Wednesday, April 30, 2008  

Fasting Glucose 94
Weight 188
Blood Pressure, Resting Pulse 121/72, 54

I managed to fit in a long lunchtime run today -- nearly 6 miles. Maybe that's why my blood pressure was lower in the evening than it has been lately. I tried to make up for my recent overeating with lighter meals today. To be honest, I did have dinner at a brewpub with friends tonight, and I did drink strong ale there, but at least I ordered a salad this time.

The weather has been surprisingly cool and breezy the last few days, and the running clothes I've been bringing to work with me have been a little too light for the weather. It's hard to judge that, though, because when you're running (especially on hills) your core body temperature rises even if your skin is feeling chilled. On days that are even slightly warm, I tend to continue sweating long after a run and a shower, and this can be embarassing in the office. In the end I felt glad that I had been a little under-dressed for the run, because the wind-chill factor meant that I wasn't a big sweaty mess at the afternoon meetings I attended later.

Tuesday, April 29, 2008  

Fasting Glucose 92
Weight 188
Blood Pressure, Resting Pulse 134/78, 50

The evidence keeps coming in that the incidence of Type 2 diabetes is growing at a remarkable rate -- and at an especially remarkable rate among young people. Kaiser Permanente (a big health-care outfit in California) analyzed data on pregnant women who had prenatal care at their hospitals, comparing the incidence of gestational diabetes (which appears to be, for all practical purposes, the same thing as Type 2) for the years 1999 and 2005. Between those years, the incidence of diabetes more than doubled. That was for women of all ages; among pregnant teens, diabetes became five times as common during the same period.

Although it's clear that America is becoming an increasingly diabetic country, what's not so clear is why. A lot of things could have changed about life in America in recent years, perhaps without our noticing it, and who knows which change or changes are playing a role in making Type 2 diabetes more common?

Even if we assume that the increase in diabetes is simply the result of an increase in obesity, that leaves us with the problem of explaining the increase in obesity. What could cause a society to start getting fat? Is that we're exercising less, or eating more, or eating the wrong things? Or all three? Probably all three. But what would explain these changes in our behavior?

The lack of exercise is the easiest change to explain. Technology has eroded the practice, and even the concept, of physical participation in the real world. It has allowed us to become a culture of spectators -- and the kind of spectators who imagine (rather pathetically) that they are actually doing something. Playing sports is too difficult, so let's watch strangers do it and pretend we're involved somehow. No, that's not unreal enough -- let's play fantasy football -- where no one is involved! It's becoming increasingly difficult to remember a time when people who wanted to do something actually went out and did it for themselves -- a time when someone who wanted to play the guitar would buy a guitar instead of buying Guitar Hero.

What's been going on in terms of what we're eating is a little more complicated, but surely the pursuit of convenience at all costs has something to do with it. The convenience-food industry makes decisions based on what is most profitable, what is easiest to market to children, and what lasts longest on a store shelf. What's actually good for the consumer's health is not an issue. The heavy reliance on hydgrogenated oils, high-fructose corn syrup, and other sinister ingredients has certainly not been good for the public health. The increasing use of high-fructose corn syrup in processed foods tracks the increasing rate of obesity with remarkable precision.

Part of what drives both the trend toward sedentary living and the trend toward reliance on junk food is the perception (real or unreal) that there isn't enough time in the day to live any other way. I feel that way myself, very often, but the reality may be that we have developed an inflated sense of how much free time we ought to have, and how much of that time ought to be spent on passive entertainment rather than on working out or chopping carrots. Why not order a pizza and watch Sex and the City instead? And so the diabetes rate climbs upwards...

Monday, April 28, 2008  

Fasting Glucose 92
Weight 189
Blood Pressure, Resting Pulse 125/75, 57

Aaaahhhhh. Yesterday we performed the last of the concerts in the series, and now I get to relax a bit. The concerts went great, and it was exciting to be part of them, but it's an exhausting process, and I'm very glad to have life returning to normal this week. From the Thursday evening rehearsal to the party Sunday night, I was more or less continuously involved in the concert process -- either driving to the next location, participating in rehearsals and sound checks, setting things up, performing, or attending the party after the last performance. (And there was some performing to do at the party as well; I played for dancing after dinner, and also read to the group some comical short poems I had written about our shared experience.)

My BG and blood pressure are moving back down where they belong, but my weight certainly isn't.  Although I did manage to keep exercising during all this other activity, I was in party mode so far as diet was concerned for four days in a row. I wasn't preparing or choosing my meals; I was eating the food that was thre, in the green room or on the bus or at the party, and I was grazing on it uninhibitedly. Maybe I have a psychological need to get into that mode from time to time, especially when I'm away from home with a bunch of other people. But the thing is, I'm often away from home with a bunch of other people. I did the same thing the previous weekend. Admittedly, that previous weekend consisted of a very long relay race, but my participation in the race didn't have me racking up enough miles to burn off all the snacks I was eating.

So today I shifted things in a healthier direction; it was a purely vegetarian day for me, and I had a lot of fresh produce. I'd better keep that up for a while.

I'd also better get some sleep...

Thursday, April 24, 2008  

Glucose: Fasting, Post-Prandial 95
Weight 188
Blood Pressure, Resting Pulse 131/81, 55

I still felt a bit weak and tired today, but I think the virus is receding -- my immune system seems to be fighting it off successfully. I did a 4-mile run today, even though I felt more like taking a nap, because I figured that exercise would benefit me a lot more than rest. It was hard to do, but not terribly hard to do, and I figure if I can do it at all, I should. I've been drinking orange juice, hoping that the vitamin C will help. Maybe what I need to do most is relax. 

