I was diagnosed still remains to be found, a lot of other important milestones have been reached. I remember a nurse on the hospital where I was admitted as newly diagnosed showing and telling me and my parents about how she could now eat and enjoy sweets again (as in not eating them to correct hypoglycemia) because she had gotten an insulin pump. Obtaining more information on the insulin pumps of the time blurred that picture quite a bit, and for several years I thought that I would never want to be treated that way because of the risk of DKA. 16 years and 3 months – and, indeed, a lot of progress – later I was hooked up to one for the first time, and while being somewhat reluctant about it, I have come to appreciate what this treatment strategy offers me in terms of freedom. It does of course have its issues and drawbacks, but I guess most treatments and/or equipment have that ;-)

Hypoglycemia and a busy schedule do not work well together. Today, once again my afternoon has been disturbed by a low BG, causing me to have to take a break from what I was doing. I couldn’t concentrate on what I was reading, and thought that I might as well take advantage of the time I needed to spend away from it, repairing the low BG, and write on my blog :-)

I am in the process of working this out, but it a process that is significantly slowed down by an immense amount of work-/study stress. Just after New Year I actually started the process of thoroughly testing my basal rates, as my numbers the last couple of months – and in general if you ask my loving pump- and D-nurse ;-) – clearly indicate that insulin levels need to be reduced. Even though I had a lot of plans to effectuate at work along with planning my trip to Glasgow at late January or beginning of February, I felt that I could work some basal test into the scheme. In the first week of 2008 I felt I was moving at a very decent pace, working out plans for experiments to carry out during week 2, researching the areas that I should check out when coming to Glasgow, as well as putting down the experiments and other practical issues that I should take care of over there. I knew that I was expected to stay in Odense until end of January to help an Italian post-doc with some data analysis, and I wanted to test the data and the software necessary for its analysis prior to her arrival mid month. This was a clever thought as I have, of course, run into trouble with this – bioinformatics is always a challenge :-)

My feeling of energy for the different tasks and assignments suffered an abrupt disappearance when I opened my University of Strathclyde mailbox in the beginning of week 2. I had received an e-mail telling me that my 3 month literature review was due now, and should be uploaded electronically as soon as possible. Reading the mail my jaw dropped down, and my mind started racing: What 3 month literature review? What should it contain? When is the exact deadline? Have I heard about this before?........ I search the university web-site to find information as I cursed the inability to obtain sufficient information about the obligations as a Scottish PhD-student. I couldn’t find the information I needed so I replied to the e-mail to inquire about it. That gave me an attachment of the institute’s post graduate study handbook with a note that I could find the information in that. Reading the 52-page Word-document sure provided me with some needed answers, both regarding assignments that should be handed in during the study (the intended contents of some of these reports were very well described) and the courses that I should attend. Unfortunately, the 3 month literature review that I was most keen on obtaining information about, was only just mentioned, its contents not described (I have later received another handbook, where it is described in more detail). Therefore, I started sending out inquiries to my supervisor in Glasgow as well as one of his colleagues. I didn’t want to start writing anything before I had some guidelines on it, and I could see that I was actually supposed to attend a course during my first year of study, where writing of literature reviews would be dealt with, but of course, since I have yet to come to Glasgow for several reasons, I haven’t attended said course :-/

Thursday last week and Monday this week, I finally received some information about what this review should contain, how long it should be, and when it should be handed in. I have 2-4 weeks to prepare an exposition about the literature available within the area of research in my PhD project, concluding with the aim and reasons for doing the actual project! It should, of course, be fully referenced. Now, if I didn’t have the data analysis of a post-doc coming up with all its issues, and the planning of my trip to Glasgow already at my plate, I probably wouldn’t fuss about this deadline, as I am not starting from scratch after all. I might even have enough energy to focus more on the basal testing I am supposed to do. But this isn’t the case, and even though I’m annoyed at low BG’s interfering with my ability to perform and concentrate, I find it very difficult to sit down and focus on analyzing the data that I have on my BG excursions in order to make reasonable changes. It is actually crazy, as taking the time to get an overview of it would probably safe me a lot more time and energy than it would cost me in the first place. Does that make any sense? As it is now, I just make minor changes from day to day, but this also means that it will take somewhat longer to get it all adjusted. I don’t know, I guess at the bottom-line I’m merely frustrated about the work load that have suddenly been placed upon my shoulders, and adding diabetes management to that doesn’t make it any easier. Anyway, it was nice to vent here :-)

Tagged for 7

2007-11-20T21:05:00.000+01:00

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:

You've got to link to the blog of the person who tagged you
You need to post these rules on your blog
You have to list seven random and/or weird facts about yourself
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? ;-))
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:

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 :-)
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 ;-)
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? :-))
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
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!
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 :-)
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 :-)

The adventures of Nemo

2007-11-12T20:29:00.000+01:00

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 :-)

Found: Nemo

2007-11-07T19:48:00.000+01:00

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.

A perfect day

2007-10-28T19:30:00.000+01:00

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!

Impatience

2007-10-22T19:21:00.000+02:00

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 when 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 :-)

I'm still here

2007-10-15T20:34:00.000+02:00

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 16^th! 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.

Diabetes and hypothyroidism

2007-07-18T16:15:00.000+02:00

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 :-)

To pay: 1779 kr

2007-06-25T19:51:00.000+02:00

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 12^th 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 4^th, 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 12^th and I was officially included in their member crowd as of June 1^st. 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 2^nd 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!

Yet another comeback :-)

2007-06-19T21:42:00.000+02:00

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 14^th, 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 Reeper bahn, 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!

Back to blogging

2007-04-15T20:17:00.000+02:00

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 1^st. 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 :-)

Very belated 7

2007-03-15T16:48:00.000+01:00

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! :-)

Different answers to a single question

2007-03-06T20:16:00.000+01:00

I know I have been tagged, and I will do that 7x7 scheme in the nearest future. Right now I need to vent though.

Work has been extremely busy lately. I still have samples to run, data to analyse, reports to do, etc. for 5-6 of the 8 different projects that I’m involved in. Also, I have to take care of all the paper work that has to do with my future Ph.D-employment. One of the things that need to be clarified in connection with this is the health insurance issue. I actually thought that would be easily overcome, but apparently I was wrong!

I was told by my German supervisor-to-be that his personnel department had told him that I need to get a German health insurance, so he advised me to look into that. I thought that I would be able to do with either a small expansion of my current general insurance, or by the coverage offered by the Danish Health Insurance, and if that was the case I saw no need to get involved with a German insurance company. So I started out searching the web-pages of my general insurance company for more information on insurance questions when travelling and working abroad. I talked to the relevant department and was told that of course I could underwrite an additional “youth travelling insurance” to cover all cost of medical assistance and transportation, but I should also consider the possibilities of the European Health Insurance Card (EHIC), which I could get from the municipality of Odense.

Thus, I contacted the relevant department of the municipality of Odense, and after having my call diverted a couple of times, I finally got hold of someone who knew about this EHIC. She told me that I would need to contact the Danish Health Insurance Department (DHID) as I might have to fill out a form before I could get the card. I got the number for DHID, and got to talk to a very nice guy, who informed me that since my working destination would be Germany, the EHIC would not do, I would indeed have to get a German health insurance. Great! At least he recommended a German health insurance company to me, and told me to , and request a specific form. I looked up the recommended insurance company on the Internet. Their webpage was rather confusing, and only in German (I do know German, but it has just been so many years since I have used it that it takes a longer time for me to scan information when only provided in German). I couldn’t really find what I was looking for, so I decided that I might as well contact them. I found the contact information, hoping that it would hold an e-mail address, so that I could just write a mail. There was indeed a link for e-mail contact, however it turned out to be a specific e-mail form where you had to fill in a bunch of information and only had very little room to actually write your question. The funny thing was that among the required information were address, postal code, and area. I just keyed in my Danish ones, but those were not accepted. The major problem seemed to be the postal code. Danish postal codes are 4-digits, whereas German ones are 5-digits, so of course this form wouldn’t accept my Danish postal code! I ended up keying in my Danish address, the German postal code for my workplace-to-be, and just “Denmark” as the area. Finally it was accepted, and I was informed that my request would be answered within 24 hours.

This afternoon I received the answer from the German health insurance company:

“Dear Mrs. Rosenqvist,

thanks that you`re intrested in a AOK insurance.

If you`ll work in germany, you need the European Health Insurance Card (EHIC). You`ll get this Card at your Helth Insurance Company in Denmark.

This Card is all you need to go to the doktor in Germany.

If there are any questions, please call me or send a mail.”

Now, I have spoken to a lot of different people the last couple of days, and I still cannot get a straight answer! According to the German health insurance company I do not need other than the EHIC! As soon as I had read this message, I called the DHID, but of course their opening hours had ended for the day, so I will have to wait until tomorrow.

Who should I trust, when they keep giving me different answers??!!!

As a more happy side note, Fido was back for a sleep-over this past weekend, and despite the fact that she had her dog basket along with her to sleep in, this time she preferred to sleep in the soft blankets on our couch :-)

Sweet isn't she? :-)

Damn Monday!

2007-02-26T21:48:00.000+01:00

I am not a big fan of Mondays, the weekend is over and there is no sleeping in (I am not a morning person, despite the fact that I like to get up and use the day fully when needed). Today has just been a prime example of a damn Monday!

I started the day on the high side. I attribute this to the fact that yesterday was a genuine lazy day with no virtually no exercise (the weather killed the motivation to get outside). Because of this I continued by lazy-day-basal until mid-morning today. By that time my BG seemed stable and in range.

I am still trying to get to the bottom of the work piles I have at work. Today this meant sitting in front of the computer all day, gathering results from one of the projects. I had my usual afternoon snack around 3 o’clock, and continued working on these result. At 4:00 PM Jimmi sent me a message, asking when I would be coming home, and I answered him that I would just want to finish those results and then I would be heading home so that we could have dinner together before he would leave for a general assembly in one of the unions he is a member of. Around 4:30 PM I finally finished the gathering of results, and mailed the resulting excel-file to the PhD-student in need of them. I was satisfied having finished that off, and started getting ready to go home. This implied a test: 1.8 (32). Damn!

I drained 1/3 of a bottle of OJ (ca. 100 ml), and called Jimmi to let him know that I was getting ready to go home, but that the BG was holding me back. 15 minutes later I retested, hoping to see the BG going up. No such luck, it had dropped even more, now giving me a 1.5 (27). More juice, some chocolate-covered raisins and more waiting and testing. Almost an hour after the first low reading, I had had a whole bottle of OJ (330 ml) and a lot of chocolate-covered raisings, and frankly, my patience was up. I wanted to go home. I would normally not get on my bike with a reading below 4.0 (72), but I made an exception today, as I figured that at least the BG-trend was heading upward and I should have plentiful carbohydrates on board.

When I got home, Jimmi had started eating because he only had 15 more minutes at home before he had to leave for the general assembly. I tested: 3.1 (56) and sat down to eat. I didn’t bolus until after the meal, but still 90 minutes later I was 2.6 (47). The low trend apparently continues, and I am still awaiting the anticipated rebound. Maybe it will come during the night?

I am up for a test before bed time. I am looking forward to see if this damn Monday will continue, or if I have finally managed to get the BG up in safe range.

Back to normal

2007-02-22T18:32:00.000+01:00

I returned to work Tuesday this week. I had planned to take it easy the first day, but as work had literally piled up during the days I had been ill, that plan never became reality. I had a load of sample to digest, and as things went smoothly with the first half of the samples, I decided to start the digest of the second half offset of the others. That took a little longer than anticipated......I had the last part of the samples ready for over night digestion at 5:45 PM (I started work 8:15 AM)! To make matters worse, I had to stop by a supermarket to pick up some dinner for Jimmi and I on the way home. Thus, I arrived at home at 6:45 PM. Man, I was exhausted! Of course a BG of only 2.8 (50) did not help matters either :-/

Now, as I told you in my last post, Jimmi and I had company in the form of his dad's little dog, Fido. Jimmi had - against normal practice - served Fido her dinner before preparing ours. She hadn't eaten it all, and once we started working in the kitchen, she was all around us, very interested in what we were doing, and not least if something should be left for her :-) As we had gullash soup there were no leftovers for her, and I guess that she was a bit disappointed about that. When we hit the couch that was all forgotten though, because that meant that she could jump up and nest on the blanket in between us, calling for our attention. Actually, she had almost fallen asleep an hour later, when we were to take her out for her night walk before we went to bed. She woke up fast though, and didn't seem short of energy, keeping the line as well as my arm straight for the whole walk :-) Jimmi took this photo when he walked her earlier that day, and as you can see even though Fido is not very big, it can be hard to tell who is walking who ;-)

Yesterday Fido's family picked her up again, so when I came home, the only trace left of her was all the shed hairs as well as part of a chewing bone, she didn't finish :-)

Double up

2007-02-18T19:25:00.000+01:00

The majority of this week I have spent at home on the couch or in bed. Tuesday I went to work as usual. During the day I noticed a progressively runny nose, and as I had a feeling that whatever had caught up on me was probably going to hold me away from work the following day, I made an effort to finish as much as I could before leaving. As I walked down to my bike I felt like the Earth was moving underneath my feet – not a good sign! I wasn’t low, I was just weak and by then sure that I was becoming ill. The bike ride home took almost twice as long as usual and I was exhausted, when I finally arrived. I hardly had any appetite, so I just had a tiny portion and then curled up on the couch.

