Thursday, July 31, 2008
|Blood Pressure, Resting Pulse||111/65, 55|
You pray for good health and a body that will be strong in old age. Good -- but your rich foods block the gods' answer and tie Jupiter's hands.
Once again, a beautiful day. Clear, sunny, 77 degrees. I did a 4-mile run at lunchtime -- not too hard a run, because I was alone and I wasn't having to keep up with better runners. (Why don't I ever seem to find anyone to run with who isn't a better runner than me? Could it be because most people who run at all are better runners than me? Yes, it probably could.)
After having a rather high-carb dinner at the brewpub last night, I'm not surprised that my fasting test is up a little today (96, when my fasting average for July has been 85). But if my idea of a high fasting test is 96 these days, I'm not doing too badly.
Originally I thought any value up to 109 was good enough, and 100 was perfection (I thought nobody needed to be lower than 100, diabetes or no diabetes). My ideas about that evolved over time. A few years ago I decided that I would consider any value above 95 to be "high" for my purposes. And, in recent months, I've begun to be disappointed by any result above 90. Obviously there's a limit to how far I can (or should) carry this. But this process of gradually improving my expectations (and my results) has been interesting.
One of the pitfalls of having a fixed goal is that, once you reach it, you stop trying to do any better. I've never understood why people who have just completed a long but successful search for a missing item ask "why is it always in the last place you look?". For heaven's sake, people: it's always in the last place you look because, when you find it, you stop looking! The location of the item is by definition the last place you look; if you hadn't found it there, you would have thought of other places to look. Similarly, if you set a goal of getting your fasting average to 120, you're not likely to get it much lower than that, because as soon as you get there you stop trying to improve it any further. But if you keep on trying to improve it, you might get it a lot lower than that.
I don't want to sound obssessive-compulsive about this, but it seems to me that a flexible goal of continuing improvement can be better than a fixed goal. If you're always trying to do a little better, over time you make progress; if you're only trying to stand still, you're likely to lose ground. With diabetes, "good enough" is never quite good enough, because any further improvement you can make is worth making. That doesn't mean you should get depressed when your results are less than fantastic, it just means that, when your results are good, this shouldn't make you think "well, thank goodness -- this means I don't have to try anymore!".
I decided to take tomorrow off; some coworkers and former coworkers have reserved a group campsite at Van Damme State Park, on the coast just south of Mendocino, California. It's a beautiful place, but I haven't been there in years. I used to go there a couple of times a year when I belonged to a scuba diving club. The cove there is a great place for abalone-diving, and although I won't be participating in the abalone-diving (I still have vivid memories of how bad I am at that demanding art), I have high hopes of being able to participate in the abalone-eating. Anyway, I'll probably be away from home and away from this website until Sunday. More later...
Wednesday, July 30, 2008
|Blood Pressure, Resting Pulse||117/68, 51|
Never discourage anyone who continually makes progress, no matter how slow.
Exercise is such a schedule problem. I used to see the difficulty of fitting it into my schedule as a lesser problem than the horrifying unpleasantness of doing the exercise itself, but now I'm over that phase. Even really hard exercise is not that bad for me now, and a lot of the time I even enjoy it. So, for me, the trickiest thing about exercise is finding adequate time for it.
I knew I wanted to a fairly tough workout today, as I was going to be having dinner at a brewpub with some friends of mine tonight, and I wanted to work off some of those extra calories in advance. I thought I had it all arranged, but my running buddy didn't show up at the appointed time (she had got stuck in a meeting that ran overtime, I later found out). Because of the limits of my own schedule, I had to take off without her if I was going to fit in a good run. I choose a difficult route -- 5.6 miles, and very hilly -- about 700 feet of climbing. As I was alone, there wasn't much pressure on me to maintain my pace (other than the pressure of getting back to the office on time), but I did my best. And the weather certainly cooperated -- sunny but not too warm (about 80 degrees, with a nice breeze) and clear air, with nice views from the top of the ridge line. After weeks of smoke from the California wildfires, the clear air is much appreciated.
Tuesday, July 29, 2008
|Blood Pressure, Resting Pulse||115/70, 54|
One of the first duties of the physician is to educate the masses not to take medicine.
