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?

17

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

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

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

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

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

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

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

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

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

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

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

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

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

Miscellaneous Christmas rants

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In hope of a Happy New Year fellow bloggers!

Christmas lunches

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

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

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

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

Busy days and hypos

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

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

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

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

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

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

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