The last rehearsal was tonight; the first concert is tomorrow. I have to be in Oakland pretty early for the concert, but if I can manage it I'm going to do a long run tomorrow morning. I won't have much time for working out on Saturday and Sunday. The concert weekend has a really crowded schedule, because the performing venues are so many miles apart, and because the concerts are so elaborate that a lot of setup work has to be done before the audience gets there. It doesn't leave a lot of free time in the day to exercise. I'm hoping I can squeeze a workout in either Saturday or Sunday. I don't like to take two rest days in a row.   

Wednesday, April 23, 2008  

Fasting Glucose 99
Weight 188
Blood Pressure, Resting Pulse 135/81, 56

I was feeling a little weak today, and then I found out that one of the runners in my van during the relay over the weekend came home sick. Great -- I just spent two days in close quarters with someone who was probably shedding virus the whole time. I thought, "No, no, no! I cannot get sick this week. it's absolutely out of the question. The concert series starts on Friday. No getting sick allowed!" But there was no mistaking that I had a mild sore throat, which is usually my first symptom when I get a cold. And I was feeling that particular kind of fatigue that tells me a virus is trying to take me over. Maybe that was why my BG was a bit elevated today.

As I do not have time to be sick this week, I did what I could about it. The first order of business was to get outdoors for a good run. It was a bit cold and windy outside, but I have found that exercising outdoors in chilly weather is often my best hope of scaring a virus away, so I went ahead with the run even though I wasn't feeling very well. I figured I would probably feel a little better after the run than I had before it, which turned out to be true.

Coming home after work, I wanted to fall asleep immediately, but I had a homework assignment to finish tonight, and I needed to get in some practice time on the concert music. If I skipped either of those obligations, I would be surrendering to the virus, and I don't dare do that. I decided to lie down for an hour, as I felt I did need a little nap, and then get up and do what I had to do. Surprisingly, I managed to carry out this plan in full. So now I've practiced, the concert music, and I've finished the homework. I feel a bit better than I did earlier today. Maybe I succeeded in scaring the germs away; I guess I'll find out tomorrow.

My numbers are lousy today all around. Too much stress, too much eating, not enough sleep. All of these things are bad for me, and the results are plain to see. Once I get through the concerts this weekend, my life ought to become a little more orderly and a lot more healthy. The trouble with participating in big sports events, such as the relay this past weekend, is that they make you think you're exercising enough to be able to get away with anything, so it doesn't matter what else is going on in your life. But it does matter, unfortunately.

Tuesday, April 22, 2008  

Fasting Glucose 87
Weight 188
Blood Pressure, Resting Pulse 131/78, 63

Once again, I'm pressed for time, with a concert series (starting this Friday) to get ready for, and a homework assignment to do for my computer class. I'll just note in passing that my fasting glucose has already recovered nicely from the dietary excesses of the big relay weekend. I can't say as much for my weight, but I'll get right on that.

Anyway, I forgot to mention that I wasn't especially stiff and sore after the relay, just tired and sleepy. I would have gone running at lunchtime today, if time had allowed, but I had to be satisfied with working out in the gym after work instead. Maybe I can run tomrrow, but it's raining tonight and likely to be raining tomorrow, which tends to discourage me. I have been known to go for a run in heavy rain, but usually it takes a lot of peer pressure to get me out there, and the peers I run with these days don't seem to like running in the rain any more than I do.

Monday, April 21, 2008  

Fasting Glucose 97
Weight 186
Blood Pressure, Resting Pulse 120/77, 46

The relay is done, and it was a great adventure. Not an easily-described adventure, but I'll do my best.

The race started in Calistoga (at the northern end of the Napa Valley) at 11 AM on Saturday. Here are some of my team-mates waiting for the start, looking energetic and ready for anything:

I must not have looked energetic or ready for anything myself; I was scheduled to be the first runner on our team to run, and as we waited for the start everyone kept asking me "Are you ready?". I wasn't at all sure that I was, but it turned out that I was readier for this than I had been for any previous race I'd run.

There were 12 team members in all; we were travelling in two vans, so most of our communication with the other van was by cell-phone (through the whole weekend, there were only six times at which both halves of the team were at the same place at the same time, and that includes the start and finish). Each of the twelve of us was assigned three "legs" of the race to run. The legs weren't equal in length or difficulty, and my assignments were comparatively easy, but I still was worried that I would be a lot slower than everyone else.

Because of the way the race is organized, every runner has to declare his estimated running pace (in mintues per mile). The teams are started off at widely different times on Saturday, with the slowet teams starting first, so that the groups converge along the way instead of diverging, and all the teams finish at roughly the same time on Sunday afternoon. Most of the other members of our team had a declared pace of 8:30 to 9:00. My declared pace was 10:00, but I was afraid I would be even slower than that. In the past it's been very hard for me to get my pace below 10:00, and the best pace I'd ever had in a race was 9:37. As it turned out, I did much better than I expected. During the hardest of my three race legs (Saturday night, climbing up to Nicasio in Marin), my pace was 9:10. During my leg in Palo Alto (early the next morning), my pace was 9:00. And during my easiest leg (the first, in Calistoga on Saturday morning), it was 8:57! Much better than I've been able to do in the past. It was exhilirating to be able to make that kind of improvement.

The teamwork aspect of the run was also fun. Despite the length of the event, the time seemed to fly by quickly because we were so busy keeping track of our runners and our schedule. Often we would be waiting for a runner at an exchange point by the side of a country road, squinting at the tiny figure of a runner in the distance and trying to figure out if it was our runner or someone else. It's surprising how much one runner looks like another from a thousand yards away.