Sir William Osler
A beautiful day. The smoke from the wildfires seems to be entirely gone from the atmosphere. The temperature was only about 80 when I went running at lunchtime. It was a comparatively easy route (4.4 miles, and not too hilly for most of the distance). I guess I should do a harder one tomorrow. (Especially as I will be meeting some friends after work for dinner at a brewpub. That's the sort of evening you have to earn. )
A man I work with, who was telling me recently that I've inspired him to start exercising more, said to me today in the locker room that he's just about ready to try running with me and my running buddies. He's been building up his distance gradually; we always run at least 4 miles and he's almost comfortable with the idea of running that far. Probably he'll be happier if he runs with me on a day when my running buddies aren't around; It'll be easier for him to keep up with me, if I'm not trying to keep up with them. But, as he sagely pointed out, I can always take the option of running with him, and allow them to pull ahead of us if they want to.
I hope he'll actually follow through on this plan; he's a little timid about pushing himself, but he recognizes that he needs more exercise. He doesn't have diabetes, or much of anything else wrong with him, except for one thing: high blood pressure, which he is having a hard time controlling. Hard exercise certainly helps with that.
I've been thinking more about blood pressure this year, perhaps because I have reached a point where keeping my glucose in the normal range is no longer that tough a challenge for me. When you're first diagnosed with diabetes, you can get a trifle obsessed with glucose readings, as if that was the only thing in the world you needed to be concerned about. It isn't an entirely unreasonable way to look at diabetes, not only because glucose control is crucial, but also because the things you do to improve your glucose numbers (I mean things besides drugs) tend to improve your other numbers as well. My efforts at reducing my glucose readings also gave me reductions in weight, triglycerides, LDL cholesterol, and even blood pressure.
Still, once you've got glucose pretty well controlled, it's worth making an effort at fine-tuning those other issues if they still need a bit of work. My blood pressure, though much improved (to the point that my doctor okayed me to stop taking the ACE inhibitor I'd been on for years), was not meeting the new, stricter definition of "normal", which is now <120/80.
Within the past few months I've made a significant improvement in blood pressure; I don't always meet that "normal" standard but I meet it pretty often. I'm not sure what the reason is for the improvement, but it may be simply that I'm focusing on it. I've been trying to reduce my stress level, by taking some special relaxation classes (one at work, and one from my yoga teacher), and I've been trying to develop relaxation practices (little deep-breathing breaks) that help me relax in situations were my natural reaction it to tense up.
I suspect that learning to relax is as challenging in its way as learning to play a musical instrument. However, I did learn to play a musical instrument, even though I didn't start until I was 32, so I'm accustomed to taking on difficult challenges. Maybe I'm capable of learning to relax as well. Here's hoping!
Monday, July 28, 2008
|Blood Pressure, Resting Pulse||116/70, 51|
All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.
Today at lunchtime I went for a run with my two main running buddies, and it was my bad luck that they were feeling especially fresh and energetic today (one of them was well-rested after three or four days without running). I couldn't remotely keep up with them on the hill-climbs. It bothered me to be falling so far behind them, but I just couldn't rise to the challenge. My natural tendency in these situations is to get very depressed and discouraged, but I know it isn't an especially helpful tendency, and I fight it as best I can.
I think that's a natural tendency for a lot of people: if you don't have a natural gift for something, just give up, and avoid it altogether. We hope to prevent embarrassment by steering clear of activities in which we know we're not likely to shine. It doesn't matter that much, usually. I think there's nothing wrong with the idea of leaving the singing to people who can sing. Also, despite what a million movies have tried to tell us about the subject, I doubt very much that dancing is the key to life, or that anyone who doesn't dance is a hopeless loser.
However, if you don't dance, you do at least have to move. Exercise of one kind or another is a necessity. You can give up on swimming, or on running, or on cycling, or on team sports; the one thing you can't do is give up on exercise altogether. It's a good thing there are so many forms of it.
I could switch to doing exercise entirely on my own, and never have to worry about the issue of not being able to keep up with others. The reason I don't think that would be a good choice for me is that exercising with other people keeps me interested, and it also challenges me in ways that I need to be challenged. Exercise is best and most useful when it is a little harder than what you can do comfortably. A good workout isn't an easy workout. It's when you are operating a little outside your comfort zone that you get the greatest health benefit (and also feel the best, because the endorphin rush that follows intense exercise is not going to be provided by easy exercise).
I went to yoga class tonight, which is a kind of strength training, but not quite the same. I meant to do some weight training at the gym over the weekend and never found the time for it. Maybe I can do something tomorrow or Wednesday.