Wednesday morning I felt just as lousy, so I was definitely not going to go to work. I didn’t realize how awful my voice sounded until I called our secretary at work to tell her that I wasn’t coming in. When I introduced myself on the phone, her immediate response was: “Oh my!” She told me that she would pass on the notification of my illness to the institute secretary, and wished me a speedy recovery. Later that day – in between all my naps – I checked my mail. The secretary had sent an e-mail to the institute secretary saying that I was sick, and probably would be for a bunch of days. I just hoped that was an exaggeration, but maybe she was right after all.

I am very seldom sick. I do get an occasional cold, but rarely something that restricts my daily activities too much. This week has been an exception, though. I have been feeling so tired, I have had a fever, something which is also a rarity for me, and most importantly I have had breathing difficulties. I have coughed a lot, and it has been difficult for me to take my asthma medication without coughing it all out again.

Friday I decided that I better get an appointment with my doctor, just to make sure that I hadn’t caught pneumonia or something like that. The doc and her trainee couldn’t hear anything alarming on my lungs, and told me that a lot of people were sick with fever, headache, sore muscles, and sometimes cough too (together also known as flu). I will not refute the possibility that I got the flu – for the first time in decades. I didn’t get a flu shot, never have, but I haven’t had sore muscles and only transient headaches, which are just as likely caused by BG-fluctuations. Anyway, I do agree with the doctor that it probably is some kind of virus, whether it is the flu virus or not. What I don’t get, though, is her reasons for giving me antibiotics. I will have to discuss that with her another time, when I am not ill. She asked me how my insulin levels were, and I told her that they were twice the normal. She seemed a bit surprised about that, though to me it just tells that my body is fighting some kind of infection. Whether feverish or not, I usually need a lot more insulin when I am sick. Also, this doctor has nothing to do with my diabetes management. She is just my general practitioner, who I might see once a year, at most, so I don’t expect her to be in touch with how I control the D or how my sugars are. And my sugars have generally been good during this illness, although it has taken double the amount of insulin that it would on non-sick-days.

The doctor told me that usually they would just sent people back home to their beds, but given that I was diabetic, and that I apparently needed a lot more insulin than usual, she would give me some antibiotics. The way she said it, at least to me, made it sound like “we all know that diabetics are immuno-compromised, so we better not take any chances”. I know that T1 D is an autoimmune disease, but I have never considered myself to be immuno-compromised. In fact, when I compare myself to both my immediate family and to friends, I seem to have a very efficient immune system that rarely leaves me sick, and if it does, it makes sure that I recover faster than most of the people around me.

I started the antibiotics Friday. I don’t know if they have had an effect, or my body is just recovering itself, but at least I am now feeling that I am approaching the surface of normality once again. I will probably stay at home tomorrow too, but then go back to work on Tuesday. By that time I will also have a lot to catch up upon. Isn’t it amazing how everybody else seems to be so hard-working, the one time when you have to call in sick? The first two days I was at home I received e-mails from two of our collaborators telling me that they were sending samples for me to analyse. Great! Fortunately I have had one of the students at work check the mail for me to make sure that any shipped samples would be properly stored until I am back to take care of them.

I may have infected Jimmi, as he has been quite ill the last couple of days too. Today he is a little better, though, and I suspect that he is doing what he can to get well enough to justify the dog-sitting agreement we have with his father, starting tomorrow :-) His dad and family are going on winter holiday, and we promised that we would take care of their adoring little dog.

New design

2007-01-29T20:02:00.000+01:00

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 ;-)).

Swimming

2007-01-28T19:27:00.000+01:00

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 :-)

When D affects......

2007-01-22T20:05:00.000+01:00

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?

17

2007-01-16T19:25:00.000+01:00

”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 17^th 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 :-)

Miscellaneous Christmas rants

2006-12-28T15:13:00.000+01:00

Hope you all had a joyful Christmas! Mine was okay.

The evening before Christmas, we spend with Jimmi’s mother and her boyfriend, a very relaxed evening - despite the intensity of the rolling-dices-for-presents-game (everyone brings some small presents specifically to this game. You role a dice, and every time you get a 6, you are entitled to pick a present on the table. When all presents have been picked, a timer is set and the game continues, only now, when you get a 6, you pick a present from one of the other players).

Christmas morning Jimmi and I went to the local zoo, as entry was free between 10:00 AM and noon. When leaving, we talked to one of the inspectors at the entry, and she said that in these two hours more than 5,200 people had entered the zoo. The weather was nice, so it was actually a great opportunity, especially to families with younger children, to get out and use a bit of time and energy walking around the park.

We spend Christmas eve at Jimmi’s father’s house with his wife, Jimmi’s younger brother, S (11 years old), and their sweet little dog, Fido. We had a three-course dinner (split into two, because S was too excited about lighting the Christmas tree and getting presents). Appetizer: Rice porridge with cinnamon. Main course: Duck and roast pork with potatoes, potatoes in caramel coat (they are called “brunkartofler” in Danish, and are essentially small potatoes that are coated with a mixture of warm, liquid sugar and butter in a frying pan until they are warm and coated with this brown sugary stuff. Yum!!), red cabbage, prunes, and apples and jelly – a typical Danish Christmas dinner. Due to the excitement of S, we then danced around the Christmas three – Fido joined us, not really knowing what this was all about, but she definitely did not want to be left out of it, much to our joy – singing a few song and then S was allowed to distribute presents. When everybody had opened their presents, we went back to the table for dessert: Ris a la mande (the dictionary says it should be called rice pudding, although I don’t think that is quite the same) with cherry sauce. There was a bit discussion about who actually got the whole almond hidden in the dessert, and therefore, who was entitled to the almond-price, but as the dispute was between S and his father the price stayed in the family :-)

Christmas day (Dec. 25) my parents stopped by as they had taken my sister back to see her new apartment. Otherwise the day was used to relax.

The second Christmas day (Dec. 26) was used on Christmas lunch – again at Jimmi’s father’s house – allowing us to also say hello to Jimmi’s younger sister and her boyfriend. They live in Copenhagen so we don’t see them too often.

My BG-levels behaved very well during the Christmas days. Almost all readings was in range, only a few outliers – 2.0 (36) being the lowest and 9.8 (176) being the highest. I have been experimenting a little with the use of the dual wave bolus for more meals, and it does actually seem to smooth sugars out even more.

Overall this would make a very nice Christmas if it wasn’t for the early “Christmas present” that I got just 4 days before Christmas, and people, of course, couldn’t help asking about – explanation follows!

December 20 was the big clean-up-and-Christmas-lunch-day at work. Everyone had been assigned to an area, in order to keep everyone busy and make sure that every inch of the lab and mass spec-rooms would be cleaned. It worked very well. After a common breakfast in the coffee-room – to make sure that everyone had energy to use for the clean-up ;-) – we swirled through the labs leaving them clean as ever. I worked with a couple of post-docs in the back part of the main lab. We worked pretty effectively, so by 11:30 AM we were done, and since the lunch was not until 1:00 PM, we took a round to make sure no one else needed help before we drifted back to our offices to clean up there.

I share my office with 3 master students, none of them being there for the clean-up. One of them was excused, though – she went into labor that day, and by the end of the day she had given birth to a beautiful baby girl :-) Being the only one in my office, I could of course be tough and throw out everything that didn’t have a name on it, but I refrained from doing that and just focused on my own stuff (which, by the way, takes up most space in our small office). When I could actually see my desk again, I checked my mail. I was excited to see a mail regarding the PhD-application I just managed to send in before deadline end of November. I knew that the assessment committee was to meet at December 18, and I was told that they expected to be able to give answers to the applicants before end of December. To receive a mail regarding the application less than 2 days after the assessment committee meeting, what could that mean? Was it rejected or accepted?

I opened the mail, and was referred to an attachment. I opened the attachment and couldn’t help scanning it quickly – only to find out that I had not been chosen to receive a stipend :-( I then carefully read the letter. They had found my application to the specific project very qualified (no kidding – the project was about mass spectrometric quantitative phosphoproteomics in mitochondria from T2 diabetic muscles, and I have worked with quantitative proteomics in my Master’s and am currently working with phosphoprotein analyses, having 6 years of mass spectrometry experience plus a lot of knowledge about diabetes!), but they had found another candidate to be better qualified! My initial thought – besides disappointment – was “Who the hell could that be?”

I ranted a bit about this rejection to a couple of people, including Jimmi of course, and decided that I would question my supervisor, who happens to be one of the supervisors on that project too, about what qualifications I was missing. Just before the lunch I ran into him in the hallway, asking him: “So, I heard that someone but me was better qualified for the project….?”

“Yeah, I had the chance to place both Z and you in Ph.D-positions, and we (as in you and I) have this meeting with W from Hamburg in January, so Z was given this one – but I would like to discuss this with you”, he replied.

“Sure” I said, while inside me anger was starting to build – in close contact with the aforementioned disappointment!

I didn’t enjoy the lunch as much as I had wished to, and really just wanted to go home early. Before going home however, I wanted to discuss the issues with my supervisor, since I wasn’t sure when he would leave for the Holidays (turned out that this was actually his last day and he wouldn’t be back until beginning of January). Fortunately, he had the time to talk that afternoon.

“I didn’t know that you had applied for that stipend” he said, closing the door to his office.

I told him that I saw the advertisement just 3 days before deadline, and he was out of the house at that time so I didn’t have the possibility to discuss it with him, but as he had mentioned it to me earlier in the fall, before it was announced, and because the deal with this guy from Hamburg is far from settled yet, I saw no reason not to apply for this.

He could understand that. He then told me that he had encouraged Z – one of his Master’s student, who just graduated the week before - to apply for this stipend, and that we were both very qualified for this project, but he thought that it might be good for me to get away from our lab for a while – once again mentioning the up-coming meeting with W from Hamburg.

I told him that I of course do not intend to never leave the university, but that I was beginning to loose patience a bit, and therefore saw nothing wrong in applying for whatever possible positions and project of my interest.

I guess this actually requires a bit more background for you to understand my reaction. You see, when I graduated in October 2005, I clearly stated to my supervisors that I would like to obtain a PhD-position, in case they came across something. Back in the beginning of summer my supervisor at the university was contacted by this guy, W, in Hamburg, who would like to set up a cooperation with our group. He was also looking for a candidate to a PhD position linked to the anticipated cooperation, and thus asked my supervisor if he happened to have any candidates at hand. My supervisor asked me if I might be interested, otherwise he had thought about Z for this. I said that I might be interested, but that I would like to learn a bit more about the given project before I made my decision. My supervisor fully realized that and agreed that we would need a meeting with W before we made any decisions about the cooperation and PhD position. Unfortunately, my supervisor had a very busy fall, so he and W didn’t manage to find a date that fit both of them until November 7. W would come to Odense, and plans were made for him to give a talk and for a subsequent meeting discussing the project plans. However, shortly before the meeting was to take place, W sent us a mail that he would have to cancel our appointment as he was set to go to a job interview that he could not re-schedule. He would like to re-schedule our meeting as soon as possible. Again, my supervisor’s calendar made the call – a new meeting will not be until January 17. Because of this unsettled Hamburg-deal, and the fact that a possible future supervisor might be looking for another job (that is not very reassuring in my point of view!), I of course did not stop looking for alternative answers to my PhD-wish. One of them could have been this project within the PhD school of Molecular Metabolism. Just my bad luck that this project was almost assigned to another candidate before being advertised. Z is an exchange student, who has just completed her Master’s in our group (a week before Christmas this year). She had a wish to stay, but without work or further studies on hand she would have to leave by January 2007, so of course this stipend was a golden possibility for her. However, it does leave me a let down, seeing this stipend go to a newly graduated candidate, when I graduated 15 months ago and have worked with protein and mass spectrometric analysis in this group for the past 6 years. When I was preparing to leave after having discussed the issue with my supervisor, I heard him bring Z the good news (she hadn't heard yet that she had got the stipend). Z replied that this was the best Christmas present she could get this year. I didn't really feel like stepping by her office to congratulate her. Sorry for that, I just needed to vent!

