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

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"......

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

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

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

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

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

1. You've got to link to the blog of the person who tagged you
2. You need to post these rules on your blog
3. You have to list seven random and/or weird facts about yourself
4. By the end of your post you have to tag 7 random people and include links to their posts (do I sense some sort of advertising purpose - i.e. spreading the word of the host of blogs available to dedicated readers and writers - of this meme? ;-))
   
5. You have to let the people you tag know that they have been tagged by posting a comment on their blog

Alright, rules set, and now Nemo made a jump into my lap - she seems to have a need to be tugged in - so I better get down to business:

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

I tag Doris, Scott, Adjoa, Super G, Kathy, Sandra, and Aliya. I don't know if any of you have already been tagged, or if you want to take part, so don't feel obliged to do it :-)

The adventures of Nemo

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

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

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

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

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

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

Found: Nemo

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

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

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

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

A perfect day

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

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

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

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

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

Jimmi with a sleeping Trille in his arms

Trille awake on my lap

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

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

Impatience

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

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

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 :-)