Friday, February 29, 2008 -- FBG 86*

"Leap Day". A very foggy morning, and a somewhat cloudy afternoon, but the weather-guessers still think we will have fine weather for the marathon on Sunday. I hope they're right, because the weather makes a big difference when you're going to be running that far. For purposes of comparison, here's what the Napa marathon looked like last year:

napa marathon 2007  

And here's what it looked like the year before that:

Which of these two races would you rather do? That's why I've been checking the weather forecast on an hourly basis.

There was some excitement this evening in my neck of the woods: my next-door neighbor came home and found a mountain lion wandering outside. The Animal Control people were not helpful -- they said there was no point in them coming out here, because the moutain lion would be gone by the time they got here.

It's a strange hybrid neighborhood I live in -- to look out my windows you would think I lived in the middle of the woods, but there's a busy street very nearby, and I live a mile and a quarter from Agilent Technologies, where I work. In other words, I live in one of those places where human beings are living in large numbers without being aware that they are encroaching on predators' hunting grounds.

I've been a bit worried about mountain lions anyway lately, but usually when I'm trail-running in the park, not when I'm taking out the garbage. I'm not taking out any garbage tonight, if it's all the same to you.


Thursday, February 28 2008 -- FBG 89*

Beautiful weather still, and according the forecast it should remain that way on race day. I did a short run at lunchtime today (a little over 3 miles). From here on I'm going to take it easy, and make sure my body is as rested and loose as possible for the marathon on Sunday.

I was talking today to two friends who are also running the marathon, and the buzz is starting to set in for all of us, the excitement that musicians or actors would associate with Opening Night. After all that preparation over the last three months, we're actually going to get to go out there and do what we've been training for. Although the marathon is longer than any of the individual training runs you do to get ready for it, in a way it's easier. At least you get a short rest before it, and you have the psychological boost of running with swarms of other people. The training feels like work, the race feels like play.

On Saturday I'm definitely going to be carb-loading. Not something I normally aim for, but special circumstances sometimes call for it, and circumstances don't get any more special than knowing your'e going to be running 26 miles in the morning. I don't want to start the race with an inadequate glycogen supply, and run out of gas before the end. So, starch it is! Rice at lunch and pasta at dinner and lots of good bread. I'll also have to be careful to drink more water than I did on my 20-mile training run (the one where I got terribly exhausted during the last four miles, mainly because of dehydration).



Wednesday, February 27 2008 -- FBG 82*  

I received a reply to my inquiry about my new batch of test strips which have been reading low; however, the reply was generic (written as if I had questioned the accuracy of the meter itself, not this batch of test strips). A form letter, plainly.

The letter did advise me to call their customer service line (exactly what I hoped to avoid by writing to them). Against my better judgment, I called and played the waiting game. I eventually reached a human (and a human from this hemisphere, too), but he insisted that there were no problems with bad batches of test strips, and we had to look into this as a meter problem. I didn't have any test fluid, so he said he would send me some in the mail, and I should test the meter when I got it. He also asked me a few rather insulting questions, such as whether I had been holding the meter rightside-up or upside-down when I got these low results.

The thing is, the sample-fluid test has such a broad range of acceptable answers that I'm sure even these problem strips are guaranteed to pass it. And then they'll tell me there's no problem and I'm imagining the whole thing. What a waste of time. He made in interesting comment -- when he said that he would be sending along a few other test strips with the sample fluid, I said -- "Good, then I can make a side-by-side comparison between my strips and the ones you're sending me" -- and he instantly replied that I shouldn't do that!

No, no, of course we wouldn't want to do that. If we did that, we might find out something! This is what happens when lawyers run the world.

The lawyers in this case are going to be much more insterested in defending their test strips than in defending their meters. They don't make money on the meters anyway; they invest in making a meter so that they can lock you into buying hundreds of test strips for it. When there's a problem, they first blame the customer (who was probably holding the meter upside down -- it only stands to reason), and if that fails they blame the meter, but they're sure as hell not going to blame the test strips, which is where their profits come from. Oh, well, I did what I could about this.

Today the weather was even better than yesterday; it seemed downright warm by the time I finished. I ran 5.25 miles. Tomorrow I'll probably run 4. Friday I'll do an easy gym workout. Saturday I'll rest, and probably eat a lot of pasta. Sunday is the marathon. And then life becomes much less dominated by running, which will be a welcome change. This training period wasn't really that hard on me, but after a month or two of it you do start to think that maybe there are other things in your life worth spending time on. I'm not obssessive-compulsive enough (about running, anyway) to build my whole schedule around that one thing for very long.



Tuesday, February 26 2008 -- FBG 86*

A frantic day at work, juggling demands from several people and repeatedly changing my schedule for the day as I went through it. No possiblity of running at lunchtime. I decided to go to the gym in the evening, but when I got there the entrance to the parking lot was blocked. There was no sign up explaining why. If they close early on Tuesdays, it's news to me. Well, according to the marathon training schedule, yesterday was supposed to be a rest day and I ran anyway, so I can take this one off.

The possiblity of rescheduling the kayaking event for this Friday was proposed, but I had to say no to that idea. Two days before the marathon, I don't want to give myself any unusual tasks, or any opportunities to pull a muscle. Now's the time to be very, very careful.

I was afraid that my coworkers who are oganizing the relay team for the big Calistoga-to-Santa Cruz race in April would consider me too slow to be on the team. From what I can gather, most of them are considerably faster than me. However, I was assured today that they just want to have fun with this and it's not about trying to win the thing. It's going to be an interesting experience. It goes on for two days (they set up the race date and time so that whichever member of the team runs across the Golden Gate Bridge does it in the middle of the night, under a full moon). Each runner is assigned three sections of the total distance to run, and you get two long breaks between the three parts you run. It's a lot easier than a marathon (and, of course, a lot of the time you're just riding in the van, perhaps asleep).

I signed on to this relay-race idea remarkably quickly, especially considering that I had been thinking of taking a break from running events after the marathon. But some friends of mine were doing it, and peer pressure has long been the cornerstone of my exercise program. I try not to shrink from a challenge. If you're around active people a lot (and these days I am), they're always trying to talk you into something that you're afraid that you can't do (mountain biking, back-packing, scuba-diving, whatever). A big part of my conversion from a very sedentary guy to a very active one was simply a decision I made to start saying yes to these people more often.

No matter how little you may be in the habit of hanging around with athletes, you probably have a few people in your life who are always trying to get you off the couch and out into the fresh air for some scary-sounding adventure or other. Don't be in too much of a hurry to say "forget it!" when you see them coming at you with these brainstorms. There just might be something in it for you.



Monday, February 25 2008 -- FBG 82*

The weather was beautiful today. I did a 4-mile run at lunch, with two training partners who will also be running in the marathon Sunday. They're faster than me, though, so past a certain point in the run they left me pretty far behind. It's the hills that get me -- our route included some steep climbs, and they're both a lot better at climbing than I am.

I suppose I should be trying to build up my speed, at least to spare myself the embarassment of being unable to keep up with other people, but I can't seem to make speed a priority. To tell you the truth, the main thing I want is to get the health benefits of exercise without hurting myself. When I worked on speed before, I tended to hurt afterwards. Being an uninjured runner is more important to me than being an unembarrassed runner.

However, I hope I can at least finish this marathon faster than I finished my first one; surely that's not asking too much of myself.

One reason I'll be glad to be done with the marathon is that I can stop writing about it, and stop giving the false impression in this blog that exercise only works for BG control if you do superhuman amounts of it. I'm usually not running marathons or training for marathons, after all, and my glucose control is still very good. Most of the year I'm not working nearly this hard, and I'm quite ready to get into that mode once more.