My favorite of the three legs I ran was the hardest one; what made it my favorite was that the unusual conditions (running after dark on a narrow country road) seemed a little scary at first but turned out to make the thing more exciting. My van team-mates kept close tabs on me during the run, so I wasn't feeling abandoned (every mile or so they drove by, cheered for me, and then pulled off the road to wait for me). There was a full moon rising over the hills, and when I turned east to head toward Nicasio I got to see the moonlight glistening beautifully on the water of the reservoir. In the darkness ahead there was a trail of twinkling lights carried by other runners ahead of me on the road. There was a magical atmosphere about the run. Some of the other runners in my van agreed with me that the night run was the best part (particularly the one who ran across the Golden Gate Bridge at 2 AM under the full moon; he said he felt guilty that the rest of didn't get to share that experience with him).

Our team finished 86th out of 202 teams, with a time of 29 hours and 20 minutes. Finish times for other teams ranged from 20 to 35 hours. The winner was one of six teams made up of a Google employees; they take running pretty seriously in that outfit, apparently. We weren't that serious, or at least we weren't seriously expecting to win, but we wanted to do as well as we could, and we certainly didn't want to come in later than our estimate. Because everyone on the team (not just me) ran faster than promised, we stayed ahead of schedule the whole weekend, and we got to the finish line (on the beach in Santa Cruz) at 4:20 PM Sunday -- 48 minutes early.

The biggest challenge of the weekend was not the running but the lack of sleep. In theory, we had an opportunity to sleep on Sunday morning between 3:30 and 6:30, while the other van was "on", but there was no quiet and comfortable place for us to do it, and I ended up having only the briefest episodes of shallow sleep during that time. I ran my last leg at 7:15 that morning, and it was nice to be finished so soon, but I was a zombie the rest of Sunday. If I do this race again, I'll have to think hard about finding a better solution to the sleep problem. Other than that, it was a great weekend.

Given that I spent the weekend eating snacks in a van, and didn't get any sleep, and had a big meal at a Mexican restaurant after the race, it's not surprising that my fasting BG was up a bit this morning. I'm sure it will settle down. Certainly the race didn't do my blood pressure any harm. And, because the event built up my confidence in my ability to run, I'm sure there was a great long-term benefit to my health, no matter how hard it was on me in the short term.

Friday, April 18, 2008  

Fasting Glucose 95
Weight 187
Blood Pressure, Resting Pulse 133/76, 57

The only item on my agenda today was getting ready for the relay race, which starts tomorrow morning and continues through Sunday afternoon. It turns out to be a complicated thing to organize 12 runners in 2 vans running a 199-mile course, with each runner running 3 parts of a course divided into 36 segments...

 I have segments 1, 13, and 25. I also have a list of things I'm supposed to bring with me (including flashlights and reflective vests for the after-dark portions of the run), and I hope I remembered to purchase (and pack) everything that's needed.

The whole idea of the relay (or at least the idea of my personal participation in it) has looked more and more crazy to me as the race date has approached, but people who have done this before swear it's a lot of fun. I hope they're right.

Thursday, April 17, 2008  

Fasting Glucose 87
Weight 186
Blood Pressure, Resting Pulse 129/79, 59

It's over! It's over! It's over! We finally did the last code submit on the software release today. Now I'm taking a couple of vacation days, Friday and next Monday. I need Friday off to recover from the stress of the past four days, and to catch up on sleep and get ready for the big relay race this weekend. I need Monday off to recover from whatever the big relay race turns out to be like. I've never done anything like it; I hope it turns out to be as much fun as people claim.

After work I drove down to Marin for a concert rehearsal. A rehearsal involving more than a hundred musicians can be an exhausting thing, even for someone who comes into it feeling a lot fresher than I did. I was dead upon arrival and deader still when I left, but at least I'm still feeling confident that the concerts will be great. We still have "issues" to work on, and areas of confusion that haven't been fully resolved, but I've been through the process with this group too many times to doubt that they will pull it all together miraculously by opening night. Now that the extreme pressure of the software release is off me, I think I'll be able to relax and get fully into the music.

I squeezed a run into my schedule, but a short one -- about 3 miles. Since I have tomorrow off work, I'm tempted to do a nice long trail-run for stress relief, but with the relay happening on Saturday and Sunday I don't think I should do anything that might wear me out. I'll do a light workout of some kind, but that's all I ought to do. 

Wednesday, April 16, 2008  

Fasting Glucose 84
Weight 187
Blood Pressure, Resting Pulse 129/80, 52

I've been feeling so stressed out lately that, despite the big pileup of tasks that I'm now coping with, I feel as if I have to make time for relaxation, no matter how difficult it may be to arrange. Today, despite all the craziness going on at work this week, I managed to do a 5-mile run. and in the evening, despite having to a homework assignment that I need to get out of the way, I managed to spend a couple hours playing Irish music at a local pub. Then I came home and finished the homework assignment (at about midnight), and am filling in this little blog update. With the homework out of the way, I will be free tomorrow night to focus on the concert rehearsal, and on Friday I will be free to concentrate on getting ready for the big relay race on the weekend. Then, with the relay race done (and me still alive, I assume), I'll be free to concentrate on the concerts coming up the following weekend. And when the concerts are done maybe somewhere along the way I get to take a vacation or something...

Tuesday, April 15, 2008  

Fasting Glucose 78
Weight 185
Blood Pressure, Resting Pulse 128/78, 52

An even higher-stress day at work, and with no exercise to relieve the tension this time. Tomorrow might or might not be better, depending on what I discover tomorrow morning when I look at the software build that was generated overnight.  But even if there are no unpleasant surprises there, a lot of other known problems need to be solved in a hurry tomorrow. I hope everything will at least be settled by Thursday, so that I can leave on time for the concert rehearsal. (I'm starting to feel good about the concert music now -- I've pretty much got it memorized, so I won't need to take sheet music to the remaining rehearsals, and I'm playing it up to speed without too much difficulty.)  Saturday and Sunday will be devoted to the big relay race, and I have some logistical chores to take care of for that on Friday. I have a homework assignment to do in my night class; I'm hoping to get that done tomorrow night. At least I don't have to do my taxes tonight -- a lot of people are doing that.