Dinner tonight was a vegetable stew, hopefully low in calories. High in vegetables, anyway. The trouble with meat-eating is that it makes you think of vegetables as "in the way", so you don't appreciate them and you don't eat enough of them. If vegetables are the center of attention and not a distraction, you appreciate them more. In this case the vegetables were carrots, celery, peppers, broccoli, scallions, green beens, and kidney beans.
Saturday, July 26, 2008
|Blood Pressure, Resting Pulse||112/74, 54|
The art of medicine consists in amusing the patient while nature cures the disease.
Well, what do you know: I did manage to get out of the house early enough to fit in a trail-run today, but a fairly short one (5 miles). I wondered, though, if maybe I shouldn't have been there, because it looked as if Saturday morning was reserved for female athletes. I saw many women running on the trails, and no men. There were some men on bikes, but even the cyclist were predominantly female. Does July 26th have a special significance I'm not aware of? Was I breaking the rules?
Men tend to be hyper-sensitive to situations in which they are the only male around; this is probably amusing to women, who are more often obliged to be in situations where they're the only female around. In yoga classes, women usually outnumber men by a wide margin, and I have to admit that it bothers me. If anyone interrupted my yoga class, blindfolded me, and asked me to say how many men are in the room, I could usually give a precise answer. Lately, there have been more men in the class than there used to be, but the issue remains an uncomfortable one. And yes, I know that's stupid.
Of course, I usually don't go running in the state park that early in the day, so maybe there's a pattern to this that I've missed until now. Certainly the morning was the sensible time to run, as the temperature was in the 70s then, and was destined to rise to the 90s in the afternoon. I have heard it claimed that doing the sensible thing is not generally a male characteristic. It isn't one of my characteristics, to be honest, and only schedule pressure made me do it. I knew I was going to be participating in a musical performance in the evening, and I needed some practice time to make sure I was up to speed on the music.
I was playing with a group of musicians at a Shakespeare-on-the-green performance in the early evening. We played a half-hour of traditional Scottish fiddle tunes before the play started. It was a bit trying to play under the circumstances (outdoors, on a stage with no shade, facing into a very hot sun, trying desperately to keep our instruments in tune in the heat), but I didn't find the music difficult and I was able to relax and enjoy playing.
That's a pretty big change for me. I never learned to play a musical instrument as a child; I took up music at the age of 32, when it is supposedly too late. For years I struggled with stage fright, and to do what I did today (standing at the front of the stage, without sheet music, playing music from memory for which I had had two practice sessions at home, and one short rehearsal with the group just before the performance) would have been unthinkable then. I'm glad I went through the experience of learning to play a musical instrument as an adult beginner, and learning to get comfortable with playing it in public, because it's not bad preparation for diabetes.
One of these days I'm going to add an essay to the Notes section of this site called Music Lessons, describing all the things I learned as a musician that ended up being useful when I became diabetic. One thing I learned was that, even though you suddenly find yourself dealing with a vastly complicated subject which everyone seems to understand much better than you do, it is possible (eventually) to acquire a pretty good grasp of the subject. Another, more important thing I learned is that a series of very small improvements, if you keep making them, can take you an amazing distance.
Our performance of the Scottish fiddle tunes seemed to go over well with the audience, but I'm not sure we were the most appropriate curtain-raiser to a production of The Comedy Of Errors which moves the setting of the play to Cuba, of all places. As soon as we walked offstage, the recorded Cuban dance music started up, and I thought, yeah, we really established the atmosphere there, didn't we?
But then our work was done, and we were free to stretch out on the grass in front of the stage, relax, share our pot-luck dishes, sip Sauvignon Blanc, and watch the play. It wasn't a perfect performance (though it got some things right, such as the prologue scene explaining the background story of the two sets of identical twins, that are seldom presented clearly enough), but it was perfect enough for me. If anything, the cast did too good a job of fooling us: in this production, the twins really did look alike, and in some scenes where Shakespeare wants us to grasp the situation better than the characters do, we shared their confusion. I loved it anyway. There's something wonderfully real about live theater, even at its most artificial, just as there is something wonderfully real about live music. It's you, and the audience, and no special effects. (And little or no paycheck; what could be more real than that?) To me there's something life-affirming about being around people who are creating something beautiful out of effort and imagination, with no hope of making significant money out of it. People who find their own motivation.
Diabetes management requires a kind of internal spark that is very much like what's needed to make performing artists do what they do. You could do worse than to take your inspiration from amateur performing artists.
Friday, July 25, 2008
|Blood Pressure, Resting Pulse||122/71, 64|
The greater the difficulty, the more the glory in surmounting it.