Sunday, February 24 2008 -- FBG 88

All right -- assuming I'm correct in thinking this new batch of test strips is reading 6 points low on average, that's probably really 94 mg/dL -- which is still okay, especially considering the high-carb dinner I had last night. Whether the measurement is right or not, I'm probably still doing fine.

Getting in my 8-mile run today was a tricky proposition. The weather was bad, at least in the morning -- high winds and rain. But the rain was episodic, sometimes heavy and sometimes not. Around 11 AM the rain (if not the wind) let up.  I decided to go do a trail run at a local state park, partly because I'm sick of road-running and partly because the trails in the state park are mostly in the woods and pretty well shielded from the wind. That was my theory, anyway, and it turned out to be a good one. Only the last two miles of the run were out of the woods and exposed to the wind, and by then the wind was dying down anyway. I did get rained on, but not heavily. There certainly weren't many other people out on the trails, but under the circumstances there was a special camaraderie between me and the the few brave souls I did encounter. That camaraderie already exists, automatically, between all people who get out and exercise in the fresh air. Whether you're running, cycling, hiking, or whatever, there's always a little bit of a bond. But when you're out exercising in bad weather that has kept more timid souls home, the bond is that much stronger.

Anyway, the big difference between trail-running in the woods and meadows of a state park and dodging cars on public roads is that I enjoy running on trails; it's always a lot more pleasurable to me than street running. Getting out of sight of civilization (no matter how nearby you know it to be) is rewarding for me. Since I have to keep exercising to stay non-diabetic, and I have to keep doing it for many years to come, it's pretty important for me to focus on rewarding forms of exercise.

It was an especially nice touch that, minutes after I finished the run and was driving home, a torrential downpour began -- as if nature had been waiting for me to finish. I don't get a lot of opportunities to feel as if nature is on my side, but I try to appreciate them whenever they come along.

So now there's hardly anything standing between me and the marathon next weekend. The longest run between now and then is on Wednesday, and it's only 4 miles. I'll ptobably end up doing 5 miles just to please my running partner at work, who isn't into wimpy runs.

During the run today, it dawned on me that the marathon training process wasn't as hard on me this time as it had been in the past. When I was training for earlier marathons, I reached a point (usually well before the climax represented by the 20-mile training run) where I was absolutely sick to death of running, and felt that running had taken over my life to a point that was upsetting and probably counter-productive. It just wasn't that hard this time. I don't think that means it's time for me to move on to a bigger challenge (the Ironman Triathlon, say); as far as I'm concerned, the marathon is as big a challenge as I ever want to take on. But it's nice that I can now go through the whole marathon training process without getting depressed about it.


Saturday, February 23, 2008 -- FBG 79

Well, that's implausibly low. I think I've established beyond much doubt that this batch of test strips is biased to read low. Looking over the test data, I find that, as soon as I started using the new test strips, my fasting average dropped abruptly from 90 to 84. So, I think I'm going to assume that whatever results I get with these tests strips are understated by 6 mg/dL.

If I hadn't been doing this for years, I would simply have assumed that the test strips were accurate -- that my glucose level had suddenly dropped to a lower level. Experience has taught me to doubt this. My fasting average is pretty stable. I expect day-to-day fluctuations, but they average out. I'm sure I've never seen my average change 6 points between one month and another (at least not in the last five years).

When I report this to the manufacturer, I suppose they'll think a 6-point change is too minor to be worth making a fuss about, but I've decided to report it anyway. Possibly there was a labelling error, and this batch has the wrong meter code printed on the package. They never tell you why you have to code the meter, but I have always assumed that the sensitivity level of the test strips varies from batch to batch, and the code tells the meter how to correct for the sensitivity of the particular batch you're using. If the wrong code is on the package, then I've given the meter the wrong calibration data.

Here's what I wrote in my e-mail to the manufacturer:

I am using a OneTouch UltraSmart meter. My glucose is very stable, and has been for several years now, but I continue to do a fasting test every morning to make sure I don't get back up into the diabetic range again. A few weeks ago I bought a new batch of test strips (the batch number is 2783998, the code number is 12). My fasting test values immediately dropped to a lower level, and this has been consistent enough to make me think the measurements can't be accurate. Comparing results before and after the transition to the new test strips, I find a sudden drop in the fasting average from 90 to 84 (with no change in my life that would explain it). I realize that a six point change might not seem large to some people, but it's quite unusual for me. Do you know of any problem with the manufacture (or perhaps the code labeling) of this batch which might account for the low readings?

I wonder what will come back.

If I'm ever going to get a high reading with these test strips, it will probably be tomorrow morning. Today was a rest day, and on top of that I had a big dinner at a Japanese restaurant. Usually, no exercise plus white rice equals an elevated fasting test, but we'll see. Maybe I'll need to be well fueled, though. Tomorrow I have my last substantial marathon training run. It's only 8 miles -- pretty minor by marathon training standards -- but based on the weather forecast it's probably going to be 8 miles of running in lousy conditions (rain, possible thunderstorms, winds of 30 to 45 miles per hour). It's probably going to take a lot more out of me than an 8 mile run normally would.

A long run in the rain, especially if it's windy, can really take a lot out of you. On the other hand, the hot shower after a run like that is a pleasure such as few people ever get to know.  


Friday, February 22, 2008 -- FBG 87

Once again I'm below 90, but at least not implausibly low.

Nine days to go before the marathon. One long run this weekend (8 miles), but otherwise the exercise schedule is going to be very light between now and then. Which means, of course, that I need to eat a lot less than I have been lately. There's no harder time to control your weight than the "taper" phase of marathon training, when all of a sudden you're burning half as many calories as you were before, but your appetite is not diminished at all. I guess I'd better get used to going to bed hungry, because on race day I don't want to be carrying any more weight than I have to.

It looks like we made the right decision to cancel the kayaking party tomorrow; the current forecast is for a major storm to blow in from the Pacific in the morning, with the possibility of flooding and power failures. Not a good time to be paddling out to sea.

The weather has been teasing me all day -- the sun would come out, tempting me to go for a run, and then it would start pouring rain a few minutes later. Normally the weather around here is not so impulsive; if you're going to get sunshine at all, you're going to get a few days of it, not a few minutes of it. At lunchtime I made up my mind not to run today, and go to the gym in the evening instead, but then, in the late afternoon, the sky turned blue with no big clouds on the horizon. I decided to go for it, and I worked in a 4-miler. It was nice; I felt energetic and kept up a good pace (by my lax standards, anyway). Exercising outdoors always feels better to me than exercising indoors, but it's especially good when the air has just cleared after a lot of rain. It feels as if there's more oxygen in the air then. 


Thursday, February 21, 2008 -- FBG 80

80? This is getting ridiculous. I really don't think I've been behaving myself well enough for that to be my actual BG right now. That's eleven days in a row of readings below 90. It's beginning to look more and more to me as if this new batch of test strips is reading artificially low.

I don't know what to do about it, though. Call the manufacturer? I hate making phone calls like that -- where you wait on hold for a long time, and then you have to talk to someone who makes you wish you were still waiting. Maybe I can send them an e-mail, giving the batch number of the test strips and asking if they have any known problem with that batch, because my results have been improbably low.
 
Still, if I do that, I'll have to give them actual numbers, and then they'll roll their eyes at how small an error I'm claiming to have found. It's probably 5 to 10 points low, and I'm pretty sure that's within the margin of error for a glucose meter anyway. (But glucose meters are supposed to have random errors that average out, not a consistent bias which doesn't average out.)