I hope I don't ever take on this many challenges in the same month again.

Monday, April 14, 2008  

Fasting Glucose 95
Weight 185
Blood Pressure, Resting Pulse 133/78, 58

A high-stress day at work, with time running out on getting a bunch of corrections done before code-freeze. It now appears that I have until tomorrow at 2 PM to make my final changes. Racing against the clock is not good for my blood pressure, but however stressful tomorrow morning is going to be, I think I will be able to relax a lot once the thing is done. I did manage to get a run in at lunchtime (4 miles), and I went to yoga class tonight. I hate to think how much higher my blood pressure would be reading now if I hadn't done the running or the yoga.

I woke up with a sore lower back this morning, no doubt as a consequence of the yard work I did yesterday (I was chopping away weeds using a scythe-like thing, with a wooden handle that wasn't quite long enough, so that I had to bend forward while swinging it). I knew that a run would help me at least a little, and it did. Before the run I had trouble tying the laces on my running shoes because I couldn't lean forward; afterwards untying them was no problem. I knew that yoga in the evening would help even more, and it did. It's all about body-maintenance when you have Type 2, because you can't afford to let yourself be incapacitated by aches and pains. My back probably won't hurt tomorrow morning, but if it does I know there are things I can do about it. I'm not averse to using such tricks as ice and Ibuprofen (or Vitamin I, as the runners call it) to get me through a bad day, and I did both of those things earlier today. But I know that, if my muscles are sore, I can't just take pills and curl up on the couch while I wait for them to get over it. I have to do something with them, use them and warm them up and stretch them. 

It's impossible to know how much longer I can get away with this -- exercising without hurting myself badly enough in the process to have to give up exercise. On the other hand, I had fairly serious aches and pains (particularly back pains) for many years before I started my exercise program, and I'm having less trouble with them now than I used to have. I certainly recover from them faster than I used to do. Right now my belief is that I can keep the machine operating for many years to come if I use it properly and do the necessary maintenance.

Sunday, April 13, 2008  

Fasting Glucose 89
Weight 185
Blood Pressure, Resting Pulse 122/71, pp

It was a busy morning, but I managed to fit in another trail run today (a shorter one, about 5 miles). I also a bit of yard work beforehand, as a warmup. And I warmed up for the yardwork by completing some health-plan paperwork which had been preventing me from finishing up my income tax return. Of those three activities, the paperwork was the one that was hardest on me. If I had to choose between running up a steep trail and trying to fill in an IRS form which employs the phrases "HSA distribution", "Qualified HSA distribution", and "Qualified HSA fund distribution" to mean three entirely different things... I'll take running up a steep trail. Today I didn't have the opportunity of choosing between them, so I did both, and running up the steep trail was the more enjoyable of the two. I ran on a different trail today, and the wildflowers were even more abundant on this one. So were the lizards. Sometimes trail-running is mostly about trying not to step on lizards.

It was not quite as warm today, about 80 degrees, or anyway it was 80 when I was running. It's a little warmer now, but that doesn't matter -- I've finished my exercise, and mailed in my tax return, and the hardest assignment I've given myself for the rest of the day is playing for the dance tonight, which shouldn't be too difficult.  

My weight measurement today (seemingly 2 pounds down from yesterday morning) shows the effect of yesterday's 7-mile trail run. Unfortunately, it has very little to do with fat loss, and everything to do with water loss. From sweating during the run, I had lost four pounds of water weight, and from drinking afterwards I had put two of those pounds back today. In today's run I lost four pounds again, and am now in the process of putting them back. A small fraction of all this weight loss is from fat-burning, but there's no doubt in my mind that the vast majority of it is from sweating. It's temporary and meaningless weight loss, bound to vanish as soon as I restore my fluid balance, but that doesn't stop me from hopping on the scale when I come home from a long run, and enjoying the low numbers I see there. I don't know why I still allow myself to get excited over that.

The psychology of home medical testing is a bit strange. There's no point in doing it at all unless you want accurate information, and there's nothing to be gained by manipulating the timing of your tests to get test results that look better. Still, the temptation to bias the results (for example, getting up earlier in the morning in hopes of seeing a lower fasting test result) is strong, and so is the temptation to read more into a result than is reasonable. I try not to do these things, but I still find myself feeling smug or anxious when any kind of test result is better or worse than usual, even if I know perfectly well that the change is caused by some minor issue of no significance. It's superstitious thinking. The Romans thought that, if a bride stumbled on the threshold when first entering her husband's home, it was a very bad omen for the future of the marriage -- and they dealt with this potential problem by having the groom carry the bride across the threshold, so that she had no opportunity for stumbling. To the primitive mind, it makes sense to try to rig a test so that it won't yield any bad news. The primitive mind, alas, is what most of us are using most of the time, except when we're trying very hard not to.

Saturday, April 12, 2008  

Fasting Glucose 87
Weight 187
Blood Pressure, Resting Pulse 123/75, 62

It was a summery day, clear and warm. I was planning to do a trail run, and the common-sense approach would have been to do it in the morning, while it was still cool. However, it had been a while since I'd been running under a hot sun, and I felt a peculiar urge to do so, I guess to get the winter out of my system once and for all. So I went in the middle of the afternoon (when it was 85 degrees) to Annadel State Park. I ran a 7.1-mile route. There were a lot of mountain-bikers on the trails, but I don't think I saw a single runner; probably they all chose the sensible option and ran in the morning. Or maybe the runners were waiting for tomorrow: there's an organized trail run in the park tomorrow, but I didn't have room in my schedule for it.