My supervisor and I agreed that we would have to get clear-cut answers from W regarding his search for other working places, as well as the exact project plans before agreeing to anything. I believe I got my point about impatience through, as my supervisor continued to say that if we could agree to start the project, then he wouldn’t mind aiming for a start in March, or whenever it would fit W, relieving me from my current contract, which otherwise does not terminate until May. So far so good. Still, I just have a feeling that I need to be prepared for something else, if this Hamburg-deal doesn’t work out. Therefore I am currently signing up for the competition about other PhD stipends other places too, so that I will have something to fall back on, just in case.

In hope of a Happy New Year fellow bloggers!

Christmas lunches

2006-12-15T15:35:00.000+01:00

Today is probably the major day of Christmas lunches in DK. On work we have the department Christmas lunch this afternoon, followed by the entire faculty Christmas party in the evening. I miss both of these though, as Jimmi and I have other Christmas lunch-plans.

Next week the research group that I work within will have a local Christmas lunch. We have this every year, the last couple of years combined with a thorough cleaning of the lab, mass spec-rooms and offices. So on Wednesday next week we will start at 8:30 AM with joint breakfast and planning of the cleaning. When we are all done around noon, we will gather in the newly cleaned, and now decorated, coffee room for the last group meeting of the year and, not least, the Christmas lunch :-) It is usually very enjoyable so I look forward to it.

Christmas and Christmas lunches have always been a challenge for me since the D entered my life, so I am also looking forward to see, how it will work with the pump in stead of injections. So far (2 Christmas lunches/parties) the results have been satisfying, but that could just as well be “beginner’s luck” ;-)

I had an appointment with Alice earlier this week, and once again we concluded that those late afternoon basals need to be tweaked just a bit more, as I still has a tendency to run low during those hours. Alice has just been to Cape Town for a diabetes conference, where she had heard/seen results on studies of augmented use of the combined bolus even for ordinary meal that we usually do not consider to be fatty. According to Alice, it seemed like the use of the combined bolus could smoothen the BG level even more if also used for ordinary meals. She suggested me trying it, something like 80%/20% or 90%/10% for 1-2 hours, on some of my meals to see what the effect would be. As it is now I virtually only use the combined bolus for pizza and lasagne. I was planning on using it for the traditional Christmas dishes though, but maybe I should broaden my use of it even more? I haven’t decided how to go about it yet. If I am to try it, I need to do it in a “controlled” fashion, so that I do not have to take too many variables into account when evaluating the result.

Busy days and hypos

2006-12-07T12:59:00.000+01:00

Why do these always seem to go together? I have been quite busy lately: Application to finish before Nov. 30, numerous samples to prepare for mass spectrometry now that our instruments are finally up running again (work), seminars to attend (work), different arrangements of the Christmas months, preparation of a talk to 140+ students that I am to give this afternoon…….

This pace obviously does not pair up well with low BG’s, but that is what always seems to happen when I am busy: Chances of getting low increase.

During the last months or so, I have noticed a tendency to go low late in the afternoon. I have decreased my basals as well as my insulin:carb-ratio (i.e., less insulin for a given amount of carb than otherwise needed during the day) in these hours. I haven’t completely solved the issues yet, though, so I am looking forward to my appointment with Alice next week, to discuss this with her.

I am most annoyed with the fact that these lows always seem to interfere with my indoor soccer practice sessions on Tuesdays – preventing me to start practice on time, mind you! This week was another brilliant example of this. I had to finish my talk for today as much as possible, because I had to hand in the presentation to the organizers on yesterday. However, I also had to attend a seminar for the Danish Proteomics Society (DAPSOC), starting at 9:30 AM on Tuesday. Fortunately, the seminar contained rather long breaks for posters and exhibition, and they were most welcome for me to retrieve the samples I expected by mail that day as well as start some experiments to be continued the next day. I had decided that I would skip the last session of the seminar anyway, in order to be able to make it to soccer practice in time, but also to take care of these experiments, and as we were much too many people in a much too small seminar room, it was actually nice to get out of there :-)

At 3:10 PM, after a 2 h seminar session, and successive questioning about my poster, my brain felt pretty crushed, but testing revealed I was at 9.0 (162), so my bolus guestimate for the served lunch hadn’t been that much off after all. I had my usual afternoon snack along with 1.8 U of insulin to cover it. Before leaving for practice at 4:30 PM I was 6.3 (113) and had the pump going at 60% basal (0.15 U/h). I had a 4.5 km (approximately 7 miles) bike ride to the sports facility, fortunately with the strong wind in my back most of the ride. Anyway, after having changed, preparing to test before starting soccer practice, I noticed I was sweating a lot more than I thought was fair, even after the bike ride. Sure enough, the test gave me a 1.3 (23). Damn!! That’s a pretty hard drop in less than 30 min! I didn’t want to miss out on most of the practice, like I have had to before, so I downed a full bottle of OJ (33 ml), a couple of glucose tabs and some m&m’s, only waiting 10 min before re-testing. At that time I was 2.1 (38), so I just waited another 10 min until taking part in the game.

By the end of our session (6:25 PM), I noticed the symptoms of a low re-appearing, but as one of the others twisted her ankle just before, we were only 6 players left, 3 on each team, and we had decided to stop at 6:30 anyway, so I thought I could just pull it off by taking it easy, watching the goal for our team. I managed, and when I tested afterwards I was at 2.9 (52), so I had to have yet another snack in order to be able to make it the 8 km back home in head wind. I felt like crap when leaving anyway, and the weather didn’t make that better. Besides the strong wind, it was also raining. At the beginning of the trip the rain wasn’t too bad, but soon it was pouring and by the time I got home, I was soaked and could literally pour water out of my shoes. After a nice hot shower, while my dinner prepared itself in the oven, I tested again, now getting a decent 5.8 (104), and I was fortunate enough to maintain in-range levels the rest of the evening.

Today I am to give that presentation to 140+ students at 5:15 PM in the afternoon. While I have ample lab work to do today, I also have to take a break to prepare my talk (only the slides are done, and I haven’t had time to test whether what I want to say fits with the slides and the amount of time available, so I might have to make some last minute adjustments). I just hope that, despite me being busy today too, the BG will behave this late afternoon!

Endo appointment

2006-11-30T21:14:00.000+01:00

Today I had my endo appointment. He thinks that my management is so good that we only need to set up appointments twice a year. I can live with that, as I get the appointments I need with Alice, my fabulous diabetes nurse in the day-hospital unit. In my eyes, Alice is the health care person in my D-team, who knows the most about me and my diabetes when it comes to management of this disease. She has done more trying to get my sugars in control, working with me to reduce the number of morning highs and subsequent severe lows (they were more or less an invariable rule for the last couple of years with Insulatard® [NPH] as basal insulin), assisting in the switches to Lantus and the pump, respectively. That she is the one to turn to when it comes to fine-tuning of insulin and use of the pump in general, was confirmed beyond everything else today.

I started seeing my current endo, when I moved to Odense almost 6 years ago and needed to find a new diabetes team here. My first impression of him was a bit mixed. He is Egyptian, and although he has been living in Denmark for many years, he still speak Danish with quite an accent, so I had to focus on every word he was saying to make sure I understood him right, which also caused me to doubt his medical capabilities a bit. This is not a problem any longer, as I have gotten use to his accent in both Danish and English (he was my co-supervisor during my master’s, and because his research unit is international, the common language in the lab and at meetings was English), and I have gained confidence in his medical capabilities too. Like many other doctors, however, he too has a tendency to focus on the overall results of diabetes care, i.e., the A1c-value. Thus, it took me quite some time to make him realise that a change in my regimen was needed 4 years ago, when I was having large issues with Insulatard® and BG-levels overnight. My A1c was around 6.0, so he couldn’t see any problem.

Sitting in his office today, I almost felt like back then. He asked about, whether I had decided to stick with the pump or not, and I told him that although I am still not convinced, I am being a bit more positive towards it than I was 6 month ago, so I felt I had to give it a bit more time to make it prove its worth. Jimmi and I do want to have kids within the next few years, and as much as I know that the hospital will not approve Lantus for use during pregnancy, I absolutely do not want to go back to Insulatard® and its unpredictability, so, as I told my doc, it will probably be wise to try to make pumping work. I told him about the issues I currently feel I have with it, but he didn’t really have any suggestions as how to solve those. As these issues are specifically related to the sports activities I like to join, he asked if the adhesive on the infusionsites would stay put when I was sweating. I told him that I would usually secure the site with an additional adhesive, because I had experienced unintentional detachment of sites due to sweating. I also mentioned that I had started swimming again, and he immediately asked me how I managed with the pump during swimming.

“I take it off”, I replied

Doc: “So you take out the whole thing?”

Me: “No, I just disconnect like this (showing him how to disconnect the pump), put a couple of pieces of Tegaderm® over the site to seal it, and go swimming”

Doc: “Let me see that again (referring to the disconnection procedure, carefully inspecting the infusionsite). It is so much smarter than those old butterfly-needles that were used with pumps 20 years ago.”

Me: “Yeah, I guess so….” (thinking to myself: Haven’t he kept himself informed about the new advances in diabetes treatment at all for 20 years?!!! He too recommended the pump 4 years ago, when he finally realised that we needed to exclude Insulatard® from my regimen if I was to regain decent control – and now he reveals that he actually knows nothing about pump therapy!!).

I am so happy that I got Alice to turn to in these matters. My endo is apparently helpless when it comes to pump therapy. What surprised me even more today was that he didn’t even wanted to look at my log sheets. Essentially, what he did today was to measure my blood pressure, hand me a lab-sheet for blood work to be done before the next appointment in 6 months, reminding me to schedule an appointment for eye check-up at the same time (the eye exams are done by specialists in the ambulatory too), and then ask me if there was anything else (not specifically related to pump therapy, as he stated that it was probably better to let Alice handle that) that I wanted to discus with him.

I've got an appointment with Alice in two weeks :-)

At long last!

2006-11-24T23:02:00.000+01:00

I did it! It has taken me more than a handful of tries, but today I succeeded in completing my swimming session without going low :-) If I had had the time, I would have been able to reach my goal of 30 laps, but one of the ph.d-students of our group was to defend her thesis at 1:15 PM, and if I was to catch some lunch before the talk, I had to stop swimming by 12:30 PM.

I started swimming on Friday noons about a month ago, as we are able to use the university’s swimming facilities for free at these times, and I thought it would be a nice supplement to just biking to and from work and only playing soccer once a week during the winter. I can’t say that I am happy about the time of our free swimming sessions. The choices are Monday-Friday mornings 7:00 - 8:00 AM or Friday 12:00 – 1:00 PM. I am not much of a morning person, least of all during the darkness of winter, and as I have got a 9 km bike ride to get to the university, the morning hours are so out of question for me. The noon time on Fridays is not ideal either, because it is usually during that hour that I will have lunch, but I am stubborn so I wanted to make that work anyway. Until today, however, my swimming sessions (usually 30-35 min, 22-26 laps of 40 m) have always caused me to go low. On the last few lanes my movements are hardly coordinated, my muscles feel heavy, and I have to give in to that stupid low. My approach so far has been to eat a small snack, accompanied by a small bolus, about an hour before going into the water. I used the same approach for soccer practise in the spring where I would also disconnect during the session, so I figured that it would also work for swimming. Apparently it did not though and I have been quite annoyed with that fact.

Today I had a low of 2.9 (52) at 9:15 AM. I treated it with ½ slice of rye bread and didn’t bolus but 0.3 U for it at 10:00. At 11:00 I had another ½ slice of rye bread and some veggies for a pre-swim snack (I have used fruit or müslibars for this beforehand). I bolused 1.3 U for this to cover for some of the carbs as well as the upcoming time off the pump. I tested at 11:45 AM before heading towards the swimming facilities: 10.5 (189). A little higher than I would like before disconnecting for 45-60 min, so I added an additional 1 U.

Due to my limited amount of time today I swam 26 laps in 35 min before having to stop if I was to attend the ph.d-talk. After showering and getting dressed, at 12:45 I tested: 5.9 (106)! When I got back to the office and P asked me how my swimming went today, I couldn’t help raising my arms in sign of victory. “Are you low?”, she asked, and I was happy to announce that for once I wasn’t. I had completed my swimming session in save range. Great! Heidi 1 – diabetes 0 :-) At least for now……;-)

Chocolate is good for you :-)

2006-11-23T14:48:00.000+01:00

Today I got chocolate at work :-) Two bars of dark chocolate, one with nuts and one just plain dark chocolate. Uhmm!!! Did I mention that I love chocolate? ;-) The reason for this chocolate coming my way – and I haven’t eaten it all yet, it will probably last me a few days, if I can restrain myself a bit ;-) – was an expression of gratitude.