This is interesting: yesterday I did a long trail-run after work, came home, and measured my blood pressure as 107/71. Today after work I went to a special "restorative yoga" relaxation class, which consisted essentially of lying around and melting into the floor. I came home from that, and measured my blood pressure as 122/71.
So, it appears that I get a good diastolic reading (the "71") from either hard exercise or relaxation therapy. However, regarding systolic pressure, hard exercise does a lot more for me than relaxation does (107 versus 122).
Yes, I know it's unrealistic to draw conclusions about blood pressure from two readings. However, I've seen this kind of thing before. My diastolic pressure usually isn't bad anyway; it's the systolic pressure that's hard for me to bring down. The only time my systolic pressure seems to dip below 120 (and that's the new definition of "normal") is when I've done a good hard workout, preferably within the last few hours.
I did a pretty hard workout today, but it was at noon. It was a 4.5-mile run, it was hilly, the temperature was warm, and I was trying to keep up with two running buddies who are better athletes than me (one of them was the guy who did the 70-mile triathlon on Sunday).
I have a busy day tomorrow -- I'm playing with a group of musicians at an outdoor Shakespeare performance in the evening, and I have to fit in a sizeable block of practice time, to make sure I'm up to speed on the music. But I also want to fit in a good workout tomorrow. If I can get my act together early enough, it would be nice to go to the state park and do another trail run -- early, before it warms up. If I miss that window of opportunity (I'm not usually an early riser on Saturdays) I guess my fallback plan will be to go to the gym, do some weight-training, do some aerobics, and maybe a little swimming. But one way or another, I need to rehearse! There's such a thing as too much rehearsal, but there's also such a thing as too little, and that's where I am right now.
Thursday, July 24, 2008
|Blood Pressure, Resting Pulse||107/71, 67|
Everybody wants to be somebody; nobody wants to grow.
Johann von Goethe
That very low blood-pressure reading was measured an hour after I finished a trail-run this evening. As I had been planning a trail-run for yesterday and ended up not doing it, I felt like I owed it to myself to go do it today. It was a nice evening for a run; after a rather humid afternoon, the air was cool and comfortable by the time I started running at 6:30. The air was a little smoky, but that was more a visual phenomenon than anything else; it didn't feel bad to breathe it. (Still, I'm very much ready for this wildfire crisis to be over -- this has been going on for month now, and I've had enough.)
For the run tonight I put on a heart-rate monitor (it's a chest strap sensor that reports data to a display that you wear on your wrist). I haven't used the heart monitor much lately. I used to use it a lot, when my exercise program first started getting serious. I found that, while running or cycling up a steep hill, my heart rate would go very high (up to 180 if I wasn't careful). My doctor told me that was too high, and that I should throttle back enough to keep my heart rate under 170 on even the hardest parts of a workout.
Over the years of exercising, I found that my heart rate was slowly getting lower for equivalent levels of exercise difficulty. I guess progress has continued. During tonight's run, I found that my rate went to 145 while climbing moderate hills (it used to be more like 160). It went to a maximum of 158 on the toughest hills (it used to be more like 170).
What this reduction in heart rate indicates is that I have built up my cardiovascular system; my heart moves more blood per heartbeat, so it doesn't have to beat as fast as it used to. You might think that the cardiovascular system is not something that can be built up -- that the blood vessels you've got are as large and numerous as they are ever going to be. However, the body is apparently able to expand its cardiovascular capacity, just as it is able to expand its muscle mass. The body adapts itself to your physical activities; placing demands on the body stimulates it to change in ways that make those demands easier to meet. Exercise brings about useful adaptations, and I don't just mean "useful" in the sense that they make you better at exercising. They are also useful in the sense that they make you better at getting excess sugar out of the bloodstream -- the primary challenge for anyone with diabetes.
Wednesday, July 23, 2008
|Blood Pressure, Resting Pulse||107/63, 55|
It took me fifteen years to discover that I had no talent for writing, but I couldn't give it up because by that time I was too famous.
I added a new essay to my Notes page called It's All Connected , which explores the connections between Type 2 diabetes and various other health problems which tend to be associated with it. Because Type 2 doesn't like to travel alone, you need to be aware of the other conditions that tend to come with it, and understand how those other conditions affect your diabetes.
Well, you have to be flexible. My plan to do a long trail-run after work today with my running buddy ran aground, because she had a schedule problem in the evening. (Actually, it was an auto-repair problem.) She was free to run at lunchtime, though. So, I thought, should I run by myself in the evening, and get in the long trail-run I'd been counting on? Or should I run in the daytime, and get the challenge of keeping up with a better runner (which I had also been counting on)?