It was a good run. The temperature didn't bother me, because we are blessed with low humidity in these parts. 85 degrees is not too warm for running if the air is dry. I once went running in Texas on an 85-degree day that seemed more like 120 because the air was saturated with water vapor and my sweat wouldn't evaporate. An 85-degree day in California is not nearly so challenging. As I ran along the trail I wasn't having a tape playing in my head that said "I hate this, I'm dying, I hate this" (that tape played continuously when I ran in Texas). I was able to relax and enjoy the run. The air was very clear, so when I got a view of the valley to the west I could see for many miles. There were a lot of wildflowers along the trail: orange poppies, bluebells, and some kind of purple heather-like variety. Apart from lizards, though, I saw less wildlife than usual. No snakes, no wild turkeys, and no deer. Also no mountain lions, but I'm not complaining.

I carried a bottle of water with me, and took the opportunity to refill it about a mile from the end, but I still lost 4 pounds during the run. Even in cooler weather, I can easily lose 5 or 6 pounds during a long run. It's a bit of a problem for me: during exercise I sweat more than a normal human, and I very easily get dehydrated. Other people I run with can drink less than I do during the same run and not have the same problem. Oh well, life is not fair.

I don't know what I'll have time for in the way of exercise tomorrow. I'm going to a party in the afternoon that turns into a dance in the evening, and I'm playing for the dance, so I need to spend some time tomorrow getting set lists together. I'll probably just go to the gym for a quick workout in the morning. I certainly need to get some kind of exercise in, if I'm going to be surrounded by party food in the evening. I have found that the combination of party food and no exercise tends to give me test results that I don't like.

Friday, April 11, 2008  

Fasting Glucose 91
Weight 187
Blood Pressure, Resting Pulse 127/74, 55

A beautiful day -- it's starting to get warm; 80 degrees most of the afternoon. I did manage to get outside for a run (4 miles).

A glance at the calendar gives me the shocking news that the big relay race is coming up very soon -- next weekend, in fact. I signed up for it mighty casually, now that I think of it; some running buddies from work said they were interested in doing it, and I said okay, sure. That was the extent of my decision-making process. The only explanation I can offer is that, at the time I was asked to do it, I had just run the Napa Marathon, and at that point any race that involved less than 20 miles of running sounded easy to me. The relay will involve (for me) a total of 16 miles of running. In the marathon, I felt great for the first 16 miles, and I didn't start to feel really awful until mile 21, so how tough could 16 miles of running be? Especially considering that I don't have to run the 16 miles continuously. I run three separate "legs" of the relay, with long breaks in between. The other eleven members of my relay team will take care of the remaining 183 miles of the route.

I run the first leg of the relay, starting our team off at 11 AM on Saturday the 19th. The first leg of the relay is a course identical to the first five miles of the Napa Marathon, so it's familiar territory (and beautiful territory as well, with the reliably comforting presence of vineyards all along the way). That part of the race will be easy.

The second leg is on the road between Petaluma and Point Reyes, going over the hill to the Nicasio Reservoir. I've done a lot of bike rides along that road, but I've never run there. It's a beautiful location. I'm used to seeing it in the daylight, though; for the relay, I'm expected to be there at about 10 PM, so I hope the place is as pretty by moonlight (there's a full moon that night). This is the only hilly leg of the relay that I'm doing, and it's a lot less hilly than some. Here's the elevation profile for my section:

I'll have to climb about 125 feet to get over the hill, but that's not much; a route that I run almost every day at lunch involves more climbing than that. And from the second mile on it will be downhill.

My last leg of the relay will be between Menlo Park and Palo Alto (I'll pass close by Stanford University).  That should be after sunrise on Sunday morning. From then on I can relax, until we all join up as a team on the beach at Santa Cruz in the afternoon, and run on the sand to the finish line together.

The gaps between the legs I will run are so lengthy that there will be opportunities for me to sleep during this day-and-night extravaganza. We'll bring sleeping bags, and probably end up napping in the fields along the route. If we choose the right places to do this, we won't be arrested on vagrancy charges.

Having never participated in an event like this, I have only a hazy idea of what the experience will be like, but the people I know who have done it before say that it's loads of fun. I've decided that that's good enough for me. My exercise program, over the seven years since I was diagnosed with Type 2, has consisted largely of hanging around with active people and allowing them to talk me into doing things that I'm afraid will be too difficult for me. I have seldom regretted going along with their suggestions, and I certainly have no regrets about choosing this approach in general. I've had a lot of good experiences as a result: bike rides around Lake Tahoe, footraces across the Golden Gate Bridge, moonlight hikes. The few bad experiences I've had as a result make good stories, if nothing else. And being able to keep my glucose levels normal for seven years without medication is a pretty big payoff.

Thursday, April 10, 2008  

Fasting Glucose 83
Weight 186
Blood Pressure, Resting Pulse 120/76,  52

Too much going on! Someone, please stop me before I sign up to do anything else this month...

Another busy day at work, and right afterwards I had to drive down to Marin for a concert rehearsal. The rehearsal took a little over 3 hours, and then I had to drive back home (which takes about 50 minutes). The oil companies must love musicians; we're always driving around like that, usually to absurdly distant concerts and rehearsals.

No exercise today, unless hurrying around trying to get things done counts as exercise (and guess what: it doesn't). I think I'll have time for a good run tomorrow, and I should be able to do a long trail run on Saturday.

If playing fiddle tunes isn't really exercise, at least it's good for my blood pressure. Anyway, my blood pressure was surprisingly good when I got home from the rehearsal, especially considering that I didn't work out today. I'm planning to combine the best of both worlds on Sunday: I'll be working out in the morning, and playing at a dance in the evening. If my blood pressure isn't nice and low after all that, I'll be very disappointed.

But now: time to get some sleep.


