‘Diabetic’ Alphabet (or Numeral) Soup: mm/dL or mmol/L

December 17, 2009

Not only is the alphabet confusing here (Хдш дхвщ ся шге ьвзгьфеш ъдхокясхж геие–that’s what it looks like when I typed the sentence above again on the Cyrillic keyboard), but I learned of another life-changing difference today between Bulgaria and the US.  I brought lots of insulin with me to Bulgaria, so I won’t be needing any for probably six months, but I only had a few weeks left of test strips, so I knew that I needed to find how to get more sometime this week.  I’ve now talked to two different doctors and have a better idea of what I need to do once we get our residency permits in order to go to the doctor, have labwork done and get prescriptions.  But I also learned that, like in the US, you don’t need a prescription for testing supplies.  I also found out that there is a drug-rep office for Accu-Chek near where we live, so today I went there with a Bulgarian friend to find out what the next step would be.  Unfortunately, they don’t sell supplies in Bulgaria for the meter I have, but I was able to buy a new one with test strips directly from the drug-rep hassle-free (This was a little weird, since I’ve never bought a meter in the US, as local diabetes educators give them out for free).

Now for the fun part.  For diabetics in the US, blood-sugars as measured in milligrams per deciliter (mg/dL). The normal, non-diabetic range is 90-120mg/dL. Hypoglycemic is below 50mg/dL and hyperglycemic is really anything over 150mg/dL. Well guess what? In Bulgaria, it’s not measured in mg/dL, but rather in mmol/L, or millimoles per liter, which according to one diabetes website is “the world standard.”  They comment:

“World standard”, of course, means that mmol/L is used everywhere in the world except in the US.

In this scale, 5.5 mmol/L is equivalent to perfect (100mg/dL).  Check out this pic of my first reading with my new Accu-Chek meter.  Right on the money!

Great First Reading, (c. 102)!

Don’t let this number scare you.  It’s not 57 or 5.7 mg/dL, but 5.7 mmol/L, which is like 102 mg/dL.  Perfect!  The normal range is 5-6 mmol/L.  Hypoglycemic is less than 3 mmol/L; hyperglycemic is greater than 8 mmol/L.  Confusing, isn’t it?  Now I know that the US has been difficult about changing to the metric system, but isn’t this a little extreme?  Mg/dL is the metric system.  Why can’t we just all get along and use the same system?  Fortunately, it’s not that bad, because you can always multiply by 18 to get the US system (e.g. 5.5 mmol/L * 18 = 99 mg/dL).  Also, meters don’t  measure accurately enough to fit the US system.  A measurement of 100 mg/dL on most meters may really be anywhere from 98-102.  The mmol/L system only measures to the tenth spot.  Since each .1 mmol/L corresponds to 1.8 mg/dL, the mmol/L scale is more appropriately precise.  The best thing about my new meter is that it requires very little blood.  I could have had one like it in the US, but I chose to use the glucometer with the test-strip drums, which is still behind the times in the amount of blood it requires.

This post may seem like a lot of unimportant details, but to me, these decimal points and units are quite critical, life or death, really.  I’m excited about learning this new system and am hoping that numbers like 2, 3, 4, 5, 6, 7, 8 will be easier to identify with than 25, 50, 80, 100, 120, 150, 180.  Only time will tell.

-James, the younger

Mr. T Speaks Bulgarian?

December 12, 2009

I was watching some TV the other day that I had recorded from the internet and came across a great infomercial starring none other than Mr. T. I think it was an advertisement for some sort of fast-cooking oven that sits on your counter. I couldn’t understand it all, though, because it was all in Bulgarian, of course. Check it out:

Mr. T on Bulgarian TV

Man, I love Bulgaria. I’m glad to know that Mr. T does, too.

-James, the younger

Добър апетит! [dobr apetit]

December 9, 2009

So I can’t guarantee that this post will be as extreme as Matt’s bone-chilling report on ice caving in Svalbard, but I think that you will find it just as thrilling.  There is hardly anything better in life than eating.  Since moving to Bulgaria, we have continued this habit of ours of eating several times every day.  This delightful rite–I say rite, because the Bulgarians themselves don’t really eat breakfast, unless coffee and a cigarette counts, or two if you’re really hungry–of eating three meals a day has given us a great deal of continuity between our life at home and abroad.  Nevertheless, there are certain key culinary contrasts, several of which I would like to present to you in this post along with illustrative photographs.  So, get ready, and as the French don’t say,  добър апетит!

Since I got married about 2 1/2 years ago, my eating habits have been influenced by my wife’s family, and in particular, by my father-in-law.  He loves to eat spicy food, and since the food is almost never too spicy, it is a custom at their house to put red (cayenne) pepper on the table along with the traditional American salt and pepper shakers.  Because of this, I have learned to add red pepper to almost any food and now know how essential it is to a Southern diet.  I feared that when we moved, I wouldn’t be able to find this favorite spice of mine easily, so you can imagine how excited I was one of our first times we went into a grocery store to find “red pepper” sitting on the shelf, in the same kind of shaker fit to put right on the table.