I share my office (office may actually be a little too big a word for this 8-10 m² room) at work with two master students. One of them hasn’t been around for the last couple of months as she is studying for an exam that she needs to pass in January in order to formally be able to finish her master's. The other student, P, is just about to finish her thesis. However, she is pregnant and due to give birth by the end of December, and all of the medical appointments she has to go to (she has Leri-Weill syndrome and Madelung’s deformity (see picture to the left), and during pregnancy her thyroid gland has been getting sloppy, requiring several tests and endocrinological follow-ups, and now medication too), means that she will not be able to hand in her thesis until after the baby is born. We have shared office for years, struggling with our different projects and thesis, and even when I finished my master’s last year and got employed as a research assistant within the group, I kept my desk in this office despite it officially being reserved for students (our group is very space-constrained with only 3 of our 6 principle investigators, as well as our secretary, not sharing their offices. Everybody else shares, usually 4-6 people in each office). P and I have helped each other a lot during the years, both in scientifically oriented issues and in personal issues. She has become quite skilled in spotting if I am heading towards a low, and know how to deal with it if I am not able to myself.

A couple of months ago P and her husband moved to Vejle, where her husband works. This causes P to have a 60-75 min commute to and from the university every day. The medical appointments she has to attend often causes her to take the whole day off because they may be situated in the middle of the day so that she would only be able to spend a couple of hours in the lab before or afterwards. This is of course not practical with this commute, so these days she will often be working at home, reading articles or analyzing spectra. Sometimes, though, these days away will interrupt the experiments that she needs to do in the lab, setting her back more than just the single day that she is actually off. Because of this we have an agreement that she just has to tell me and maybe leave a note on my table, if I am to take care of an experiment for her (e.g. dry down some samples, start or end an enzymatic digest, etc.), so that she can just continue the series of experiments when she is back in the following day. I don’t mind doing this. It usually doesn’t take much time for me, but it saves her at least a day, so I think that it is the least I can do. She is grateful for this, and because she knows that I am a chocolate lower, she usually gets me a piece of chocolate in thanks.

Handing me the chocolate this morning she told me that she just heard on TV last night that dark chocolate may actually be good for diabetics. Two different programs on two different TV channels had sent that message through. Dark chocolate should apparently be able to increase the insulin sensitivity of muscles, thereby assisting in lowering the BG. I have heart many good thinks about chocolate, and dark chocolate in particular, during the last few years, but never anything specifically related to diabetes, so I was a bit surprised though pleased that food research may actually justify my occasional craving for chocolate :-) I entered “diabetes + “dark chocolate”” into Google, and got an amazingly 261,000 hits! I didn’t really find anything new, though, but I did find a couple of sites that stated the link between dark chocolate and the proposed improvement of glucose metabolism although the main effect seems to be lowering of blood pressure and not blood sugar (ooh!). Amy at Diabetes Mine had a post about this about a year ago too where she also points out that the experiments leading to these conclusions were actually done on healthy, non-diabetic individuals with some degree of hypertension. Now I am just wondering why all of a sudden the possible positive effect of dark chocolate has reached the Danish media again more than a year after this research first made headlines (here in Denmark too), and now even focusing more on the effect for diabetes?

Severe diabetes

2006-11-20T15:55:00.000+01:00

”You’ve got very severe diabetes, haven’t you?” Ever heard comments like that? I have several times, especially when I have been “stupid” enough to open-heartedly tell people about the challenges of this disease, and what can happen if a low BG is not caught in time. I have never really known what to respond to this type of question. The reasons for this are multiple. Sure, I have had my share of problems with diabetes during the last 12-13 years, but these problems have always come in waves, and not with equal intensity. The first 4 years of my D-life were quite an ease, so things haven’t always been that difficult D-wise. When the issues were most extreme (the last couple of years with Insulatard® (NPH) as the basal insulin), I had several severe hypoglycemic episodes causing several trips to the ER. I had to drastically increase the number of tests done pr day, but as this didn’t eliminate the trips to the ER, I guess it is only natural for third parties to think that I must suffer from severe diabetes. After all, people always seem to know another diabetic who “doesn’t test much, just take the shots, and never has any problems”. I cannot help but think – and thinking back on my trouble-free years too – that when you do not test much, chances are that you don’t notice those highs or lows that ought to have been corrected, e.g. by change in your general insulin regime, thus generally you are a bit on the high side some times and on the low side at others.

I guess it all points down to the eyes that see in the given situations. The reason I am ranting about this today is that I was asked the above mentioned question during the weekend. On Saturday we had our soccer team’s end-of-the-year-/Christmas party, and at some point I got to chat about diabetes with one of my team mates, getting this question (I cannot remember the exact context, but that doesn’t really matter anyway). She is a teacher and one of her students was diagnosed a couple of years ago. A recent change in his medicine had also caused his levels to fluctuate greatly. I told her about some of the difficulties I have had with diabetes, and answered some of her questions about diabetes in general. Having talked for a while, she suddenly said in a serious tone: “It is quite a difficult condition to handle, isn’t it?” Apparently, she had come to realize that with diabetes thing aren’t always plain black and white, and just to follow some “simple” rules to avoid problems is not the way it works. If this was really what happened, then all I can say is: Mission accomplished! :-) It is not always easy to manage diabetes, and the more people are aware of this the better, especially for the sake of the diabetic children who may not be able to “defend” themselves against the verbal attacks and judgments that ignorant people can come up with (I still remember being told: “Ah, you’ve probably been sinning (not religiously meant), haven’t you?” if I had a high reading, and regardless if the reason for that high was that I had had something sweet or not, I would always feel that I was being convicted for not taking proper care of myself).

Anyway, the party was great, and we were still able to perform pretty well in the indoor games that we had to play on Sunday. Most importantly we had a draw with one of our local rivals, 2-2 (the same result as last week, by the way), and a win of 2-0 against the other local rival, the Football Club of Odense (OB). Maybe it was because we had such strong support with us – despite the late night party, a “fan club” of ours of 7 people (team mates and coaches) had taken the 30 min drive to cheer on us :-) I don’t know. I just know that this past weekend seemed far too short, as one of my team mates put it when we were driving back towards Odense in the dark, rainy afternoon yesterday: “I wish tomorrow (i.e., today) would have been Sunday – but then again, I guess we would just have gotten around to do something else tonight that would make us feel just the same by the end of that day too :-)”.

A break

2006-11-15T20:21:00.000+01:00

I just read Kerri’s post, ”An open letter to my Pancreas”. I need to join the pack of admirers of her writing style and sense of humor :-) Still, as always, she’s got a point, an important one: Things sure would be much easier if Mr. Pancreas would fulfil its job and not just part of it!

At the moment I am trying to figure out how to predict the effect of cycling on my BG. Usually, my cycling to and from work and activities do not pose any large challenges. Sure, the BG will be lowered a bit, but usually no more than 2-3.0 mM (26-54 mg/dl) on ride of 8-12 km, which does not necessarily pose any threat to my well-being. The last couple of days however, it seems like my bike rides, notably those in the afternoons will send my BG into an almost vertical decent.

Yesterday, I tested at 4:15 PM and got a 6.2 (112) reading. This seemed reasonable. I had a slight bolus from a bun that I ate at 3:00 PM, and because I was heading for indoor soccer practise at 5 PM, the basal was reduced to 60 % at 4:00 PM. The trip to the sports facility where we practise is little more than 4 km. I didn’t have a head wind or anything. I was in a hurry, though, because I had been busy at work (needed to finish a presentation I was to do today), so I was a little late. When I arrived the others were ready to start warm up, and I just thought I would quickly change my close and join them. I did feel a bit light headed, but thought it was just the stress of the still unfinished presentation and me being late. It wasn’t. When I tested just before joining the others, I was 1.7 (31)!! Quite a drop in just 45 min I think! I took me an additional 45 min to get back up in safe range to play, which I of course was rather annoyed with. I didn’t go to the sports facility just to sit around and watch the others play and have fun, I wanted to play myself, but couldn’t because of my BG. I only got to play for about 30 min – we stopped early because we were only 7 people and indoor soccer is quite strenuous when you are constantly involved (the others had been playing 3 against 3 while I had tried to get my BG back up, and once I joined we started a rotating substitution where each player would get 5 min break, thus continuously changing the constitution of the teams to allow every one play with as well as against each other). Fortunately, the anticipated rebound of this low wasn’t too bad. I was 12.1 (218) by bed time, not having been higher – at least what I know of ;-)

Today I went to Glostrup (near Copenhagen) to do the presentation that I had finished during the train ride. Everything went well. I felt - and was indeed - low at lunch, 2.2 (40), probably because I had lunch a little later than usual and having had a busy program all morning, without thinking about where the BG might be at. When I got back to work in Odense in the middle of the afternoon, I had a snack, covered by an appropriate small bolus, worked for a couple of hours and then prepared to head home. I did a test before heading home: 8.6 (155) at 4:30 PM, so this should be enough to get me home without any problems. It takes me approximately 30 min to ride home on my bike, today with a little head wind, but not too much. On my way home I noticed that I started yarning. Not because I felt particularly tired, just because I needed to. To me that is a sign of a BG not being where it is supposed to. Usually it is going low, but sometimes high – why does some symptoms have to be ambiguous? Anyway, I got home and because we were due to eat within 30 min, I didn’t got to do a test right away. I just took part in the preparation of our dinner and then tested at 5:45 PM: 2.8 (50). Dropping 5.8 (104) in just 75 min seems a bit drastic, I think, considering that I didn’t have much insulin in the system (last bolus of 0.8 U at 3:00 PM and basal only being 0.3 U/h from 3:00 PM to 6:00 PM). I would just love a break from this!

Rebound highs

2006-11-12T19:45:00.000+01:00

Today we had the first games of the indoor soccer tournament. The first game was at 10:59 AM in a sports hall not too far away from Odense, so we were to depart at 10:00 AM. Because I had a few things I would like to do before taking off towards our meeting point at 9:30 AM, without being too busy, I had set the alarm clock for 8:00 AM.

I didn’t hear the alarm clock. It showed 8:20 AM when I first opened my eyes because Jimmi came into the bedroom to see how I was doing. A morning low :-( I still got around the things that I wanted to do before taking off for soccer, but in addition I got the joy of rebound highs during the rest of the morning. Before the warm up I was 13.6 (245). The pump didn’t think a correction was necessary. I overruled that decision, though, and sent 2 U into the system. When I checked again about 45 minutes and two games later, I was 15.6 (281). Great! The adrenalin from the games combined with the other hormones of a typical rebound swirling around in my body. I took an additional 4 U, because I don’t play too well when I am high either, and we still had 3 games to play. When we had finished our 5 games about an hour later, I was down to 12.4 (223), and it was time for lunch and another aggressive bolus.

Back home a couple of hours later all the insulin finally seemed to take effect, and I had a reading of 3.0 (54), but except from that I have been steady in target since then, enjoying the effect of exercise on the BG-level too.

Next Sunday the second round of indoor games are on. I hope that I will be able to start the day without a low then. There are enough of other challenges for our team this day as we have our team’s end-of-season-/Christmas-party on Saturday night ;-) I am pretty sure that this will cause as least some to suffer a bit from a hangover. Fortunately, we should be 7 people, and as only 4 will be on the field at a time, the ability to make substitutions should be good. We have a few games to revenge ourselves next time as well as repeat the victories we had today :-) The best of our games today, we won 5-1. In all the games I was responsible for guarding our goal, but because of the rules in indoor soccer (each team has to have at least 1 player on the opponents half at all time – unless they are in minority due to a suspension), the goal-keeper usually take part in the attacking play to create a “power play” situation. Therefore, I was on our opponent’s half in the end of this particular game. From the side line I heard one of our substitutes cheering for a goal in the final 10 sec. of the game. I had just passed the ball to one of the others and turned my head to look at the clock, seeing a “4 sec” left of the game. A fraction of a second later I got the ball back again. I made a short, quick move and took a shot towards the goal. The ball hit the net just as the final whistle sounded :-) Our substitutes were thrilled, they told me that they had actually just been joking when they cheered for a final goal 10 sec. before time, because they didn’t really think we would make it. I just told them that I saw no reason to give our opponents any last chances, thus I took the shot as late as possible! It gave us a good laugh, but I guess that we were too high on our performance in this game, because we weren’t quite as focused in the two final games, both of which we lost. We’ll make that up next weekend!

Power out

2006-11-09T12:40:00.000+01:00

Yesterday Jimmi and I were perfectly rested in our sofa, watching soccer on TV – first a cup game between the local heroes, OB (short for Odense Boldklub), and Broendby, and then F.C. Zulu (a soccer team created by the Danish TV station TV2 Zulu, constituting a bunch of guys who have never played soccer, or any other sports for that matter, before being enrolled in this project, where a former top-player has been their coach :-)) and their Spanish equivalents, with the Danish team targeting revenge for our real national team’s loss of a game to Spain at the World Cup back in 1986. Check out some pictures of the Zulu-boys here.

