To pay: 1779 kr

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

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

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

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

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

The Danish health insurance certificate also serves as a travel health insurance to some degree in some parts of the world. Therefore, I had this certificate along with me, when I went to Germany, as I hadn’t received any card to show my relation to the German health insurance company. On the night of June 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 :-)

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 Reeperbahn, sit down and wait for half a package of glucose tabs to do their job. After that I completed my errands, and returned to my room around 8:20 PM. My intension was to test right away, and I had actually prepared both meter and lancer for this, I just never got around doing so, apparently already being low enough for my brain not to function properly.

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

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

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

Back to blogging

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

As some of you may remember, I am to start a PhD-study by June 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

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

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!

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

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

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

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

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......

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?