Most people who use glucose meters are expecting (and getting) larger variations in BG than I ever see these days. Because my BG is pretty stable, and has been for a long time, a change of 5 to 10 points seems like a big issue to me, and I tend to forget that most people (including most doctors, I suppose) would call it trivial. It's sort of like my take on the weather -- I live in Northern California, not too far from the coast, and I simply don't experience the kind of weather extremes that are commonplace nearly everywhere else. Consequently, a 5-degree temperature change seems a lot more significant to me than it would if I lived in, say, Buffalo. My reaction to a change in glucose readings is similarly outsized, and you could argue that I ought to lighten up on the subject. Still, I like to believe in the numbers I'm getting, because I like to think I know what impact my daily behavior is having. It screws up my system when my BG drops and I don't know why.

Today I didn't run at lunch because it was raining; I decided I would go to the gym after my night class. However, when I was driving back from class I felt an almost overwhelming urge to declare this an unscheduled rest day, and go home without stopping at the gym on the way. I usually don't experience that sort of temptation any more (although it used to be the way I felt every single time I contemplated working out). Anyway, I managed to overcome it. I went to the gym and did my workout like a good boy. And I'm sure I feel better right now than I would have if I'd taken the easy way out.

Wednesday, February 20, 2008 -- FBG 87
Still under 90, but not by such a wide margin as before. Still, that's ten days in a row below 90. It almost seems far-fetched. Maybe I've simply got things right these days, and shouldn't think about it too much.

The marathon training continues to taper down. At lunchtime today I did a 6-mile run. The only other long run I've got left before the marathon will be an 8-miler on Sunday.  My kayaking trip on Saturday looks likely to be canceled -- the weather forecast indicates it will probably be cold, wet, and windy; nobody seems too interested in going out to the coast to deal with that. Well, I hope the weather for the marathon is a little better.

And now I already have my next exercise challenge lined up. It all happened pretty fast. I learned today that a group of my coworkers are putting together a 12-member team to run in "The Relay" (formerly known as the Providian Relay), a 199-mile race that takes place over a two-day period in April The route runs from Calistoga (near me) to Santa Cruz (not at all near me). Along the way it goes through Napa, Marin, San Francisco, and Palo Alto. I told them I was interested and my name is now on the team list.

The relay team travels in a van along the route; each member has to run three segments of it (totalling something like 15 to 20 miles, depending on which segments get assigned to you). The race is a fund-raiser for organ-donation programs. I hope I don't need an organ donation myself, after the race is over. Of course, most of the time you're riding in the van, not running. The organizers of the event call it "California's Longest Party", and I've heard that it's a lot of fun to do.

We will need to come up with a team name. Some teams have already come up with some good ones: "Sponge Bob No Chance" and "Know Us By The Trail Of Drugs". You need to set the right tone, you know?

Compared to the marathon, the relay probably won't be very hard. Anyway, even if it does seem hard, I only need to remind myself that Dean Karnazes (the madman ultra-marathoner) has been known to run the entire 199-mile route by himself. If he can do that, surely I can run a twelfth of the distance.

Here's the route:


Tuesday, February 19, 2008 -- FBG 82

That makes nine days in a row with a fasting test below 90. I had been aiming for that, or at least hoping for it, but I'm a little surprised to be getting it so consistently, even during a 3-day weekend when I was eating a lot more than usual. (On the other hand, I didn't gain any weight over the weekend either, and I was expecting to, so maybe I was active enough to cancel out the effect of the extra food intake.)

I suppose it's possible that the new batch of test strips I'm using is biased to read low. I changed to the new batch shortly before this hot streak began. Looking back over the records, I can't really say that my results were consistently lower after the transition than they were before it. Still, nine days in a row below 90 seems almost too good to be true, and if this goes on much longer I'm going to start wondering if the new test strips just give lower readings than the old ones did.

I don't mean to look a gift horse in the mouth, but when you're managing Type 2 diabetes you pretty much have to function as a scientist, which means (among other things) that you need to be on guard against "confirmation bias". This is the natural human tendency to give much more credence to that evidence which confirms what we want or expect to find. If, when my test results disappoint me, I am going to look for reasons why the results might be inaccurate, then I should be willing to consider that excellent results could be wrong, too.

Looking back on my history, I have occasionally had hot streaks before, in which I seemingly could do no wrong in the BG department. Even when something is varying randomly, streaks can happen -- in fact, they're statistically inevitable (and usually meaningless).

Of course, there are probably dozens of factors that can have an impact on BG, and maybe all these things just happen to be aligned favorably for me lately. I'll try to enjoy this situation while it lasts, without allowing myself to get too complacent about it. Nothing boosts a BG test result quite like a firm expectation that it will be low.


Monday, February 18, 2008 -- FBG 82

I'm back from my musical weekend in the country, and my test results remained almost puzzlingly excellent all through it (85 on Saturday, 83 on Sunday, 82 today). What's puzzling about the situation is that I spent the weekend eating all day and all night. The food there is always good and always abundant, and for the occasion I freed myself from most kinds of dietary restraint. You might think that my BG tests would be high and getting higher, not low and getting lower. It's hard to know exactly what explains the good results. I have a theory that it's good to relax and eat whatever I feel like eating on special occasions, provided that I don't get into the habit of declaring every occasion to be a special occasion. I was there to relax and have fun, and maybe doing that and not worrying about the things I usually worry about was beneficial to me.

I did exercise (two marathon training runs, 5 miles on Saturday and 12 miles on Sunday), and although my main activities the rest of the time were music-making and eating, I also did a great deal of walking around the place. I spent more time standing up than I would at home, plus more time going up and down stairs and more time walking between the scattered buildings on the site. Sometimes I think just being away from home almost qualifies as a kind of exercise; the familiar, convenient configuration of things at home makes it easier to be sedentary during your non-exercise time. Everything is where you expect it, and nothing is far away.

I just started using a new batch of test strips last week, and often when I start with a new batch I get the impression that this batch reads lower on average, or higher on average, than the previous one. Usually that impression doesn't last long, because I start to see enough variation in the results to make it clear that there's no special bias. So far, I've never seen a difference that persisted long enough to push one month's average up or down by more than a point or two in comparison with the previous month. I'll keep an eye on the issue, but probably I'll start seeing higher results soon. Probably tomorrow, in fact!
 

 

 

 


 February 11 to 17, 2008


Friday, February 15, 2008 -- FBG 79

Better than I expected -- after only a four-mile run yesterday, and a dinner that included pasta salad, I expected to be a little above 90, not a little below 80. Well, this isn't a very exact science (or a very exact measurement process), so it's a little silly for me to think I can predict or interpret small variations from day to day. There are a thousand things that affect BG, some of which are hard to control (and even hard to be aware of), so surprises are inevitable in glucose testing. And yet, if I don't at least try to make sense of my daily results, I'll be flying blind. I've always got to think about my results, even if I'm missing the point a lot of the time.

I am about to take off for my musical weekend in the country. It appears the weather is going to be nice. I plan to do a 5-mile run on Saturday and a 12-mile run on Sunday (that's what the marathon training schedule calls for -- after the 20-miler last weekend, a 12-miler shouldn't be too tough). But the weekend will otherwise be very relaxing; making music will be the dominant activity, day and night. We'll probably go on a hike, and if history is any guide the hike will end at a local winery. There will be a lot of good food this weekend, so I'll have to watch myself there a bit, but it's also healthy food. I'm certainly not going to lose any weight this weekend, but I'm going to try not to gain any either.

I'll update this again when I can, probably Monday.