Watching the Zulu-boys play is always amusing, but yesterday the entertainment was abruptly interrupted: At 9:05 PM there was a complete power out in our area! The whole neighborhood was dark, although we didn’t realize that at first. We thought that maybe it was just our own cut-out relay playing tricks with us, but after having groped for a flash light in the dark, we could see this was not the case, so we looked out the window and couldn’t see any lights around our house either. We then had to find some matches and candles – this was actually very cozy :-)

As today apparently is officially D-blog day, you may wonder what this episode has to do with diabetes. Last night, when we were done lighting candles, Jimmi asked: “What do we do now? I want to take a shower and go to bed with a book. Only, I will not have enough light to read by in my bed”. His question made me think about how dependent our daily living and activities are on electrical equipment (TV, computers, powerful light to read and work in, freezers and fridges, etc.). We don’t think much of these facilities until we aren’t able to use them. On the other hand, it is commendable that at least the stuff needed to manage the D on a daily basis (meters, pumps, pens/syringes etc.), if anything, are battery-driven. We do not live in an area where natural calamities may cause power outs and/or other emergency situations very often, thus we have never really thought about having a plan for such situations. We usually have matches and candles (although mostly tea-light candles with a limitted number of burning hours) on stock, but batteries for flash lights and bike lamps are not something we always have in the house, because we primarily use rechargeable batteries for these devices – and once they are flat, they need electricity and a couple of hours to get back to work :-) I don’t even have an emergency kit of supplies and other D-related stuff packed for me to quickly grab if we for some reason or another would have to evacuate our home someday (luckily, I think chances are very slim that this scenario should ever arise). Anyway, I guess I actually ought to have such a kit, regardless.

Power came back on at 9:37 PM yesterday, so it wasn’t that long we were without power. Despite the cozy atmosphere created by the lit candles, I actually appreciated being able to test and treat that bed-time hypoglycemia (2.0 [36]) having sneaked up on me, without having to carry a torch around the kitchen to find the needed snacks in the fridge and cupboards. Although, maybe being a bit inconvenient, a torch-search for food might actually keep one from returning to the cupboards and fridge, over-treating the low? ;-)

".....your result sure embellishes the statistics...."

2006-11-06T13:28:00.000+01:00

As I wrote in my last post, I wasn’t sure how my diabetes nurse, Alice, would react to the result of my last HbA1c. I haven’t had time to post about it until now, although my appointment with her was Thursday last week.

The appointment started out with us discussing some things related to the “insulin pump” that the hospital is working together with a company to develop. Alice told me that they had just had another meeting with the company the day before, this time with patients using insulin pens. These patients had, as expected, been far more positive in their evaluation of the product than us pumpers had been. She also had to tell me that the company seemed to have realized that perhaps they ought to work a little bit closer with the caregivers, i.e. the nurses, on some of the dosing issues that had come up during the meetings. One of the representatives had done some calculations the night before the last meeting, and although he couldn’t recall exactly how he reached the results, he was proud to announce that based on his calculations, the typical daily dose of insulin for a type 2 diabetic would be around 15 U! No need to say, the nurses’ reaction to this statement was utter surprise that was not to hide behind a tolerant smile :-) Anyway that is another story; I just think it perfectly illustrates the need for companies working with diabetes remedies to work closely with patients as well as caregivers to obtain the best results.

Proceeding to talk about my management with the pump, we got to HbA1C result. Alice’ reaction to the results just illustrates why you got to love her as a nurse and a person! With a sincere smile upon her face this was her comment to it: “Well, I don’t know how I should reward you, if I ever manage to see a 6.0 on your chart. On the other hand, I must admit that your result sure embellishes the statistics of the A1c of our pumpers!” No hard words, just a smile and this comment along with the “as it is now, I still think we should aim as getting you a bit higher, though”.

I think Alice is the only caregiver I have been seeing through all of my years with the D, who acknowledges the facts that she can say as much as she like, but there is no guarantee that the patients will comply, and that the changes to be made need to be realistic from the patients point of view too. This is also why the conclusion to this appointment was that I would start out cutting 0.05 U of all the basals during the day, so far not touching those in effect during the night, because night time lows do not seem to be an issue. The aim still is to slowly elevate my general BG level just a bit, but at a pace that I am confident with (I do confess not to like seeing numbers above 11.1 (200) in general, many times having a hard time confining my desire to correct it). She understands that, and tries to work with me to find satisfactory solutions. She really is great, and I wish that all of you could be seen by someone like her, when you need to make adjustments that cannot just be made by a few words from the endo in his consultation (no many adjustments can, by the way!).

5.3

2006-10-31T21:07:00.000+01:00

The last HbA1c I had before starting on the pump was 5.8 % (Nov. 14 2005). In April this year, when I started pumping, the aim of my diabetes nurse and I was to try to increase this just a little (to 6.0 %) to see if this would also eliminate some of the nasty lows that had experienced. While these nasty lows were not that numerous after the switch to Lantus 3 years ago, they would occasionally show their ugly face, usually leading to a trip to the ER or a visit from the paramedics in our home, so I sure would like to get rid of those.

As described in previous posts, the switch to the pump still has to prove its worth in relation to lows. Because of that I wasn't too surprised to see a slight decrease in my HbA1c at my endo appointment in the end of June, almost 3 month after pump start. At that time it was 5.7 %, which would be great if it wasn't because of all the lows it included.

Last week I mailed another sample for HbA1c-analysis. Sunday evening I went into my web health portal to see if the result was back yet. It was. I have an appointment with my diabetes nurse this Thursday, and I am looking forward to see her reaction to the result. 5.3 % it said, which is the lowest it has been since I moved to Odense in the beginning of 2001.
My HbA1c results the past 2 years

Before that I had results as low as 5.1 %, which at that time was more a concern to my doctors than to me, because I didn't had that many low, and certainly not as many requiring assistance in their treatments as I have had afterwards, even with higher A1c's.

I will have to admit that the perfectionist inside me most certainly aims for an A1c that is normal, i.e. in non-diabetic range (4.6-6.4 % as far as I remember from patophysiology classes). Not at any costs though. The current 5.3 % result, while in this range, stores too many low lows. I cannot remember ever having tested, or even being able to test, at 1.1 (20) or lower (my meter just reads LO for values of 1.1 and below) in all the years I was on MDI. I have already lost count on the number of times this has happened while on the pump, but it is at least a handful of times. Of course these lows are somehow outweighed by the highs that has also been present, especially after soccer games, but that just shows that the BG-curve has not leveled out as much as anticipated. Hopefully this will happen with time, but it is a bit difficult to be patient, when you were promised results, potentially within 3 months.

It may sound like I am all negative about the pump and the promises that comes with it. That is not the case. I certainly see advantages with this therapy as well. I am probably just, still, a bit frustrated by the fact that I cannot seem to get a hold of things with CSII, and that it regularly causes issues that are not only troublesome but also scaring at times. I hope that my next A1c will be as great as this one, only without the hypoglycemic backside of the result :-)

Winter is coming

2006-10-29T16:28:00.000+01:00

The past night we changed from summer time to winter time. While it is lovely to have your weekend extended by 1h – especially when you have attended a party (soccer season winding-up party) on Saturday night – and I am looking forward to be able to go to work in daylight, at least for a couple of weeks, it is getting darker and colder outside. Winter is coming. The weather forecast for the week to come had sleet in it. Like the roads and bike tracks aren’t slippery enough as they are now with all the wet, fallen leaves lying around!

I don’t know about you, but for me there has always been a good correlation between required insulin doses and season of the year. I tend to need more insulin during the winter months, probably because I am not as active as in summer. I still ride my bike to work every day during the winter, and this year I have also, besides the weekly indoor soccer practise, resumed swimming again, so it is not like I am totally inactive. Still, compared to the summer, where I usually have two soccer practises, 1 game, and extra bike rides “for fun” on the program, winter does not entail as much physical activity. When on MDI I would usually have to increase my Actrapid (Regular) doses by a couple of units with each meal, the Lantus dose in general staying the same.

Approaching the first winter with the pump, I am looking forward to see, whether the tendencies noticed on MDI do also apply to CSII, or if that is just another set of experiences that I can forget all about in relation to diabetes management. Starting on the pump was like starting from base once again. Of course, some of the experiences that I had build through 16+ years of diabetes would still apply, but the vast majority of them had to be modified.

Resuming swimming has been a challenge. I have about 18 years of swimming experience, 12 of these with diabetes, but the last 3 or 4 years I haven’t really made it to the swimming facilities. This winter I have decided to give it another try, though. I work on the University, and students as well as staff are allowed to use its swimming facilities for free at hours when no teaching takes place there. For the staff, Mon-Fri from 7:00-8:00 AM and Fridays between 12:00 and 1:00 PM are available. The morning hours are a no-go for me. When it is dark outside, I cannot get myself out of bed before absolutely necessary, and as I have a 30 minutes bike ride to reach the University, I would have leave home at 6:30 AM or something like that to take advantage of the morning swimming hours. The hour on Friday noon is not ideal either, but I am working at getting into a routine that allows it. So far (3 attempts) I haven’t had too much success. I thought I could use the same strategy that I used for soccer practise in the spring: I would have a small snack, accompanied by a small bolus (<>r at 12:35). Hmm, another indication that I was low. I did not expect to see the number I did on the meter, though. Sure I felt the weakness you do when you are low, but other than that I didn’t feel too impeded by it. Until I saw the number, that is! 1.6 (29)! Damn, grab glucose tabs and M&M’s in my back and start chewing. Slowly made the 700 m walk back to my office, cursing and wondering whether I should make a stop at the canteen. I decided not to stop at the canteen - my hypoglycaemic brain couldn’t handle that challenge - and headed straight to my office and my lunch box and sugary cola. It took me a good 45 minutes to get back to my normal self. Why does it have to be so difficult to succeed? With 3 failed attempts, I am now considering not to do the extra snack-bolus thing before swimming. My guess is that it may prevent me from going low, but is also likely to leave my above 11 (200) when I finish, and that is really not in my interest either, as by that time I am usually hungry because I will normally have lunch around 12:00-12:30 PM. Maybe this is just another one of the choices between cholera and the plague that diabetes offers you?

Up front on diabetes research and development

2006-10-24T21:59:00.000+02:00

A couple of weeks ago I got a call from my diabetes nurse. She told me that the hospital had started an innovative collaboration with a private company. The “aim” of this collaboration was to develop a sort of a “single use pump”, a device to be put onto the skin to deliver insulin for 3 days, after which it should be replaced. The company was not really into diabetes and insulin treatment, and thus they would like to discuss the features and possibilities of this device with patients and caretakers. Therefore the company had asked the hospital to arrange for a meeting with a host of diabetics, half being pen-users and half being pumpers. If I was interested, I was invited to participate in this meeting. I thought that sounded interesting, and figured that I would be able to make arrangements in order to leave work a little earlier on the day of the meeting, so I accepted the invitation. “Great, you will receive a letter from H (chief physician on the endocrinology ward of the hospital, and apparently consultant for the company on this project) with more information about the meeting”.

The letter informed us that apart from us as patients, the three diabetes nurses that are involved in pumping and H himself would participate in the meeting. Apparently the company, in collaboration with the hospital, had developed a new insulin pump that would go into clinical trials at the hospital next year. As the company was new on this field, without much experience with insulin treatment, they would like diabetics to advise them about views on pumps in general, as well as evaluate their prototype regarding the idea behind the concept, the design, and other wishes or needs in connection to pump treatment. They would want to present the prototype and get a patient to try it. That sure sounded interesting!

Yesterday was the day for the meeting. This was the first meeting in Odense that the company and hospital would host. We were 8 diabetics on pumps, the three nurses, H – attending another meeting simultaneously, and two representatives from the company. H opened the meeting by welcoming the company representatives and us, describing us as part of the elite of diabetics, people who were on top of their diabetes management (nice to know :-) although I am not sure how much insight he actually has on this, as I don’t think that he is a consulting doctor anymore). By the company representatives request we introduced ourselves to them and each other, on camera because they needed to be able to take our opinion back to their engineers. It turned out I was among people, who had been diabetics for as long as 50 years! A few had lived with this disease for 35+ years, one of them having had a pump for more than 20 years (several different types along the way).