Wednesday, April 9, 2008  

Glucose: Fasting 86
Weight 186
Blood Pressure, Resting Pulse 118/75, 52

After a frantic morning at work (in which other people scheduled me for two simultaneous meetings, and someone actually showed up at the first to see why I wasn't at the second), I managed to break free for a good solid run at lunchtime. It was a long one (6 miles), and it was also a hilly one (about 600 feet of ascent). It was hard, but it was what I needed. There are various things you can do to relieve stress, but nothing works as well as hard exercise, or has more lasting impact. It's the gift that keeps on giving. Note that my systolic blood pressure was only 118 this evening, compared to recent results which ranged from 129 to 132 (on days when I wasn't working out as hard).

For whatever reason, I can usually meet the diastolic pressure goal of <80, but meeting the systolic goal of <120 is much harder. Well, I met it today, at least. The definition of "normal" blood pressure used to be more liberal, but <120/80 is where the goalposts have been placed now, and whether we like it or not that's what we have to aim for, especially those of us with Type 2 diabetes.

I recently read that, according to the statistics, diabetes is just as big a heart-attack risk factor as having had a previous heart attack. Yes, you read that right: the odds that a diabetic person will have a heart attack are as bad as the odds that someone who has already had one heart attack will have another. Of course, that raises the question of what we mean by "a diabetic person". Does it include anyone who has ever been diagnosed as diabetic, even if their BG is normal now? Or does it mean only mean those whose BG is routinely elevated to the point that they could be diagnosed as diabetic any old time?

I usually insist on making a distinction between someone like myself, who manages to keep his blood sugar normal, and someone whose blood sugar is elevated on a routine basis. However, in terms of the cardiac risk associated with diabetes, it is not always possible to make a sharp distinction there. Maintaining good glucose control, by itself, only takes you so far in terms of reducing the cardiac risk associated with diabetes. It helps, but it doesn't solve the problem. That is why prescription drugs for Type 2 diabetes are such a disappointment in the last analysis; they do bring your BG down, but they do it without serving as any kind of practical defense against heart disease. As the primary goal of diabetes therapy is (or should be, in my opinion) not having a heart attack and dying, it seems clear that it would be better to bring your BG down through the use of a therapy which does serve as a practical defense against heart disease.

So far, exercise is the only diabetes therapy that works that way. It's the pharmaceutical I chose. I haven't always loved it, but I've always had good luck with it. It's brought my BG under very good control, and it's brought my blood pressure way down. Plus: no heart attacks.

Of course, I could have a heart attack tomorrow. If I do, what will that prove? That I did all that exercise for nothing? Maybe not. Maybe it will mean that I managed to delay a heart attack which would otherwise have happened six years sooner. There's no getting to the bottom of these things, no way to replay the recording of your life to see what would have happened differently if a few details had been changed early on. We can't arrive at certainty in such matters; all we have to work with are the odds. The odds say I'll do better if I continue what I'm doing, and that's close enough to certainty for my purposes.

Tuesday, April 8, 2008  

Fasting Glucose 85
Weight 185
Blood Pressure, Resting Pulse 129/79, 52

I didn't do any post-prandial tests today, and I don't think I'm going to continue doing them on a daily basis. I had given them up almost entirely until a month ago, when an unexpected high result led me to think I ought start doing a lot of post-prandial tests for a while, and find out what was going on. What was going on, as it turned out, was that my post-prandial test results were quite good (except when I was having a high-carb dinner accompanied by strong ale, the combination which caused this little panic in the first place). I noticed that my post-prandial results seemed to track the amount of exercise I was getting more closely than they tracked my diet. On a day with a hard workout, my post-prandial results were strikingly lower than they were on a day with a wimpy workout or none, even if there was no obvious difference in diet.

Today was on the wimpy side, I'm afraid. I couldn't make enough time in my day to go running with my usual running partners at work. I ended up going to the gym after dinner for a workout on the stair-climber, because that was what I had time for. I hope I can do better tomorrow. I need to get a few serious running workouts in before the big relay race on April 19 and 20. It's not as long as a marathon (I'll be running about 16 miles, but in three separate sections with long rests in between). Still, it's enough of a challenge that I should do some long training runs to make sure I'm in shape for it. The rest of the people on my relay team are faster than me, and I don't want to stand out more than I have to.

If only I didn't have to sleep, I bet I'd have time for every single thing that I've signed up to do this month...

Monday, April 7, 2008  

Glucose: Fasting, Post-Prandial 87, 82
Weight 187
Blood Pressure, Resting Pulse 133/78, 54

Well, so far my results with the new test strips aren't bad at all. The very low post-prandial result (lower than the fasting result!) is easily explained: I had did a good, hilly 4.4 mile run at lunchtime, at a fast pace for me, and the lunch I had afterwards was low in carbohydrates (it was a big plate of stir-fried vegetables, without rice or other starchy extras). I expected the post-prandial result after that to be low. Not necessarily as low as 82, but low.

On most days, I would have felt a need to get more carbs into my system after a strenuous run, and I would have added bread or something to the lunch. This time I just didn't feel like it, I suppose because I had spent a weekend doing way too much driving from place to place, and not enough time exercising. Usually I do some kind of big workout, such as a long trail-run or bike ride, during the weekend, and if I don't find time to fit something like that into my schedule I feel uncomfortable about it, as if I'd spent the whole weekend on the couch eating potato chips. I hadn't actually spent the weekend that way, I hasten to add, but spending the weekend away from home with a bunch of musicians, eating whatever snacks are around, and not getting any more exercise than it takes to carry your instrument from the green room to the stage and play it, is not necessarily a lot better. (I did fit in some exercise, but it was very minimal -- less, not more, than I usually fit in on the average work day.)