Thursday, February 14, 2008 -- FBG 76

76! That should help my monthly average, all right.

No big mystery about why my glucose was so low this morning. Yesterday, despite doing a pretty strenuous training run (8 miles, and with steep hills involved), I didn't have a big lunch or a big dinner. Lunch (right after the run) was a salad, a whole-wheat roll, and a banana. Dinner was a bean burrito (and not a big one). I felt hungry when I went to bed, and hungry when I woke up, so it wasn't surprising to get a result below 90 (though I wasn't expecting it to be below 80).

The reason I was eating lightly yesterday is that I'm trying not to repeat the mistake I made in training for previous marathons -- overcompensating for the calories I was burning, and gaining weight as a result. I want to get my weight down a bit by race day, and I certainly don't want to get any heavier (which is
surprisingly easy to do when you're marathon training). In running, particularly over long distances, carrying just a few more pounds can add enormously to the difficulty of the race.

This final phase of marathon training -- in which the weekly mileage tapers down -- is where you have the biggest risk of weight gain. The problem is that your exercise intensity declines, but your eating intensity doesn't. Without realizing it, you developed the habit of eating more, because you were getting away with it, but you don't drop the habit when you're exercising less and you can't get away with it.

Today, for example, my lunchtime run was only 4 miles. That's certainly not enough exercise to justify taking in any extra calories. That's about as much exercise as I should be doing on any ordinary day, when I'm not training for anything in particular. In fact, 5 miles of running has become par for the course for me in terms of weekday exercise.

I expect my glucose will be a lot higher than 76 tomorrow, but we'll see.

Tomorrow I'm going off to weekend in the country with a musical organization I belong to. We're staying at Rancho Obispo (the Bishop's Ranch), a church retreat near Healdsburg, California. It's an annual event. We'll spend the 3-day weekend making music together day and night. I'll have to interrupt the music-making (or at least my participation in it) on Sunday morning to do a 12-mile training run for the marathon, but for the most part the weekend will be about relaxing and making music together. I don't expect I'll have a chance to update this blog before Monday.


Wednesday, February 13, 2008 -- FBG 85

Great -- yet another day below 90. I'm on a roll!

I guess you could say I've been on a roll for seven years, but in all that time I've been wondering how long it would last. Although I am sure it was a good idea for me to get my glucose under control without resorting to medication, I have never quite stopped worrying about how long this approach can continue to work.

Most of what I have heard and read about Type 2 makes it sound as if lifestyle adjustment is bound to fail eventually, though it supposedly can work for "up to 10 years". Figuring out what lies behind this claim has become a preoccupation of mine, but it's hard to find out much about it. Little research has been done on people who do what I'm doing, partly because it's hard to find many people who are doing it, and partly because research of that kind is not going to lead to a patent, so nobody wants to fund it.

What little research has been done on lifestyle adjustment as a treatment for Type 2 diabetes has not looked at periods longer than 10 years; that seems to be the real basis of the implied 10-year limit on the effectiveness of this therapy. (It's sort of like saying that a democratic state can endure for "up to 232 years" because you've noticed that America has been around that long.)

Of course, there is also a general tendency within the medical profession to assume that Type 2 diabetes always gets worse over time. The idea is that insulin sensitivity and insulin production both decline steadily over the years. No doubt they do, in a lot of people -- but does it always have to be that way? And how do we know? These declines seem to be at least partly the result of "glucotoxicity" -- the harmful effects of elevated BG over long periods. Perhaps, if lifestyle adjustment allows you to maintain excellent glucose control, your insulin sensitivity will actually improve over time, and your insulin production will hold steady, or at least won't decrease much. Maybe Type 2 diabetes only gets worse if you let it.

Although I have every reason to suspect that the supposed 10-year limit on the effectiveness of lifestyle adjustment is nothing more than a wild guess (and an irresponsible one), the figure has stuck in my mind as a milestone, and I'll be glad when I'm past it. A friend of mine with Type 1 diabetes was told as a young man that the average life expectancy for someone with that disease was fifty years; it used to bother him, but he turned fifty more than ten years ago and nothing happened, so I think he's starting to let go of the idea.

While I'm waiting for that 10-year milestone to come and go (in February of 2011), I am at least a little comforted by the fact that glucose management has not been getting harder for me. If my underlying condition (insulin resistance) was getting worse, or if my insulin production was dropping, I would be having a harder and harder time keeping my fasting tests within the acceptable range. Although there has been some volatility in those results just lately, probably because of the disruptive effect of the marathon training I'm doing now, my monthly averages have stayed within a narrow range (90 to 93) for years. That doesn't look like ever-worsening diabetes. In fact, it doesn't even look like diabetes. Therefore, I am probably right in thinking that I can continue to succeed with the approach I'm currently using for a good long time. If it was going to fail at the 10-year point, it would probably not be working this well at the 7-year point.

Even if it turns out that my current approach works for 10 years and then stops, that won't mean it was a bad idea to try it. There's hardly any doubt that I'm getting better results (in terms of glucose conrol) than I would have got if I had relied on medication. And all the exercise I've been getting has given me cardiovascular benefits that I never would have obtained by taking pills.

My work schedule was more flexible today, so I did the full 8-mile run that the marathon training schedule called for. I'm still feeling good about running; I'm pretty energetic, and no aches or pains afterwards.

Still, it would be nice to do a bit less running. When the marathon's over I think I'm going to start shifting over to doing more cycling.


Tuesday, February 12, 2008 -- FBG 89

Another day under 90 is always welcome.

Tuesdays are difficult in terms of lunchtime exercise, because of meetings I need to attend that don't leave me a big enough block of time free to go work out. (It's too bad, because it was a beautiful day outside.) Instead I needed to hit the gym after work.

I'm looking forward to Daylight Saving Time (starting the second week of March). During the spring and summer months I usually do a long run on Wednesday evenings at a local state park that has miles of beautiful trails. A lot of the people I work with go running or mountain-biking there on Wednesday nights. All possible routes through the park are hilly enough to count as a workout even if you're only walking. My favorite routes there are in the range of 6 to 9 miles. I especially like to run there around sunset, and finish just as it's starting to get dark. The downside of being on the trails at that hour, unfortunately, is that it increases your risk of being eaten by a mountain lion. Not that the risk is all that high, but it's not as close to zero as I'd like it to be.

My exercise program forces me to do a lot of risk/benefit analysis. The kinds of exercise that I actually like to do (cycling and trail-running) are certainly not risk-free activities. In theory, we should exercise in the safest way possible. Working out in a gym is the kind of exercise that is least likely to result in an accident (and if you do manage to have an emergency there, there isn't much change that it will go unnoticed). Unfortunately, working out in a gym is the kind of exercise that is most likely to bore you into giving up exercise, and that's the riskiest option of all. If I don't do at least some exercise outdoors among the woods and fields (even at the risk of being injured), I will be in danger of losing my motivation to keep exercising. There has to be at least some part of my exercise program that seems like pure pleasure to me, otherwise I'll burn out on it.

Still, it would be an awful irony if I managed to get my cardiovascular system into great shape, only to have it torn apart by a cougar or an SUV. I wouldn't get much sympathy, either. Nothing makes the sedentary public happier than a news story about somebody who died while exercising. In 1984, when Jim Fixx (a leading fitness guru of the 70s) died of a heart attack after a run, at the age of 52, there was joy throughout the land: here, at last, was proof that exercise kills! Actually, Fixx (whose father had died from heart disease at age 43) was a walking catalog of heart disease risk factors (including a history of obesity, smoking, high cholesterol, and alarming cardiac symptoms). In fact, his autopsy showed evidence of repeated heart attacks in his past, plus severe arterial blockage; if he hadn't taken up running he probably would have gone a lot sooner than he did. Nobody wanted to hear that, though.