When the representatives presented this new “single use insulin pump” to us, they soon learned that some parts of the concept/design was not ideal. We also had to turn our minds into not seeing this new product as an insulin pump in line with the pumps that we use, but rather sort of an insulin pen based infusion-device. It is an oval-shaped, wireless, plastic device with an electronic part that is reused when the “pump” is replaced. It is filled with insulin from an ordinary insulin pen – a very smart feature in my opinion. On its backside it is covered with an adhesive, and to insert the devise, you attach it to your skin, pres a button to introduce the needle into your skin, and remove said button, so that you are left with only this 7.5 x 5 cm (2.95 x 1.97 inches) and about 0.7 cm (0.3 inches) thick oval shaped devise. 20 minutes after insertion the “pump” will start infusion of insulin at a pre-set basal rate. A button on the devise allows you to administer boluses, each press on the button will release 1 U of insulin. The “pump” will continue working until empty, or about 3 days, at which time it will alarm you by vibrations, sound and light, to make you replace it. As you might have guessed by now, said presentation (of which I have only reported the most essential parts) led to quite a few points of criticism and comments. The devise did not enable you to change the basal rate, nor did it allow administration of “odd” numbers of units for boluses. This of course should be seen in the light of the target group of patients for this devise: Diabetics currently on a pen regimen, who may not yet be fit to take the full step into pumping, or who attends a hospital without the economic potential to pay for a pump (in DK, pumps and pumping supplies are financed by the hospital treating the patient) – this devise is supposedly cheaper than regular pumps although, of course, more expensive than traditional pen-treatment, and otherwise might benefit from a “near-pumping” regimen.

I tried the prototype on, without a needle in it, and it was actually surprisingly comfortable to wear, despite its size. I would like to show you a picture of it, but I will refrain from that as I am not sure whether the company has otherwise gone public with their new concept yet – and I wouldn’t want to give their idea away now, would I :-) We all filled a questionnaire about our own way of treating our D as well as our thoughts about the new devise, its advantages and limitations. The company representatives expressed that they had greatly benefited from the meeting, being a bit surprised about our main point of criticism (the lack of the possibility to change the basal rate as needed), and they would take our response into consideration in the ongoing development of the devise.

H returned to close the meeting by handing us another questionnaire, this one being related to his own project on developing a sensor to alarm diabetics about hypoglycaemia – also an interesting project indeed. The nurses handed out envelopes containing a tube to sample blood for an HbA1C and a question about our quality of life before and after the pump. This is for their continual specification on the regulation of pump users. Thus, this was an afternoon of multiple questionnaires as well as a demonstration that the hospital, and especially H, is up front in research and development when it comes to diabetes :-)

Damn diabetes

2006-10-16T14:11:00.000+02:00

I guess the title of this post eloquently expresses what I, along with all other members of the OC, feel about this disease from time to time! My need to express myself in this way now emanates from its interference with my plans and performance this weekend.

I hate when an out-of-range BG-reading requires me to change or postpone my plans! Yesterday we had the final game of the fall season. It was a morning game starting at 10 o’clock (very wet grass and temperatures slowly creeping up from 5 degrees Celsius – something like 41 degrees Fahrenheit – but actually it wasn’t that bad playing in shorts!). My fasting BG at 7:45 AM was a little higher than I like it to be: 9.9 (178). I didn’t correct for that though, as I knew I had a hard game coming up. However, when I tested 1.5 h later, getting ready to go out to the field to start the warm-up, I had dropped to 2.9 (52). I changed the temp basal rate from 60 % to 0 % for 90 minutes, while I chewed down glucose tabs and banana. Out on the field we got the line-up. I was to start as left defender. Certainly not a favorite position for me, but to the long line of injuries, especially among our regular defenders, our coach apparently saw no other option than to place me there. So, I started warming up, not feeling too fit due to the low start, but hoping that it would improve before the game started. It didn’t. My legs felt more and more heavy, my passes were generally off, and 10 minutes before game start I capitulated and found my meter again: 2.4 (43). Not good! There was no way I would be able to get it up to 6.0 (108), where I like to be during soccer, before the game started :-( Our coach changed the line-up and I sat down, exhausted and pissed at the D, finding more glucose tabs, juice and müslibars to elevate the BG, while wondering what the hell had happened to my solid breakfast that should definitely have had time to take its effects before I left the house 5 minutes before our time of meeting prior to the game (it was a home game, being played just across the street where I live, so there are only about 1.3 km [0.8 miles] from my front door the locker room where we meet before games). About a quarter of an hour into the match, after having consumed an additional 40 grams of CHO or so, I was slowly climbing to 3.2 (58). By the end of the first half I could start my warm-up for the second time that morning, so that I could replace one of our wings at the break.

The damn diabetes precluded me from playing a full match of soccer! More than anything, I hate when diabetes prevents me from doing things that I like to do, e.g. play soccer. Also it is frustrating that hypos or hypers occurring before or during a game affects your performance negatively. I ended yesterdays game on a fair 8.0 (144) at 12 o’clock, but I sure didn’t play the best I could. By the way we lost the game 2-1 despite having had our opponents very well matched during most of the game :-( I got myself a strained inner ligament in my left ankle, but because it was only minutes after I had finally made my entrance to the game, I continued playing and the pain went away, but as you may guess it returned once the joint cooled down after the game. Today it is sore, but there has hardly been any swelling, and I can move around although it hurts like hell if I have been sitting too long ;-)

I guess the winter break for soccer has come on an appropriate time point. The current situation for our team is 5 knee injuries, 1 hand injury (soccer induced!) and then at least a handful of “minor” injuries of fibers in thighs, groin issues, inflamed toes and strained ligaments. That is actually a whole team out with injuries - we are a poor crowd! Anyway we don’t start practicing indoor until next week, so my ankle has a couple of weeks to recover – hopefully :-) Hopefully the D will not interfere as much with my performance in the indoor games either!

Reflection

2006-10-13T09:19:00.000+02:00

The soccer season is coming to an end. We play the final game this Sunday. If we win, we end third and collect a cash prize to make our ending-party even better :-) Approaching the end of the out door soccer year makes me reflect upon the seasons (spring and fall) as a whole.

I entered a new club in the spring and felt welcome there from the first minute. A couple of team mates from my former club are in this new club too, and that made the transfer a bit easier – at least I only had to learn about 20 new names in stead of 22 ;-) I am proud of the fact that I fairly quickly entered the team for the games, having only missed 4 games or so (of 20) over the two seasons in total, and three of these were due to me having other appointments on game days. Given that we are more than 20 players, occasionally our coach have had to drop players, so being picked for the team on those occasion feels extra good.

This year was also my first of combining CSII management of my diabetes with soccer. Before that I had about 15 years of experience in handling insulin dosing with injections around practise and games. I was comfortable with that, and although it did not always work out quite as would have liked it too, it usually did not cause too many problems. Exchanging Insulatard for Lantus as my basal insulin three years ago didn’t cause any changes around soccer, other than making it a bit easier to manage in some situations. Starting pumping back in April this year, however, is another story! I felt quite helpless not really knowing how to handle things around soccer. This of course was due to lack of experience, but also because I knew the theory behind pumping, the pharmacokinetics of NovoLog that I was now totally dependent upon and needed to learn my response to, and not least the fact that I did not feel like wearing the pump while playing soccer. Practise quickly turned out not to pose any problems, as my theory about giving a small bolus along with a snack about an hour before starting practise worked very nicely, without causing too many lows during practise or highs post practise. Games turned out to be a tough challenge, though. It was, and actually still is, not at all an easy task to make things work without too large fluctuations in BG levels, and I have expressed my frustration about this several times on this blog. In the summer break my diabetes nurse and I agreed that I should try to wear the pump while playing. That prompted finding a way to wear the pump in order to protect it against the hits of close encounters with the field, ball and other players that occurs in the heat of competition, without affecting my free movability. After a few unsuccessful attempts, the sports pack entered the scene and solved the problem in an acceptable way. I must admit, though, that I would still prefer to play without wearing this. Anyway, the next challenge was to find out how to regulate basals around games. This challenge has yet to be solved completely. For the first game of the fall season I was able to wear the Guardian RT sensor, which provided me with very useful information about BG trends during games, and gave me some ideas on how to fit the basals to counteract large fluctuations. Still, theory and actual occurrences are not always the same. I have only had a few successful game days BG-wise in the current season, and it bothers me because even though I may not see the high BG until after the game, being too high or too low surely affects my performance. The issue have mostly been high BG’s, especially towards the end of the game and immediately after. I am annoyed by the fact that I still haven’t been able to figure out how to avoid the spikes towards the end and immediately after games, without having to battle low blood sugars during warm-up and the first part of the games. It is not that I had perfect sugars for games when I was doing MDIs, but the post-game highs never really went above 13.0 (234), whereas with the pump 15-18.0 (270-324) are the typical results. An example of this is from one of the games this fall. I played most of the game, being replaced about 15 minutes before the end of the game. At that time I tested and got a perfect 6.3 (113). Knowing that it was likely to rise, but also wanting to risk going low, I entered a small bolus, 0.8 U (1U will usually drop me 2.7-3.0 mmol/l [49-54 points]). The game ended, we did a short evaluation of it and then headed for the showers and victory beers. Out of the shower, I did a quick test just to be sure I wasn’t too low. About 45 minutes after the perfect 6.3 (113) and 0.8 U bolus, I was at….. 15.7 (283)! Where did that come from? I had not had anything to eat or drink other than lots of water, and the result had me turn down the beer offer outside the locker room, as I did not want to make it even harder to get back into range again.

The series of examples of severe BG changes in relation to soccer while being on the pump is already long. Why is it that I can start out with a 4.7 (85), just a little lower than I would like, thus eating a couple of glucose tabs and a small banana, and then two hours later, after a full warm-up and only 15 minutes break during the 90 minutes game, landing at 16.8 (302)? I just don’t get it!

Anyway, now the indoor soccer season is coming up, and I look forward to that. Not only because I like the technical aspect of indoor soccer, but I also anticipate that it will be somewhat easier to manage BG-levels for this, as the games usually are no more than 7-15 minutes each. Thus, disconnecting for games should not be an issue, and as for practise I may wear the pump or disconnect by the same procedure as I used for outdoor practise back in spring. Time will tell which it will be :-)

60 million blogs

2006-10-10T13:56:00.000+02:00

Sunday evening, in a news-program on one of the Danish TV-channels, there was a feature on web-blogs and blogging. The feature was about what blogs and blogging is, and how it has become increasingly popular to share thoughts and experiences with the rest of the world on the Internet, regardless you being a big company or a "small" Mr. or Ms. "Nobody". This is also the case in DK. Said TV-station started web-blogs via their home-page not too long ago, the aim being that people could discus different topics with the different hosts of the station, and it has been a success. The feature ended with interviews with two Americans, one who had quit his job to be a fulltime blogwriter, and another who was just about to quit her job for the same reason. The speaker announced that world wide an anticipated number of 60 million blogs are now available on the Internet! 60 million blogs! I am just glad that I found the host of D-blogs about a year ago. The number of D-blogs that I have bookmarked in my browser since then has increased. I am no longer able to follow them all every day, but in any idle moment I the up-dates :-) I have (and still do) very much enjoyed reading, writing and commenting on D-related struggles of/in an understanding audience. Doctors, relatives, friends, colleagues and others can express understanding, but in reality we all know that they do not have any chance of really understanding what we go through with the D - just as we do not really have a chance to understand how the our D affects our parents, siblings, significant other.... Therefore it is a relief to blog in a community where members have felt this disease on their own bodies, whether that be as diabetics themselves or as close relatives.

So happy blogging fellow D-bloggers! Together we are strong :-)

Time to blog

2006-10-01T13:15:00.000+02:00

I admit it, I am not good at squeezing in time to up-date my blog every day, or even every second day :-) Thus, again it has been more than 2 weeks since my last post. Not that there hasn’t been something to blog about during these weeks, there has actually been plenty, time and blogging-discipline just haven’t been on my side ;-)

Speaking of discipline, yesterday my soccer team and I had an important game. Our aim this season is to end third. We do not have the potential nor the desire to advance to the national series (Danmarksserien), which the winner of our pool will do and number to have to go into play-off games for. We do think that we have the potential to end third, though, and since this position also means a cash prize, it motivates us even more. Yesterday’s game was against a team that we knew we could defeat (we won 4-1 last time). However, at the moment we have a number of injuries, the last one occurred within this week, among our defenders. Unfortunately, two of our most stable defenders were not able to attend the game due to other appointments that they had agreed upon months ago. Therefore, in reality we had only one defender left for at least 3 positions, so Tuesday’s practice was used to try to figure out who could fill the 2 two other positions of the defence. It was difficult, and we could certainly have used Thursday’s practice as well, but as this was the last practice of the month, it was dedicated to five-a-side with the boys. I was among those tested for a marking player’s position on Tuesday, but I hoped that could avoid that position in the game. Everybody was exited about the line-up when our coach started his tactical presentation prior to the game. And guess what, I was handed one of the marking player’s positions! His reason for handing me this position was my discipline. He told me that in contrast to some of my team mates he was confident that I would fill the position handed, because when he game me directions I would follow them the best I could. I guess that it is true, although I am still far more confident playing forward or wing. Anyway, I played the full match as marking player yesterday and it went okay. Actually, together with our defensive midfielder I was appointed our team’s WOM (woman of the match, we vote about this after each game, and yesterday 7 different players were nominated, so Stine and I won with just 3 votes each). Our coach once again praised my discipline after the game, immediately nick-naming me Andreas Brehme (German defender from the late 80’s and 90’s, German soccer is known to be very disciplined).