I would love to believe that playing a musical instrument is the same thing as exercise, but I know that it's not. I wore a heart monitor once while playing, and found that most of the time my heart rate was about 64, which is the kind of heart rate many people have when they're asleep. (This probably makes it sound as if I'm not a very energetic player, but I don't think that can be true, based on the complaints I sometimes  get from other musicians who wish I would slow down.) So, even though I'm going to be pretty wrapped up in music for the next few weeks (getting ready for concerts at the end of the month), I'll have to find some way to make sure that exercise doesn't get crowded out of my shedule. It's a difficult challenge, but I've been dealing with that challenge for seven years now and I think I've learned not to be defeated by it. Tomorrow, for example, is going to be very hard day to fit a good run into, but I'm determined to do it somehow.

Sunday, April 6, 2008  

Glucose: Fasting, Post-Prandial 90, 123
Weight 188
Blood Pressure, Resting Pulse 132/82, 54

I finally used up all of that set of test strips that seemed to be biased to read 6 points low. Today's numbers were made using a new set, which presumably are not biased in that way -- so I expect my BG numbers will be going up. I don't necessarily expect them to be high; I just don't think they will be artificially reduced, the way they have been since February 10. It's too bad, because I've become very comfortable with those artificially reduced numbers and it's going to be hard to say goodbye to them.

I'm surprised today's numbers weren't worse, though. I have had too busy a weekend, with way too much driving around and eating on the run, and not enough exercise. I did go to the gym today, but I was running late on my way somewhere else, so it was what I would consider the bare minimum of a workout (30 minutes on a not-too-difficult training machine, and that is no substitute for the long trail run I had originally wanted to do instead).  

I guess I don't have much else to say today. April is going to be a difficult period to get through; I've got too many activities scheduled, and maybe the only thing I can do about it at the moment is to get some sleep...

Friday, April 4, 2008  

Glucose: Fasting, Post-Prandial 81, 106
Weight 187
Blood Pressure, Resting Pulse 130/81 51

I'm feeling a little bit less overwhelmed today. I was afraid I'd have to work over the weekend, but this afternoon it became clear that I had already fixed everything that could be fixed before the Monday code freeze, so I might as well concentrate on other tasks. I just finished the lab assignment for my computer class and submitted it to the class website -- which is good, because the deadline was midnight tonight.

Tomorrow I'm playing in a benefit concert, which unfortunately is happening 90 miles from here. That represents a pretty big chunk of time (and gas money), but it's something I feel I ought to participate in. And I'll have to exercise tomorrow, though I haven't decided what to do exactly. If I can find the time I'll do a trail run, but more likely I'll just have to stop by the gym on my way out of town.

Today's workout was a fairly tough 5-mile run -- tough in that it was hilly, and that I was trying to keep up with a couple of runners who are faster than me. Actually, most runners are faster than me. It's hard for me to maintain a pace of less than 10:00 per mile over a long distance. My best pace in a 10-kilometer race was 9:37. Real runners will tell you that's not even running, that's "jogging". Whatever. I do what I can.

One of the many things you have to develop, if you're going to exercise regularly, is the determination to keep doing it whether you're good at it or not. When I run with other people, I very often end up feeling exhausted from keeping up with them, or embarrassed from not keeping up with them, or both. I just can't afford to allow that to discourage me. Fortunately, there are a lot of people these days who run even though they're not good at it, so I can sign up for a footrace without having to worry that I'll be among the very last people staggering over the finish line. Typically about two-thirds of the participants in a footrace finish ahead of me. Well, that means a third of them finish behind me. I can live with that kind of outcome. It would be nice to do better, but I'm not sure that I'm sufficiently fired-up about doing better to devote the kind of energy to speed-training that would be required.

I suppose it's psychological -- my speed limit, that is. When I run fast I start to feel bad (usually the feeling takes the form of mild nausea). Still, there is something unreal about this feeling of "nausea", as it has never actually made me throw up, or come close to it. Maybe it's a mental rather than physical feeling, which a real runner would learn to tune out somehow. I try to. Where I can't tune it out is on steep hills. I just can't help slowing down on the climbs (and living where I do, climbs are not avoidable). Maybe I'll never become a good runner. That's okay. I can't afford to become an ex-runner, but I can afford to remain a weak runner indefinitely.

My run today had a good effect -- my post-prandial result was quite low, and it followed a lunch that included a vegetable pasta stir-fry and a wheat roll, so it was pretty high-carb. The pattern I'm seeing lately is that my post-prandial BG is affected more by how hard I work out than by how much I eat. There are limits to this, of course -- no workout is going to allow me to eat three desserts and not get a glucose spike afterwards. But one of the reasons I try not to have too many short, wimpy workouts is that I like the freedom a hard workout gives me to eat what I want.

Thursday, April 3, 2008  

Glucose: Fasting, Post-Prandial 84, 139
Weight 186
Blood Pressure, Resting Pulse 123/71, 52

I'm feeling more overscheduled than ever. The dangerous intersection of a night class, a software release deadline at work, and preparations for the concerts later this month is beginning to put more strain on me than I can cope with gracefully. Okay, so I'll cope with it ungracefully.

Exercise is beginning to seem to me like an oasis -- the calmest and easiest part of my day. Today I went running on my lunch hour, and because of limited time I made it a short run on the par course (a trail along some very steep hills immediately adjacent to the work parking area). I hadn't been on that trail in a while, and once I got over the hill and into the west-facing side of the course, I was pleasantly surprised to find myself among brilliant beds of wildflowers -- mostly California Poppies, which look like this (although photography doesn't really capture their intense colors):

There were also several wild turkeys on the hill, including a male  doing the big tail-feather display thing. Mooning me, really. The air was clear, and from the hilltop on the west side I had a panoramic view of the city and of the distant hills around Forestville, Graton, and Occidental. And then I had to finish up the run and go back to the office.