If I die from a heart attack while exercising, I don't think it will prove that I was wrong to start exercising; more likely it will prove that I should have started sooner. Like Jim Fixx, I turned to exercise only when it became clear that I had screwed up my health to a frightening degree. If I'm not able to solve the problem I created, it will just mean I didn't go to work on it soon enough.

If I get eaten by a mountain lion while exercising, though, I'm not sure it will prove anything at all, apart from the reminder that, despite our assumptions to the contrary, we are not necessarily at the top of the food chain.


Monday, February 11, 2008 -- FBG 88

Good -- it's nice to be below 90, especially after a rest day. The fact that Sunday was not only a rest day, but a sleeping-till-noon day, may actually have helped. I'm sure I needed to catch up on sleep.

This morning I felt entirely recovered from Saturday's hellish run, and ready to exercise again. I ran 5 miles at lunchtime, and felt surprisingly energetic. No aches or pains, either. I'm starting to feel more confident about the marathon. I hope I've got all the bad luck out of my system.

The warm trend continues; during my run today it was sunny & 67 degrees. It's a good thing I don't live in a place that has real winters, because I'm not sure I'd be able to cope. I found it challenging enough running outdoors when I was in Idaho for a family gathering at Thanksgiving this year, and that was before the snow started. I guess in cold-weather regions people can always work out at a gym, but I'd hate to have to depend on that for weeks at a time. To me, at least, running on a treadmill is a pretty poor substitute for being out in the fresh air. I can't shake the feeling of being a hamster on a wheel. Four miles on a treadmill seems longer to me than eight miles outdoors -- even if it's raining outdoors. Maybe I feel that way because running outdoors is usually an option for me; if the trails at the state park where I like to run were covered in snow for three months out of the year, I suppose I would learn to like running indoors a lot better.


Sunday, February 10, 2008 -- FBG 95

95 is not bad. I thought yesterday's adventure might have driven it higher, because I must have been pretty badly dehydrated. Even after drinking what seemed like a lot of water last night to replace the lost fluids, my weight was still down 4 pounds this morning (and I'm not naive enough to think I burned 4 pounds of fat during the run).

I didn't have much choice but to make today a rest day, as I was still pretty much wiped out from the big run yesterday. At least I wasn't limping around -- my hips and knees felt okay, and I could walk without stiffness. In the earlier phase of the marathon training, I was worried because I was having problems with sore knees and hips after comparatively short training runs; whatever was going on there, I seem to have got past it.

My chief activity today was napping, at least in the morning. I was going to a jam session in the late afternoon, and I wanted to be fully recovered and alert for that. I get frutrated if I'm trying to make music with other people and my playing isn't up to snuff because I'm too fatigued to concentrate. The napping helped; I was fine. And nobody there was saying "What happened to you? You look awful!", so I guess I'm recovered enough from yesterday's run that it doesn't show on me.

Considering how bad I felt immediately after yesterday's run, it's a minor miracle that I already feel as well as I do today. I seem to recover quickly from these things. I'm still not going to do any running today, but I will tomorrow. 


Saturday, February 9, 2008 -- FBG 87

Well, what do you know, my glucose went down instead of up. At the moment, though, I'm wondering if it might have been better if it had gone up.

Although my dinner last night wasn't as light as my dinners have mostly been this week, no athlete would have described it as "carb loading". I had a little bit of pasta, a little bit of bread, and there was a little bit of potato in the curry, but the total carb count wasn't really all that high, and maybe my glycogen supply had become a little low as I was trying to work my glucose down this week. And this morning, I didn't have as much to eat before the big run as I probably should have.

Whatever the explanation, my 20-mile run was harder on me than it needed to be. It started out great, though. The weather was beautiful (more like late April than early February), and everybody in town who was capable of it was outdoors engaging in some kind of activity, if only walking their dogs. Lately I'd felt a little freakish, out there running in the rain, but today I was surrounded by active people, and it was energizing. I was feeling good. For several miles, I was able to keep up a better pace than I usually manage to do. I was even feeling like the run was going to be easy, that it was going to seem short when I finished it.

I started feeling hungry at 12 miles and swallowed a glucose gel, and I thought everything was going great. But around mile 16 something went awry; I got very tired and my pace slowed down considerably. I didn't feel hungry, and I found it hard to believe I needed another glucose gel so soon, so I didn't take the other one I had with me. But those last 4 miles were very, very hard -- much harder than the previous 16. One of the challenging aspects of it was that I was running an improvised route around town, watching my GPS unit to keep track of the miles. I miscalculated the route and ended up back at my car at 18.5 miles, and the urge to just call it good enough at that point, and drive home, was almost overwhelming. I don't know how I managed to resist the temptation, and keep running around that neighborhood before the GPS read "20.0", but somehow I did. And then I felt very weak and wobbly.

I kept pacing around, worried that if I sat down I'd faint or something. I drank a bunch of sports drink, and eventually got in my car and drove to the gym, so I could sit in the hot tub and stretch my legs. That helped, although my left calf and both feet were cramping for the first five minutes in there. I drank a bottle of water while I was in the hot tub, once again monitoring myself to make sure I wasn't feeling faint. I showered and went to a Mexican restaurant for dinner, taking in lots of carbs. I drank two glasses of water there. I came home and noted that I hadn't had to use the bathroom after the run, or at the gym, or at the restaurant, even though I had taken in about 3 liters of fluid -- and that my bladder still wasn't full. Clearly I was pretty dehydrated. So I poured myself some more water, and resolved to keep drinking a lot more of it.

Now, here's my dilemma: I have no way of knowing whether my difficulty with the run came about because I didn't carb-load beforehand to build up my energy supply, or because of simple dehydration. Probably both of these played a role, but which was more important?

It's not as if this was hot summer weather (the temperature was a steady 68 degrees all afternoon), so at first I was inclined to downplay dehydration as an issue. However, when you've been running in the rain and cold for weeks, and suddenly you do a long run in 68 degree weather, maybe your body is caught off guard, and doesn't manage its water supply so well -- or maybe you just don't realize you're sweating more than you have been lately. I was carrying water, but you can only carry so much, and maybe because the run was so long I was too stingy with it.

Oh well, I guess I'd better assume both issues are important, and think about my strategy for the marathon. Fortunately, these things are easier to manage in the actual race. There are tables set up every mile or so along the route, offering water and sugared drinks, so I can keep grabbing a little of both throughout the race, and (with luck) not fall behind on either of them, as I seemingly did today.

I've been through the marathon training process more than once now, and I always have some trouble with the big 20-mile training run. So far, I have always managed to do better in the marathon itself. I hope it will be that way this time, too.

Anyway, despite everything, I feel pretty good at the moment. I've got the hardest part of the training out of the way, which is a big relief. Now it tapers down for three weeks, so that I'm rested and energetic on race day.

Because of the dehydration, and the carbs I'm taking in tonight to recover from the run, I expect my glucose test tomorrow morning to be on the high side.  So be it. I can't be a diabetes hero and a marathon runner; sometimes I have to choose one goal over the other for a while.


Friday, February 8, 2008 -- FBG 91

Well, if I didn't get below 90, I got pretty close.

Today is a rest day in the marathon training schedule. And I'd better rest myself well, because this is the peak weekend of the entire training period: I've got a 20-mile run to do tomorrow.

The actual race in March will be 26 miles, but you don't do any training runs longer than 20 miles because it would take the body too long to recover from that, and you'd have to interrupt your training.