Honored about the compliments from my coach, I can’t help thinking about the basis of this discipline capability of mine. Actually, I am quite confident that the most important reason for this comes from me being diabetic. Think about it; everything about diabetes and diabetes management is somewhat build upon discipline. We need to acquire at least some discipline to remember shots, boluses, tests, and to occasionally resist food-related temptations. Though it is a somewhat boring word, discipline can enable us to feel okay most of the time and take part in the activities that our non-D friends indulge in. Apparently this acquired discipline is useful in other aspects of life too, although we may not give it many thoughts :-)

By the way, yesterday’s game was the first one this year that my BG seemed to act okay before, during and after. Starting at 8.5 (153) and ending at 5.8 (104) about half an hour after the final whistle of the game, I was thrilled that for once I didn’t seem to spike uncontrollably just after. I therefore found it appropriate to celebrate – the BG success and the result of the game (2-2 after having been down with 2 at the break) – by having a beer with my team mates before we returned to Odense (it was an away-match). Now, why is it that one is never allowed to celebrate a success without being haunted by it afterwards? The game and the beer kept my BG on the low side the rest of the evening, and this morning too. Damn it, I just had one single beer, something that usually makes me go high rather than low, and I had had plenty of water during the match and ate something before the beer too, why does it have to slap me in the face like that?

I will stop my rantings for now. I may not post that often, but when I do, I write a lot :-)

To pump or not to pump, that is the question……

2006-09-14T20:29:00.000+02:00

…..I am asking myself these days. The post is partly inspired by several conversations that I have had with one of the girls that I share my office at work with over the past 5 months.

When I started on the pump in April, the agreement was that I would give it at least a 3 months try-out, and if I still felt that it wasn’t a kind of diabetes management that suited me, I could go back to MDI and the nurse would keep her mouth shut about the pump for the next year or so (that was her exact saying, although I am not sure if she would be able to keep that promise if I return to MDI ;-)). When I agreed upon that, I had several reasons to finally give in to the pressure of my diabetes nurse for at least giving it a try. First of all she managed to “sell the concept” to Jimmi, who had been on my side regarding pumping until then. Second, I had – and still have – a wish to eliminate the visits of paramedics/my visits to the ER due to severe hypoglycaemic reactions, not only for my own sake but also for Jimmi’s as these episodes are tough on him too. These episodes had probably also affected his attitude towards the offer of a PhD.-position that I got from Denver back in January. I wasn’t sure about whether to go for that offer or not, at least not until I had had the chance to visit the lab in Denver. I hoped that if the promises of the pump (keeping the BG in safe range) would really turn out to be true, I would at least be able to convince Jimmi that we should go to Denver just to take a look at the facilities and the area in general, in order for me to make a fair decision about the job offer. Both still has to happen :-/

Now the initial 3 months are long gone and I am still pumping, but also still debating the advantages and disadvantages of this therapy with myself. Within the initial 3 months I was so close on quitting several times. I felt like I was starting all over again, having to collect experience for the handling of different situation once again, and being frustrated about very low or high BGs. I managed to pull myself together, however, because I was aware of the fact that it would be impossible to give a fair evaluation of the therapy based on less than at least 3 months try-out.

Having tried the pump has changed my conception of it in some areas, but it has also confirmed others. I have no doubt in the fact that an insulin pump is actually the best mimic of a natural pancreas available for the time being. However, I also believe that things can get a lot better. A pump is not optimal in every context of life. Still, it may be the best alternative in others. This is probably also why I am still not convinced about pumping, yet certain that it definitely is the alternative of choice in some situations.

I want to become a scientist. Working as a scientist in the biotech-/biomedical fields means that your working hours are determined by the experiments and other scientific work that you have to do, and that you are likely to go abroad frequently to participate in internal conferences and meetings with collaborators. For a diabetic this offers several challenges in terms of regulation and the need to be flexible. In this regard, no doubt the pump offers most freedom. I got the pump about a month before I was off to a conference in Prague, with limited success D-wise, but as I did not participate in any such conferences while doing MDI, I don’t really have a basis for comparison yet. Regarding the ability to be flexible in order to finish a day’s experiments late in the evening, I have experience with that on MDI, even before Lantus, and that was not easy. Thus, from a “scientific” point of view, I will probably be better of with the pump than with a MDI regimen.

Why am I debating with myself about it then? One of the reasons is leisure time activities. I still find it very annoying to have to wear the pump during soccer. In general, I frequently have moments where I miss not being attached to anything. Although the pump can be disconnected, you still have the infusion site sitting around. Another thing is high readings. Though I do not have that many of them, every time they make me doubt in the function on the pump just as much as in my own actions in the hours before (did I miscalculate the carbs of my last meal, have I done anything different that may cause this, ect.). With injections there are not that many options to consider evaluating a high reading. Of course you can always doubt the absorption and general effect of the insulin, but usually it pins down a wrong assessment of dose size covering your last meal(s). With injections you can visually confirm that the insulin is going into your system by looking at the movement of the plunger move in the pen. With the pump you have no visual of where the insulin is going (I have tried having a leakage somewhere around the place where the tubing enters/connect with the site once, noticing it by an unexplainable high reading and a very wet site patch when I started a correction bolus).

I guess that what it all comes down to me not being totally comfortable with and trusting in the pump yet, despite the fact that I recognise the advantages of it. That is probably why I find it so difficult to evaluate. So far the list of disadvantages with the pump is longer than that of the advantages, but some of the advantages are compelling, so at the moment I guess it is more like a tie that may tip to either side.

More lows

2006-09-04T10:44:00.000+02:00

Once again it has been a full week since my last post, and once again due to being busy, not really having time and energy left to sit down at the computer at night.

This last week my soccer team had 3 matches: Monday and Wednesday evening and Sunday afternoon. I played all three matches, only the one on Sunday full time, though.

Monday evening our opponent was the top team of our league, a team that will most likely be promoted to the Denmark’s series (3^rd highest national league in women’s soccer in Denmark) by the end of this season. We meet them in the final match of the spring season, loosing that match 2-0, so we were top-motivated to take our revenge – and we did! We won 3-2 after having been behind twice in the match, so it was really a fight. I took part in the warm-up, but only played the second half. Still, the BG stayed in range (at least to my knowledge) as I was 8.0 (144) at the end – much better result than most of the other games I have played while being on the pump :-)

Wednesday’s match was against a lower ranging team, but we still managed to fall behind after only a few minutes play. Despite that we came back strongly and won 4-1! In this match I had a break of 20 minutes or so, and unfortunately had to fight the D a bit more. I started out at 5.1 (92), but during the first part of the first half I didn’t feel that fit, suspecting that the BG might be the culprit. I was replaced 35 minutes into the first half, and when I tested, I had a 3.1 (56) – no wonder my legs felt so heavy! I had reduced the basal to 65 % about an hour before the warm-up (I already run the lowest basal of the day in the hours from 3.30 to 6 PM, so doing a 35 % reduction gave me a basal similar to what I used in the first match – early afternoon – when I wore the Guardian sensor) and had it running like this for 1 h 30 min, but apparently that was not enough this time. I guess the fact that I already had the match of Monday plus all the ordinary exercise of my weekdays in the system may have played a role.

The nights following these two games all meant noctural hypoglycaemia to me. Annoying, but I guess that by time I will finally figure out how to tweak the basals overnight to avoid these lows. The sooner the better as I am not awakened by the lows myself. Jimmi is, or happens to wake up by some other cause, and notice how warm, sweaty and generally unresponsive I am. Thus he has to feed me some glucose tabs until he can wake me up or at least see that I respond to his actions.

The game yesterday was in the afternoon and I had hoped that this would help me avoid noctural hypoglycaemia. I did avoid it during sleep, waking up at 7.1 (128) this morning. Just before going to bed, however, I had a bad low. I was able to treat it myself, although I still wonder how the h… I was able to do that with a reading of “LO” (i.e., a BG below 1.1 (20))! The most scary thing about it was that it sort of came sneaking up on me. I was actually sitting at my computer preparing this post with the plan of posting it before going to bed. I was yarning a bit, but didn’t pay much attention to that as it was almost 10 PM and I had played a hard, full time match of soccer in the afternoon. Jimmi wanted me to check something out on the computer, which I all of a sudden had difficulties doing, and when he looked at me, he told me that he though I was low and I better go test. I was about to anyway, getting prepared for bed, but when I am that low I usually act very slowly. I remember testing at 10 PM, Jimmi standing beside me, immediately putting a piece of banana into my mouth, just to get me started on eating something. He offered me different treats, but I couldn’t really decide upon any of them, so I ended up continuing to eat banana, accompanied by some chocolate and a few crackers. When I finally started to fell a bit normal again, my eyes hit the time display of my old VCR recorder: 10.45! OMG! To me it felt like I had just used 10-15 minutes to eat while logging the result of the day on my BG sheet – I don’t know why the routine of doing something at a certain time of day/context never seems to be put off by the hypoglycaemic mind of mine!

As a side note, we lost Sunday’s game, unfortunately due to a ridiculous mistake by the referee, giving us a 2-1 defeat in stead of the tie that would have been fairer, given the possession of the ball and number of chances to score each team had. There was one happy note about the game for me, however: I played the full match, despite minor troubles with the BG cruising on the low side at the end of the first half/beginning of second half AND was awarded our team’s “Player of the match” title, entitling me to hold our team mascot until the next game :-) I can’t even remember what this hand-doll duck is called, but it is always with us, of course wearing a pink bow tie (because we are the pink army, of course).

Saturday was a bit sad on the other hand. I had to help my younger sister and her boyfriend move from their apartment here in Odense to their new one in Vejle, Jutland ;-( I will miss having her around the city!

That is all for now, folks!

Telling people about diabetes

2006-08-27T15:02:00.000+02:00

Last week, at the end of the final practice before the first game of the season, our coach called 4 of us together for a few words. He had just set the team for the match, and wanted to stress to us that given the fact that we were 4 forwards, we couldn’t expect to all be on the field at the same time, nor that we would only be given forward positions. Some of us might need to fill in a wing position for part of the game. Fair enough. The majority of the higher educations do not start until September 1, and thus quite a few of our team mates, especially defensive players, have not returned from holidays and/or working holidays yet, so of course we will have to take on alternative positions until all are back on the field again.

Our coach wanted to hear any objections we may have towards this before the match. There wasn’t many so we adjourned the meeting. As an aside, I just wanted to tell our coach that I would be playing with the pump for the first time, and therefore I would likely be a bit more focused on monitoring during the game (usually I only test before going out, not bothering to do it during the match), because I was at a loss about how to dose the insulin. One of my team mates overhead that, and asked me if I shouldn’t tell them a little about what to do “if you should collapse one day”. This girl has been my team mate in the club I played for before I transferred to my current club, so the reason she asked, I guess, is that she has known me for the last 5 years, some of which I have had great problems managing the D. Our coach quickly added that I had given both him and his assistant a piece of paper about that when I started, and that he carried it in his folder at practice and games. While I did that for obvious reasons, I haven’t really said much about it to my team mates. They know that I am diabetic and I don’t hide my remedies, but I usually don’t have any significant BG issues on the field.

Still, I couldn’t just dismiss the wish of my team mate, because maybe more of them had a need for just leaning a little more about diabetes, despite the fact that I myself haven’t considered it a big deal. My reasons for not having done something like what she felt missing is that when I meet new people, I evaluate the expected amount of time I will spend in their company before enrolling them in a long course about diabetes. For the soccer teams that I have attended, I have always told my team mates and let them know that of course I would be willing to answer any of their questions, and besides that I have made a hand-out for the coach, containing a few more details. To me this seems to be the wisest thing to do as the coach and/or assistant will always attend practice and games, whereas you will never see all of your team mates at once for these. E.g. my current team counts something like 25 different players, yet only 14 are allowed at each match, and for practice we will be anywhere from 7 to 20 players.

Another reason for being a bit hesitant about sharing more information about signs and treatments of low and/or high BG levels to my team mates is that in my experience you can tell people a lot, but it is not until the experience for instance a hypoglycaemic episode that they will really know what it looks like and how it may be treated. This experience primarily comes from my high school years.