"Red Pepper" (not Cayenne)

The first time I applied this red spice to my food, we were eating lentils, and to my dismay, regardless of how much I added to my food, it didn’t really get any spicier.  I concluded that it wasn’t really red pepper, but a sick trick to fool unsuspecting Americans, and we later found out that it is paprika.  It turns out that they do have real red pepper, but it’s “hot red pepper.”  I am now relieved, but it was a major disappointment to start with.

Some of our other discoveries have been less tragic, but equally important.  For example, they don’t have salad dressings here, unless you think of this as salad dressing:

Bulgarian "salad dressing"

It’s definitely different to not have a handy bottle of Ranch that you can pour on your salad, although maybe this is for the best, because I guess dressings aren’t particularly good for you.  The stuff in the packet isn’t too bad, and we have been using regular oil & vinegar most of the time.  Also, they do have iceberg and other kinds of lettuce here, which is amazing, considering that the authentic Bulgarian equivalent is cabbage.  Cabbage is good, but not all the time.

Oil & Vinegar

Oil & Vinegar

Another difference is that milk here comes in a paper carton.  Most of it isn’t refrigerated and says that it stays good for six months unless you open it (hmm…how is that possible?)  Bulgarians love dairy products, and there is one whole aisle in the store just for yogurt, and another for cheese (yum!)

Milk & Juice

Also, there is a great variety of juices here.  Pictured above is cherry juice.  Maybe I’m just unobservant, but I don’t think I’ve ever seen cherry juice in the US, just cherry-flavored Kool-Aid.  Real cherry juice is actually quite tasty.  Whenever I have those diabetic moments, you can rest assured that I’ll be bringing my sugars back up in style.  By the way, on that juice bottle there’s no way to tell whether it says “Cappy” or “Sarru”, since it could be written in either the Latin script or the Cyrillic.  There’s one furniture store here called “Como”, but then we realized it might be “Soto.”  Who knows?

In Bulgaria, thoughts about coffee are quite different.  When I tried to order “American coffee” in a breakfast place a couple of weeks ago, the waitress simply told me “It’s not any good.”  In contrast, instead of fresh, hot filter-coffee, the cream of the crop is Nescafe instant coffee.  Some say that this is because during Communist times they couldn’t get it, so now it’s the rave.

Instant Coffee, a Symbol of the West

Hmm…so before you pour yourself another cup of America’s finest, think about how much better your life could be with Nescafe’s 3-in-1 instant coffee/creamer/sugar.

Finally, take a look at our “spice rack” below, as I’ve pulled it all out of the cabinet for this photograph.  They don’t really sell spices in sealable containers here like at home, but in little plastic baggies.

Our spice "rack"

It’s very odd to me somehow, because you have to clip them shut with clothes-pins.  We’ve been told it partly has to do with the fact that people are much poorer here and they can’t afford to buy large containers of things like that.  For example, when you buy chicken bouillon cubes, they come two to a package.  We’ve even been told that when you go to the pharmacy, you can buy one pill at a time, if you want.

Well, I hope you enjoyed this post and that I didn’t make you too hungry, because if you want some of our food, you’re going to have a hard time getting it.

James, the younger

78 Degrees Cold

December 3, 2009

Longyearbyen is a small town in Norway, in a archipelago called Svalbard, north of the Arctic Circle.  It’s home of the northernmost institution of higher education, the University Centre in Svalbard (78 degrees N).  Last month, I had the pleasure of visiting there to work with a friend and research collaborator who studies glacier caves.  I flew into Longyearbyen via Oslo and Tromso.  After hours of flying over clouds, the sky cleared as we appoached the island.  This made for a spectacular view of the mountainous snowy terrain as we descended.  The peaks were all lit by the setting sun, and this is the last time they would see the sun until spring.  Perfect timing on my part.  The beginning of the polar night.

My first day was spent in a safety orientation, which mostly consisted of loading and shooting a .30 -06 rifle, in practice for polar bear encounters.  The next day was our first day of glacier caving. We went up to the glacier nearest town, Longyearbreen, to visit a cave there.  This cave had a walk-in entrance and around 1 km of passage, which was mostly walking.  Right near the lower entrance was a belly crawl, which had the novel feature that if you stayed too long in one place the floor would start melting and make a puddle.  Surface temperatures were cold that day, around 0 F, and, while they were at least out of the wind, the caves weren’t much warmer.

The next day, we went to another glacier and cave, called Rieperbreen, which was a much longer walk (3-4 miles) and a more challenging cave.  The entrance was vertical and dropped into a narrow meandering canyon.  After some roped traversing, and a couple of restricted drops, we reached the base of the glacier and an active flowing stream of water. Most of this cave is formed along the contact between the glacier ice and the rocky glacial till beneath the glacier.  This cave felt more like real caving, with its squeezes, climbs, ropes, and crawls.  It was strange to cave in crampons though, kicking into the walls while climbing, and to be able to see several feet into the walls.  It seemed like there should be real rock down in there somewhere…way down inside…but it was nothing but ice.

-Matt, the elder

Hiking up the Longyearbreen glacier in the midday sun, on the way up to the cave.

Looking back down at the town of Longyearbyen from the Longyearbreen glacier.

Nice banding in the Longyearbreen cave.

The crawl in Longyearbreen.

Clear ice from an old refrozen channel.

One of the crawls in the entrance canyon of Rieperbreen.

The passage at the base of the glacier in Rieperbreen.