20 miles is the point in a marathon at which most runners find that it becomes a lot harder to keep going. Whether the barrier is psychological or physical I don't know, but somewhere around mile 20 the going starts to get very tough. A lot of runners refer to the final 6 miles of a marathon as "the second half", because those last 6 miles seem to take as much effort as the first 20 did. It's easy to start doubting you will finish the thing.

However, there's also a feeling of euphoria that comes in at mile 25, because at that point you start to become convinced that you really are going to make it. It dawns on you that, if this race was going to kill you, it would have happened by now. You can surely keep going for another mile, even if you have to slow down to do it. And you start anticipating the taste of champagne.

If you ever run a marathon, be sure that someone is waiting for you with a bottle of something nice at the finish line. The best champagne in the world is post-marathon champagne, and this will be only my third opportunity to taste it.

This evening I faced a dilemma about dinner: my first impulse was to have a light dinner, to continue the glucose-reduction effort I'm making lately. On the other hand, I'm going to be doing a 20-mile run tomorrow, for heaven's sake. Any non-diabetic athlete in that situation would certainly be "carb loading" tonight (eating platefuls of pasta), to avoid running out of gas during tomorrow's run. The phrase "carb loading" sounds pretty creepy to anyone trying who's trying to manage his glucose level, but sometimes your circumstances require it. Anyway, I had a kind of compromise dinner -- not huge, but pretty substantial; lots of vegetables, but a good bit of starch too. I expect that my fasting test will be up a bit tomorow. However, under the circumstances, I think I'm better off starting the day with my glycogen supply topped off. If my BG is up a bit tomorrow, I can live with that.

One nice thing about tomorrow's run is that it will probably be done in good weather. After a long period of training in the cold and rain, the weather is forecast to be sunny and springlike tomorrow. For once, a training run that requires sunglasses!

Thursday, February 7, 2008 -- FBG 87
Great: today, at least, I'm below 90 -- let's see if I can manage to spend more time there.

Of course, one thing I could do to achieve that would be to get more sleep. For reasons unknown, sleep deprivation promotes insulin resistance. Even healthy young people start to get hyperglycemic if they're sleep-deprived. If I was getting more sleep I would probably be getting lower fasting tests in the morning. Easier said than done, though! Believe it or not, getting more sleep is a tougher challenge for me than, say, training for a marathon. Sleep and I have a long and troubled relationship.

Not that I'm an insomniac; I'm not the sort of person who lies in bed, exhausted, desperate to go to sleep and unable to do so. No, my real problem is that I don't like going to sleep. Even as a child, I always wanted to stay up as late as possible; every night, I would fall asleep only when I could fight it off no longer. I remember asking my parents to explain why sleep was necessary at all, as it seemed so pointless (they didn't have a satisfactory answer, but neither does anyone else to this day). I have heard it said that very old people develop a fear of going to sleep, because they think they might never wake up; I don't need to wait till I'm 85 to experience that feeling, because sleep and death have seemed equivalent to me for as long as I can remember.

It might be that I'm simply a nocturnal creature, and that I wouldn't have a problem if society ran according to the schedule that feels more natural to me. If we all lived like rock stars, going to bed around 2 or 3 AM and waking up at midday, I might fit in better. Well, maybe that would make things easier for me, but to be honest, what I would really like is not to have to sleep at all. As it is, though, I have a job to get to in the morning, so my tendency to get perky around midnight is a bit of a problem...


Wednesday, February 6, 2008 -- FBG 93

Good, I'm more comfortable being below 95. However, getting below 90 is still my goal, so let's see if I can get there tomorrow.

I worry that, in this blog, I am giving a false impression that an exercise program for diabetes management has to include the same sort of heavy-duty endurance running that I happen to be engaged in right now. Trust me, I'm not always working out this hard. Occasionally I sign up to participate in some event that's very demanding, such as the marathon I'm currently training for, and then I have to put in a lot of time preparing for it. It isn't necessary for me to do this sort of thing; I just decided to do it. I can keep my BG under control without running marathons. "So why don't you?", you're probably thinking. Let me see if I can explain.

I'll be the first to admit that training for a marathon is not easy on a person. To tell you the truth, my glucose control is probably a little better  (or at least more stable) when I'm not engaged in this kind of heavy training. My averages have looked good during the last two months, but the day-to-day variations have been getting wider and harder to predict.

Extreme workouts are disruptive in a lot of ways. When your exercise schedule includes some extremely demanding workouts, followed by rest days or light workouts, the body has a hard time adjusting to the constantly-changing demands placed on it. Heavy-duty training has a destabilizing effect.

Also, extreme workouts tend to dehydrate you. I carry water with me on long runs, and I try to replace what I'm losing, but I always find when I get home that I've lost at least 2 pounds, and sometimes as much as 5 pounds (hot weather intensifies the effect). It takes a day or two to rehydrate fully after something like that, and dehydration can make you less sensitive to insulin. Of course, exercise makes you more sensitive to insulin, so there are two opposing trends going on here, but if you're dehydrated enough the net effect can be, at least temporarily, to push you in the wrong direction.

Because of all that, you might think that it is counterproductive, in terms of diabetes management, to get involved in heavy-duty endurance sports, such as marathons. I don't think it really is, especially if you're not doing them all year long. I'm pretty sure the benefits outweigh the costs.

I'm convinced that my cardiovascular system gets a big benefit from marathon training, and let's face it: when it comes to cardiovascular health, people with Type 2 need all the help they can get. Controlling my BG is important, but it's not as if that's the only problem I need to work on. Before I started my exercise program in 2001, I spent many years mistreating my cadiovascular system. I did a lot of eating, and every little exercising, and I probably did my arteries considerable harm. Maybe I've repaired all the damage by now, but I doubt it.

To be on the safe side, I need to give myself an advantage, in the form of a stronger-than-average heart and expanded blood vessels. Serious athletic training can give me those things. One sign that it is doing so is my resting heart rate, which is typically in the low 50s (instead of the high 70s, as it used to be before I started a serious exercise program). When your resting heart rate goes down, it means that the blood-pumping capacity of your cardiovascular system is higher than it used to be. That is, my heart can now pump more blood with each contraction, so it can beat at a slower rate and still move the same volume of blood per minute.

As it happens, there isn't a pill that will do that for you. The prescription medication that can build up your circulatory system and strengthen your heart has not yet been invented, and I'm not waiting for that to happen. Maybe it will, some day, but it's about as likely a development as a new pill that enables people to play the saxophone. Some things have to come from training, not from medication.

But if I'm honest, the real reason I sign up for endurance events now and then is that it, in several ways, it helps me maintain a positive attitude towards exercise. First of all, it makes me feel capable of exercising. I'm not a natural athlete by any means, and I have often had to fight an unconscious feeling, while I was working out, that I couldn't do this, that I wasn't strong enough, that I wasn't cut out for it. Knowing that you've run a marathon and lived to tell the tale gives you a certain confidence in these situations.

Also, signing up to participate in a big, public athletic event gives my daily workouts a positive focus: instead of being tedious chore to check off my to-do list, they become a helpful means of getting ready for the big day.

Finally, getting involved in big athletic events gives me a sense of becoming part of something dramatic and exciting. Not that anyone is excited about my own performance in these events, but it's exciting to be involved nevertheless. Until you have actually gone to a marathon and hung around with the runners waiting to start, you really can't imagine the buzz that the situation generates. It's something like the atmosphere backstage on the opening night of a show, except that the marathon runners have worked harder and risked more to get there, and the intensity is greater in proportion.