It was only about a 3 mile run; minimal by my usual standards. Maybe that's why my post-prandial BG was a lot higher after lunch than yesterday, when I had a higher-carb lunch but a longer run.

Because exercise is so important for anyone with Type 2 diabetes, you have to get beyond tolerating it, and start to see it as something more positive -- if not pure fun, then at least a break from drudgery and a relief from mounting stress. What I find is that, the harder I work out, the better I feel afterwards. So, even though it's hard to make time for exercise when I'm feeling too busy with other duties, exercise always has to take a very high priority. You can't do those other duties if you're not healthy, and you can't be healthy if you don't exercise. 

Wednesday, April 2, 2008  

Glucose: Fasting, Post-Prandial 86, 102
Weight 188
Blood Pressure, Resting Pulse 135/74, 61

I'm not pleased with my recent weight fluctuations, but the post-prandial BG result of only 102 was nice -- especially considering that it was after a high-carb lunch (a pretty generous serving of pasta, and a piece of garlic bread on top of that). I had a good workout before lunch (a 5.3 mile run), which is what gave me the confidence to eat a meal with that much starch in it. The day before, which was a non-exercise day, my lunch was less carb-heavy and my post-prandial result was 133.

What you can get away with, in terms of carbohydrate intake, depends heavily on how much (and how hard) you exercise. Unfortunately, even someone who gets a great deal of intense exercise, and "gets away with" a high carbohydrate intake so far as BG is concerned, still has to think about weight management. It's all very well for me to say that my running today let me get away with eating pasta, on the grounds that my glucose didn't go up -- but I didn't truly get away with it unless I can also say that my weight didn't go up. And apparently I can't!

A lot of people think that exercise can melt the fat right off their bodies, but unfortunately there's very little truth to that. Fat is such an efficient medium of energy storage that it takes a huge amount of exercise to burn off a small amount of it. Running an entire marathon would probably not be quite enough to burn one pound of fat, so imagine how little fat you burn when you do a typical health-club workout, sweating for 30 minutes or so on a treadmill or a stair-climber. I don't mean to suggest that working out isn't worth it; I certainly believe that it is. It's just that the biggest benefits of exercise are in the areas of glucose management and cardiac health; as a means of losing weight, exercise is no magic bullet; unless you combine it with reduced calorie intake you're not going to shed any pounds.

I'm stressing out this week because of a hard deadline at work -- by Monday morning everything has to be completed and working in our software release. I've also got a night class, concert preparations, filing a tax return, and a 2-day relay race to deal with over the next week or two. It's during times like these that we are most tempted to give up on diabetes management and let nature take its course. However, I think that the discipline that's involved in diabetes management can be a stabilizing force (sometimes, it seems, the only one!) in my life. I can't give it up when the going gets tough. Exercise, in particular, is probably most important when you least have time for it. Exercise has seen me through some mighty stressful times, so I'm trying my best to be loyal to it.

Tuesday, April 1, 2008  

Glucose: Fasting, Post-Prandial 88, 133
Weight 186
Blood Pressure, Resting Pulse 126/80, 55

A difficult day at work; it left me feeling stressed (especially as it was a non-exercise day), but my blood pressure's not bad.

There doesn't seem to be very much research done on lifestyle modification as a means of controlling diabetes. The reason is not hard to guess: researches have learned to follow the money. It's a lot better (for a scientist's career, anyway) to concentrate on research that might lead to a profitable drug patent. You can't get a patent on exercise, so there's no reason to expect that exercise research will be generously funded. Still, once in a while scientists take a look at what lifestyle modification can do for diabetes patients, and when they make that kind of study, they find out some pretty interesting things.

The Reuters news agency reports on some research that was originally published, last month, in the Journal of Clinical Endocrinology and Metabolism. I don't happen to subscribe to that magazine, so I have to take Reuters's word for it. Anyway, they say that Dr. Jason J. Winnick and his colleagues conducted a study on obese adults with Type 2 diabetes. The purpose of the study was to find out what would happen to insulin sensitivity in these patients after a week of daily exercise.

It turned out that insulin sensitivity went up. In fact, it went up so much that, even though the patients stopped taking diabetes medications during the week of exercise, their fasting glucose levels did not go up, and in many cases their post-prandial glucose levels went down. The week of exercise followed a week of supervised dieting, by the way, and the dieting continued during the week of exercise. However, to separate the effect of diet from the effect of exercise, only half the dieters did the exercise program, and it was the group of patients who exercised who had an increase in insulin sensitivity.

The researchers also did careful measurements to see which tissues in the body were becoming more sensitive to insulin as a result of exercise. There was a theory, apparently, that exercise caused the insulin sensitivity of the liver to go up (with the result that the liver was less likely to release inappropriate amounts of glucose into the blood). It turned out that this was not the case; exercise specifically boosted the insulin sensitivity of the muscles (which is anything but surprising if you ask me).

Neither the diet plan nor the exercise plan in this research seem to have been anything very extreme. The exercise consisted of vigorous walking. The diet was described as "a balanced diet consisting of 50 percent carbohydrate, 30 percent fat, and 20 percent protein".

Anyway, doesn't it seem like this ought to be front page news? They took a group of sedentary, obese patients who were dependant on expensive pills to control their glucose, and showed them that they could do just as well, and maybe better, without those expensive pills, just by eating a balanced diet and going for walks.

It's funny what journalists on the science beat regard as big news. A new drug or a new medical technology is sure to get heavy media coverage: now that is big news. But once millions of patients have come to depend on that new drug or that new medical technology, and it turns out that most of those patients could do better without it, news editors decide that we don't need to hear a lot about the subject. I guess they would argue that "eat right and keep fit" is just not a sexy enough story. But what is so sexy about "buy these expensive and unnecessary pills that will give you diarrhea"?