The first year of high school we had a 4 days team-up-trip, and on the second year a week long study tour, both of which seemed obvious reasons to inform not only the participating teachers but also my class mates about what to do if something should happen. Nothing did happen during the first 2.5 high school years, or at the trips, and I felt confident that should I ever run into a bad low that required other people to help me, my class mates would be able to do so. That turned out not to be true. I experienced a bad low in the middle of my final high school year. It didn’t really give me any warning signs, I was just a bit tired, but did think too much about that as it was the second lesson of the morning and we were watching a movie. However, my teacher had noticed that I seemed incredibly tired, and I remember him asking if I was alright when we were dismissed. I think that I told him “yes”, but I really can’t remember any of what happened neither in the break nor at the next lesson, where finally one of my closest class mates, Morten, suspected that I might be approaching an insulin shock. My responses when accosted by my class mates or our Danish teacher was just too off compared to normal so Morten took action. At that time it had been approximately 60 minutes since I started showing the first signs, apparently not being aware of them myself. They tried to feed my juice and glucose tabs, but I was so low that they didn’t really saw any improvement and just awaited the arrival of an ambulance to bring me to the hospital. I have a blurry memory of the trip to the hospital, and remember that if my eyes could kill, Morten would have been dead, when he looked at me saying: “Now we are going to Disneyland”, as we arrived at the ER, so their initial treatment did have some effect ;-) I don’t blame any of my class mates or teachers, not at all. I just think that this episode is an excellent example on the above stating that if people do not experience you having problems, then they are not likely to react when you really need them to. Because they are in doubt or maybe just do not remember what they have been told.

At practice the other day I asked those attending whether they too felt a need for me to tell them a bit more about diabetes. The answer was: “Yeah, maybe, but maybe mostly whether any hypoglycaemic issues are recurrent, i.e., likely to happen in relation to soccer, so that we know how much attention to pay towards it. And you should probably do it a day, when most of us are here”. This answer kind of says it all, I think: 1) People do want to know, but most of all they would like to be reassured that any issues are not likely to require their involvement; and 2) They want to be sure that they are not the only ones having heard it, so that if one should forget something another will remember it.

I think that I should take a few minutes at practice, when appropriate, to say a few words to the crowd. At least to soothe the minds of the few worrying souls. But then again: You never know if it should actually come in handy at some point, or if it does, whether they will then remember it.

What do you guys do in this regard?

This and that

2006-08-26T17:39:00.000+02:00

It has been a while since my last post now. Work has kept me busy, and for most part the D has “behaved” nicely. Anyway, this post is going to be a lengthy one, with more about the issues on soccer playing with the pump, general management of the BG and my experience with the Guardian RT.

The last couple of weeks have been quite hectic. I have been awaiting a sports belt bag for the pump to use when I play soccer. It arrived a week ago on Friday, so Tuesday I wore the pump throughout practice for the first time. I had reduced my basal rate to 50 % for an hour before starting, but when I tested before going out I was only 3.7 (67), despite having eaten a banana without blousing for it 25 minutes earlier. Therefore I had 6 glucose tabs and set a temp basal of 50 % for the first hour of practice. I should probably have postponed the starting of practice a little, until the BG was back up in range, but as usual I was eager to get started so I just hit it. I did not feel too fit though, and had to quench a bottle of juice during the practice, still ending it at 3.3 (59).

After practice I had dinner with Jimmi, nothing out of the ordinary, but when testing before bed I had an unbelievable 17.4 (313)! I have no idea why I got that high, so I just corrected, 4 U, to get back in range. That was probably too much, or maybe I should just have reduced the basals throughout the night, although that just did not seem obvious considering the level of my BG when going to bed. Anyway, I woke up at 1:30 AM a bit confused, noticing that Jimmi was not in bed with me and the light was on in the kitchen/living room. At the same time my pump alarmed and I found that it had been suspended. Just as I resumed infusion, I could hear Jimmi showing two Falck-men (the Danish equivalent to paramedics) into our house. In a minute they were in the bedroom, much to my resentment. There wasn’t much for them to do, though. They tested my BG – 2.3 (41) – before watching me down a couple of glucose tabs, a piece of rye bread with cheese and a glass of milk, leaving me at 4.8 (86) afterwards. I tried to bolus for the carbs of the bread and milk, knowing that before the arrival of the Falck-men, Jimmi had loaded half a pack of glucose tabs (7-8 pieces) into me, and thus I anticipated a large rise in the BG. It came, and despite a 2.5 U bolus at 1:50 AM, I was 17.8 (320) at 6:00 AM :-(

The rest of Wednesday as well as Thursday my readings were mostly in range, though. To avoid starting practise on the low side Thursday, I reduced my basal to 50 % an hour before, ate a bit more without bolusing for it, and had a BG of 6.3 just before practise. That was perfect. For the first hour of practice I then ran a 75 % basal, feeling quite good. We played an interval game for the last half an hour, something that is quite strenuous though still a lot more fun and relevant to the games of the season than just running intervals between cones. Thus I was very sweaty at the end of practice, and when wanting to use the lower part of my t-shirt, a part not completely wet, to dry my face, I noticed that my site had come out. I guess the adhesive couldn’t cope with the excessive perspiration. It was up for a change anyway, but afterwards I couldn’t help wonder for how long it had actually been out. Not that the BG was that high afterwards, 7.9 (142), but within half an hour it had climbed to 9.9 (178), so I felt I better increase the bolus for my dinner just a bit to avoid the highs that I became familiar with following the matches of the spring season. That may have been a wrong decision though, as I was only 2.6 (47) when getting ready for bed. I ate a banana and some chocolate, figuring that would due the trick. Apparently not.

The next morning I could hardly wake up, and when I managed to test before Jimmi left for work, I rang in with a stunning and frightening 1.1 (20). I had an appointment with Alice, my diabetes nurse later that morning where some of the obvious topics were how to set the basals during and after practice/games, and keeping the site in place.

In spring I used to just disconnect during practice. This did not generate a need to reduce the basals during the following night, but I have also changed the night basals since then, and when not disconnecting during practice, I guess there is reason in running a slightly lower temporary basal on the nights following practice (the only problem in this is just to remember to do so, but I will get back to that later). Securing the site should be fairly easy with Tegaderm® or an equivalent adhesive. I got a stack of two different types to try. So far the winner is Tegaderm®, because it is much easier to apply, and also remove afterwards, than the other alternative.

Our first match of the tournament was coming up on Saturday, and when I expressed my frustration about having to figure out the insulin requirements for games in the dark, Alice offered me to wear one of their Guardian RT’s for a game day. She had one available so we agreed to just go ahead with that for the game of that weekend. When placing the transmitter on my stomach, she stated that the adhesive on it was very strong, so we wouldn’t need to secure that, just the part were the sensor entered would be sufficient. Again, not true!

For the game Saturday afternoon my newly acquired sports belt back came in handy. It is roomy enough to hold more than just the pump, something I appreciated when also having to carry the Guardian during the match. Both my pump and the Guardian fitted nicely into the back, and despite it being a bit bulky, it didn’t bother me during the game. I was to start as a substitute, but took part in the warm-up at equal intensity as the 11 starters. During this time my BG cruised nicely at 5-5.6 (90-100) with the pump going on 55 % basal. I kept it that way during first half, and having a 5.6 (100) just before entering the game at the start of the second half, I decided to play safe and keep the basal at 55 %. Just after the game the Guardian had me at 7.9 (142), but when I got out of the shower my meter told me 12.3 (221) in contrast to the 8.5 (153) of the Guardian. I didn’t have time to go through the records of Guardian at the time. Jimmi and I were to be at his mother’s at 6 PM, celebrating her birthday, and that meant a 6.5 km bike ride for me (depending on traffic that would be around 20 min). I was out of the locker room at 5:15 PM and needed to go home and secure the transmitter properly, as its adhesive had given in during the game, making it dangle from the Tegaderm®-secured sensor site. So much for the strong adhesive on its back :-)

I have had the opportunity to wear the predecessor of the Guardian sensor 3 or 4 times before, so I found it very advantageous that the Guardian is wireless and enables BG trace-tracking while wearing it. Still, with the 3 days I wore it this time, I wasn’t that impressed with the precision of the device. I am aware that there is a lack in time and therefore slightly different glucose levels in the blood and interstitial fluid is only to be expected, but it seemed that if one was to wear it more consistently, one would have to figure out this approximate lack in order to fully benefit from the low and high BG alarms that the system offers. I would usually test lower than Guardian would have me at when it alarmed for a low. I only had one high alarm (above 10 (180)), one that I did not test for because I expected it, but generally found that when I tested 8-12.5 (144-225), Guardian would show me a 7-9 mmol/l (126-162). The more levels entered into the system, the closer it seemed to get at my meter values, though.

I went to get a download of the Guardian data on Tuesday this week. In general I was pleased with the fact that – despite the differences between meter and Guardian-values – it seemed I was generally below 11.1 (200) during those days. What surprised me the most was the effect of the game. Despite being very consistent at 5-5.6 (90-100) before the game, during the warm-up and the first half that I saw from the touchline, the moment I entered the field, my BG started an ascent to more than twice these levels! Talk about an adrenaline surge! I honestly did not think it would be that pronounced. About 8 h after the game, the effect of the exercise seemed to turn in, lowering my BG to levels and making the Guardian alarm (I didn’t hear it, but Jimmi heard it and acted upon it). Thus, once again I had a low BG-start of the day, this being something that could have been avoided if I had been able to think constructively before going to bed at midnight the night before. Besides the soccer game, my Saturday had 36 km of bike riding on the exercise account, so I guess I ought to have foreseen up-coming hypoglycaemia, but apparently I was too tired to do so.

This week has been only work and practice. We have two games next week, Monday and Wednesday, so it is nice to relax a bit this week. Practice went well both Tuesday and Thursday this week, but Tuesday night I forgot to reduce the basals during the night, so I had a 2.3 (41) to start the day with on Wednesday. Thursday I remembered, and decided to try running a 90 % basal throughout the night. That gave me a 7.1 (128) Friday morning so that was pretty successful.

Tonight we are watching Jimmi’s younger brother, Steffen. Steffen is 11 years old and he recently started to show interest in cooking (much to my delight as he used to be a very picky eater), so he is going to cook for us tonight – he offered that himself, we are not forcing him to do it ;-) Last time we had him here for a sleep-over, he made homemade pita breads with a variety of vegetables and ham. This time the menu is a vegetable soup with homemade bread rolls, so right now he is busy in the kitchen. A thunderstorm is above our heads right now, so I guess our plans of playing soccer after dinner should be revised. Maybe we will just end up watching a good movie and enjoying the banana-cake that I made earlier today – we are allowed to spoil him a bit, when he is with us :-)

Wet, wet, wet

2006-08-04T08:43:00.000+02:00

After my initial, and not very successful, try on wearing the pump during soccer practice - to get some experience with this before going to wear it during games - I debated with myself most of the afternoon yesterday, about weather or not to wear the pump during practice yesterday using other means to make stay put. Tuesday try with wearing the pump in my sports bra did not make me want to do that again. The pump moved too much around under my arm to be comfortable, and I ended up disconnecting after about an hour in which I had used every tiny break to move the pump back to the wanted position.

The following day I toured the Internet in the attempt to find other possible solutions for wearing the pump during soccer. I ended up deciding to go for the sports pack that integrated diabetes offers from their store. I will probably not receive it until next week, however, so yesterday I was considering trying the velco-strap pouch that I use for sleeping. As I use this pouch for sleeping, I came to the conclusion that I would probably not find it very comfortable to wear in bed that night if I had been soaking it in sweat during soccer practice a few hours before. Thus, I went for the disconnection. Finishing practice yesterday, I was very glad that I made that decision!

The weather yesterday was mostly cloudy, but it had been dry all day. Going home after work I noticed a very black cloud that was obviously pouring a lot of rain in another part of town. This cloud, I think, paid my area a visit just as we started practice yesterday, and it stuck around until we were done 90 minutes later! Let me tell you, it was not just raining, it was a regular cloudburst! After 5 min. or so we were all soaking wet, and every time our feet hit the grass you could hear a splash from the water lying on the field + all the water being contained in our socks and boots. Despite the weather we had a rather good practice, and when we finished, the sun broke out. Isn't that just typical? :-) With clothes several kilo grams heavier due to the excessive amount of water, I jumped on my bike to ride the 800 meters back home. When I got out onto the street, I saw that I would actually have been better of with a water bike, as little down the street a large "lake" had appeared: For 25-50 meter of the street, from one side to the other and across the pavement, about 15-20 cm of water were standing. Now, I was soaked anyway so I decided just to go right through it, but I barely made it as I had not expected the water to be that deep.

When I got home I wringed my close and stuffed my boots with an old newspaper, wondering if a neoprene pouch would have been able to keep the pump from being soaked as well in such a weather, and if not what that would have meant for the function of the pump afterwards.....