Buried within America's largely sedentary, indoor way of life is a subculture of people who like to get outside in the fresh air and get moving; when I'm out running or walking or cycling, I see a lot of them, doing the same thing, and I exchange greetings with them (which I assure you I don't do with strangers in, say, the grocery store). I feel as if I've learned the secret handshake, and been inducted into the fraternity of people who are doing something to stay healthy besides taking pills. I feel more fully part of that fraternity when I participate in organized athletic events, and I suppose I will always want to do that from time to time. I don't know if I want to do more marathons, but events challenging enough to require some serious preparation will always have some value for me.


Tuesday, February 5, 2008 -- FBG 95

Well, 95's not bad, but it's the same as yesterday, and I wanted it to be lower this time. It probably would have been lower, if I had lightened up on the carbs a little yesterday. Looking back on it, I guess lunch and dinner were both a little starchier than they needed to be.
The day after a long run like the one on Sunday, I take a break from running, though I usually do some easier type of exercise. I went to the gym last night and did a pretty mild workout (on a stair-climber that's easier than most). Fortunately, I wasn't hurting from the run. My hips felt okay. After my gym workout I went to my yoga class, and I didn't have too much trouble with it. There was one pose that my hips weren't in the mood to do, but I got through it. Balance was a challenge, though. I'm never very steady when I'm standing on one foot, and I was especially wobbly last night. Whether that had anything to do with the run is hard to say. (Could be it's just brain damage.)

Today was a busy day. I couldn't run at lunch, because of a training class I was in. I had to go to the gym after work, and do my running on a treadmill. I don't much like treadmill running, especially if I have a long run to do (5 miles today), but I had to fit the run into my day somehow. Another thing I had to fit in was voting, which I did after work. I've also got homework to do for a computer class I'm in. I've also got this web site to work on.

Life (with all its various obligations) goes on, regardless of what's happening with my health, and sometimes it's not easy to make time for the process of keeping myself healthy. I deal with that by putting health first; everything else will simply have to get in line behind that. My justification for this approach is that, if I don't put health first, before long I won't be able to do those other things anyway.

However important your career, family, friends, and hobbies may be to you, it's not very likely that you would be able to serve them better if  you were willing to sacrifice your health for their sake. Yes, life goes on, but you don't want it to go on without you.


Monday, February 4, 2008 -- FBG 95

A fasting BG of 95 is considered normal, so why was I disappointed that it wasn't lower than that? I guess because I think that, where diabetes is concerned, there is hardly any such thing as "good enough". No matter how much progress you've already made, you always have to be aiming for a personal best. If there's any way you can do better, then you should try to do better. I know I can do better than 95 (my average fasting BG was 91 last month, after all), so I'll aim to do better than that in the coming days.

There are all sorts of reasons why you could argue that it's silly of me to talk about hope and disappointment in connection with minor fluctuations in test results. For one thing, the fluctuations are small enough that (at least in theory) they could have been caused by nothing more than variability in the performance of my glucose meter; as I've said elsewhere on this site, you have to pay more attention to long-term averages than to any one test result. For another thing, I'm engaged in marathon training, which is doing a lot to shake up my system currently, no doubt with a few peculiar effects on my BG (but with highly desirable effects on my health overall). It's only to be expected that I'd be getting slightly erratic results now.

Despite all that, I still intend to watch my test results, think about them, have feelings about them, and try to learn something from each one. That's the approach that has worked for me so far. I'm not saying it's entirely logical, I'm just saying it's useful. Over-reacting has its drawbacks, but under-reacting is usually worse.
 
After the run yesterday I resisted the urge I always get after a long run or bike ride (to go to a Mexican restaurant and replace every calorie I burned, and then some). Instead I had a modest lunch at home, and then went off to an afternoon house concert (that is, a small concert held at somebody's home). The hosts and the musicians were all people I know, and there is something very satisfying about music-making in such intimate surroundings. The music and the setting were great. Also, by going to this event instead of to a superbowl party, I was not placing myself in the path of temptation in terms of snacking. At least that's what I had thought; as soon as I got there, I ran straight into a table covered with plates of cookies.

I think this sort of thing can be a huge problem for anyone who is trying to exercise any kind of dietary restraint: we are surrounded by temptation wherever we go. Almost every place where Americans congregate, even in small numbers, is an occasion of sin. The likeliest explanation for the low obesity rate in France (of all unlikely places) is that the French generally don't eat between meals; their dinners may be rich, but they aren't supplementing them with snacks before and after. I assume that, in France, you can step outside your door without immediately running into a buffet table; in American, you can't.

So there I was, and there were the cookies, and I admit that I had some. At least I didn't eat all of them, which I would have been perfectly happy doing. It was so easy to think "I just ran 14 miles, surely it's okay for me to have cookies!". Maybe it was okay, but it wasn't necessary, and I have no reason to be taking in unnecessary calories right now.

After the concert I went to a jam session in Sonoma; that at least wouldn't involve food. Or so I thought. Half-way through the session it was announced that the session host was having a birthday; all the musicians put down their instruments, and out came a big cake.

I don't know how I did it, but I managed to refuse the cake repeatedly until they stopped asking. So I resisted that temptation, at least. It's hard to be a good boy. 


Thursday, January 31, 2008 -- FBG 79

79? Holy mackeral! Maybe I was too good yesterday.

At first I thought I was on track to be a good boy today, too. It' rained hard all day, but I still went out and did my 5-mile run. After work, I went to a computer class I'm taking at the local junior college, and discovered that the class was canceled because the instructor had the flu. Because of the class, I had been expecting to miss my Dad's birthday dinner, which was taking place about 60 miles away. So I placed a quick phone call, told him I would be there after all, and hit the freeway.

The dinner was at an Italian restaurant, and I knew from the start that there was no way I was going to eat there without taking in a truckload of calories. It was a big, rich meal, high in carbs and probably in fat as well, although I tried to minimize that. So, I'm not expecting to get a low fasting test tomorrow, but I'm curious to see what I will get.

Average BG for the month of January was 91; pretty good, I'd say. I have been operating on the assumption that keeping it below 95 was good enough, but now I'm wondering if I could get the average beow 90.



Wednesday, January 30, 2008 -- FBG 85

Well, that's more like it. Yesterday's fasting test result of 105 bothered me, and I was determined to do better today. I was hoping to get it below 95, but I'm happiest when it's below 90. 85 is great.

Achieving this was fairly simple. Last night I came home from work and had a comparatively low-calorie dinner (a bowl of spicy vegetable stew, and baked potato with seasoning but no fat added to it). I went to the gym and did a fairly intense workout (running 40 minutes on the treadmill at a higher speed than usual). After I came home from the gym, I didn't do any snacking. Result: fasting glucose 20 points lower than the day before.

Perhaps you're thinking, "Why run 40 minutes on a treadmill, or eat vegetable stew instead of pizza, when you could have just popped a pill and got the same result?". Well, don't be so sure that popping a pill would have got me the same result. There are lots of people with Type 2 who have been using pills to control their blood sugar for as long as I have been using lifestyle adjustments to control mine, but not very many of them can bring their fasting BG down to 85. Pill-based BG control just isn't that good. It isn't even control, really. All you can do is swallow the pills and hope for the best.

When you're practicing lifestyle-based BG control, you don't wait and hope, you act. If it only takes a little bit of carelessness to produce a bad test result, it takes only a little bit of care to produce a better test result next time. That's why the daily glucose test is so useful: it keeps you on track. Or rather, it tells you immediately when you're getting slightly off the track, so that you can get back on it without a lot of fuss.

Of course, if your fasting glucose is well above the normal range, it's going to take time and effort to bring it back down where it ought to be. Still, if my experience is any guide, it doesn't take long to achieve some kind of noticeable progress, and once you're moving in the right direction it becomes easier to keep on going that way.

The real secret of managing Type 2 is to test every day and then think about why the results are what they are. If they're good, what did you do right? If they're bad, what could you be doing better?

So long as my results are good, I tend to feel relaxed about the whole issue: "Obviously I'm doing everything right!" After a while, this turns into dopey complacency, and I begin to allow myself more and more liberties, developing an exaggerated sense of what I can get away with. Then my test results start moving in the wrong direction, and I get nervous. That's when I start paying more attention to what I'm eating and how much exercise I'm getting.

I think I will always need that little nudge back onto the proper path; I will always need feedback in order to find my way forward. That's why, when I'm driving home at night, despite my familiarity with the road... I still turn on the headlights.

Today I decided to do pretty much the same program again, only more intensely. The marathon training schedule called for a 9-mile run today. It's not so easy to fit something like that into my Wednesday routine, so I split the run into two separate workouts: a 5-miler at lunchtime, and a 4-miler on the treadmill at the gym. I set the speed higher on the treadmill this time. Also, once again I had a light vegetarian supper and no snacking later. We'll see what that does to my fasting test tomorrow.


Tuesday, January 29, 2008 -- FBG 105

Whoops -- 105! I don't like to get a fasting BG above 100. I'm usually at 95 or less. As always when I get a result above 100, I think about all the factors that might have influenced the result, and what I might be able to do about them.

To begin with, I didn't do any aerobic exercise yesterday. I went to yoga class, but that doesn't count, and it was the only exercise I got. Still, a single rest day (especially when the day before included an 18-mile training run!) shouldn't have much impact on BG.

Another possible factor was that I overslept a bit this morning, and then woke up in a panic about being late. Beginning the day with a little burst of stress like that does tend to elevate my fasting test (stress releases adrenaline, and adrenaline raises BG).

A more likely factor: I ate some fruit and walnuts after I came home from yoga last night. I'd had a light dinner and I was feeling hungry when I got home, but I should have resisted the temptation -- eating after 9 PM, especially on a rest day, can easily raise my fasting test the next morning. And I ought to be bringing my weight down a bit for the marathon; late-night snacks won't help me do that.

The trouble with doing really long workouts, such as that long run on Sunday, is that you tend to give yourself too much credit for them. You feel that you can afford to bend your own rules, because you've been such a fitness hero lately. It's easy to think, "Why shouldn't I have a late-night snack? I ran 18 miles yesterday, for crying out loud. I've been a good boy! I'm entitled!". Unfortunately, where diabetes management is concerned, rules are helpful but feelings of entitlement are not.

The other problem with really long workouts is that they deplete so much of your body's stored sugar that you have no choice but to replace it. If you're going to run more than 10 miles or so (or ride a bike more than 40 miles or so), you're really going to have to take in some sugar, either along the way or after you finish. It's important to do this, but easy to overdo it. On Sunday, I swallowed a glucose gel during the run; right after the run, I drank a fruit shake, and I followed that up with a lightly-sugared sports drink. All told, I probably took in well over 100 grams of pure sugar within a 90-minute period. It felt necessary at the time, and maybe it was, but more likely it was excessive. Maybe I restored my sugar reserves more than they needed to be restored. It's always tempting to think that extreme exertions require extreme remedies. Another example of the entitlement mentality at work, I guess.

So what's the bottom line? I guess a combination of factors pushed my fasting BG slightly above its usual range, and I'm going to try hard to bring tomorrow's test result back down where it belongs. I'm going to the gym tonight to do 4 miles on the treadmill, and I'm going to set the speed a little faster than I'm used to. I'll make sure my dinner is on the light side. And nothing to eat after dinner. I don't know whether I can get tomorrow's test under 95, but I'm sure I can do better than 105.



Monday, January 28, 2008  -- FBG 91

After the 18-mile run yesterday, this was a non-running day. (Even when you are marathon training, you have to take some days off.) I did, however, go to my yoga class tonight.

Yoga isn't aerobic exercise, but it does qualify as a kind of strength-training exercise. Mainly, though, it is body maintenance. I think everyone who does a lot of challenging exercise should also be using one of the body-maintenance disciplines (yoga, Pilates, tai chi, Feldenkrais, massage, whatever). Exercise can't help you if you are too stiff and sore to do the exercise.

It's a good thing that my yoga class is on Monday nights; it helps me undo whatever I did to myself on the weekend. By now my yoga teacher knows the drill; when I come in she asks me what big exercise challenge I gave myself over the weekend, and which muscles are sore because of it. The thing is, I wasn't all that sore today, despite the 18-miler. Stretching in the hot tub after the run helped a lot. I was able to do everything in the yoga class without hurting.

Whenever I have a rest day, I wonder if my fasting BG will be higher the next morning because I haven't exercised. I try not to eat as much on a day when I'm not exercising, but sometimes it's tough to stick to that plan. When you're doing serious sports training, there's a strong temptation to give yourself a little too much credit for whatever your last big workout was, and reward yourself for your heroism by consuming more calories than you burned in the first place.

Of course, another problem with training for an endurance event such as a marathon is that, when you finally complete the event you're training for, your exercise level drops way down, but your food consumption might not. You get in the habit of eating a lot as your exercise level keeps increasing; getting out of that habit is not nearly as easy as getting out of the habit of doing very long runs on the weekends.


Sunday, January 27, 2008 -- FBG 83  

I'm training for the Napa Marathon, which is coming up on March 2nd. Marathon training involves a mixed schedule of longer and shorter runs, with the longest runs saved for the weekends. Today the distance was 18 miles.

It rained -- not terribly hard, but hard enough to ensure that I had to the run by myself. My training partner had warned me that he wouldn't show up for the run if it was raining, and he was as good as his word. Honestly, it wasn't that bad. At least this is California, so it wasn't snowing. And the location (among the hills and vineyards of Dry Creek Valley, near Healdsburg) was beautiful.

Right after the run I went to my health club and sat in a hot tub for 20 minutes, stretching my leg muscles to work the stiffness and soreness out. It helped a lot; I was walking a lot more comfortably when I left.

I know that 18 miles sounds ridiculously long, and it still seems strange to me that I've become capable of doing something like that. Seven years ago, when I started this diabetes adventure, I would have had trouble running 1 mile, let alone 18.

As a newcomer to exercise, I was certainly not good at it to begin with. I just gradually built up my stamina. This happened slowly, over a period of years. At first I just started doing longer and longer workouts in the gym (the first one was 15 minutes long, and I thought at the time that it was going to kill me). Later I started cycling and running, trying to make myself go a little farther every time. Every once in a while, I'd challenge myself to participate in some kind of endurance-sport event, such as a long bike rally or trail-run -- something difficult enough that I'd have to train for it. After about five years of this, a coworker talked me into signing up for my first marathon. I lived through the first one, and later did a second one. Now I'm training for my third.

I don't know if I'm going to keep doing marathons or not. They take a lot out of you, and the training you have to do for them takes up a lot of time and energy. Still, marathons are awfully exciting events to get involved in, and it's not surprising that people get hooked on doing them. You do your first marathon to prove you can survive it; then you do another one to prove that you can run it and not hurt so much this time; then you do another one to prove that you can do it a little better or faster.

This could be my last marathon, but even if I never do one again, I'm sure I will continue to do occasional endurance events of one kind or another. They give you something to focus on in your daily workouts, and that's valuable.