I decided it was better to get the challenge of a run in which I didn't get to set my own pace. Due to various schedule problems, I hadn't run with anyone else in several days, and when I run alone I always set too easy a pace for myself. I need a bit of peer pressure to make me work out hard. So, I ran at lunchtime. Within the limited time I had available at midday, we managed to fit in a pretty hard run. The distance was 5.5 miles, which isn't that much more than we typically do, but the route featured a major hill-climb, and the pace was faster than it would have been if I'd been running alone. (Maybe that's why my blood pressure was nice and low this evening.). It was a bit warm during the run(83 degrees), but not too bad. I remained sweaty for about an hour after I returned to my desk, but I've decided I don't care about that kind of thing anymore.
The wildfire situation in California continues to be an issue. The air looked reasonably clear today, but the smell of smoke was strong. The air-quality rating today was "moderate" rather than "unhealthy", so we decided to risk it, but some of the other runners at work were too worried about it to exercise outside; they worked out on the equipment in the company gym instead. I was hoping that the smoky smell comes more from gases than from particulates, and that we could go for a hard run without getting black lung disease as a result. Maybe it's the equivalent of smoking one cigaratte, which is okay, as I'm not likely to get hooked on the experience. I'll be perfectly happy to have this wildfire season over with, as soon as possible.
During the run, my running buddy shared with me some cooking advice, which I put to use tonight this evening (a vegetarian stir-fry which turned out rather nicely). Yes, you can actually converse while you run, provided you don't try to do it while you're running uphill.
I'm not a strict vegetarian (or "vegan"), but most of the time I eat plant foods. I don't have any moral scruples about eating animals, but I think there's pretty good evidence that a diet dominated by plant foods is healthier than one dominated by animal foods, so I concentrate on the plants whenever it is practical to do so. (I don't make a scene at a dinner party by refusing to eat what's being served, but where there's a choice I take the vegetarian choice.) I find it very hard not to gain weight if I eat a lot of meat and cheese. It's hard enough for me not to gain weight anyway, but when I'm eating meat and cheese there's no hope, so I steer clear of that kind of thing as much as I can. I don't especially miss eating meat. The smell of meat barbecuing does make me hungry, but it doesn't make me specifically hungry for meat. Cheese is a little harder to resist, but my solution there is to buy (once in a while) high-quality cheeses that are so expensive I can't afford to have very much of them. (Try some Parmigiano Regiano; at that price I can guarantee you won't overindulge.)
I think the real reason plant-based diets are healthier is not that animal-based foods are toxic (although some researchers think they are) but simply that animal-based foods tend to crowd vegetables out of the diet, and we need the things that vegetables give us. Maybe the only people who get enough vegetables are the people who make vegetables their primary source of nourishment. It works for me, anyway.
Tuesday, July 22, 2008
|Blood Pressure, Resting Pulse||125/76, 55|
An apple every eight hours keeps three doctors away.
Monday was a pretty low-intensity workout (30 minutes on the stair-climber at the gym, then a yoga class), so I felt the need to fit in something a little tougher at lunchtime. I did a 4.3 mile run with steep hills. Even that wasn't very challenging, because I was running alone, and didn't have to struggle to keep up with anyone else.
Tomorrow, though, I've made arrangements to go on a trail-run after work with one of my running buddies, and she is quite capable of challenging me. That ought to be a good workout. Plus, it will have that special summer-evening atmosphere; I love being out there in the hills and meadows as the sun is setting, the birds are roosting, and the mountain lions are coming out to eat the joggers. (If it literally works out that way, I guess the local paper can make a good story about the "the victim's tragic final blog-post".)
Someone in the locker room at work today (a guy I don't know at all well, but I see him there fairly often) asked me today how long I had been doing this. He said he's seen me running at lunchtime seemingly every day, for years, and was wondering how I came to be so dedicated, so consistent. I told him it was a simple matter of having your doctor call you up and tell you that your lab report looks nightmarish and you'd better start a diet/exercise program immediately, unless you want to be dependent on diabetes medications for the rest of your life. (I reassured him that it had worked, so I wasn't worried about my health, but if I stopped working out I would have to worry about it all the time.)
Just two weeks earlier, another guy in the locker room (him I know better, as we worked on a project together in the past) told me that he had started exercising regularly now, in part because he had been inspired by my example, and he thanked me for giving him the inspiration.
It's highly ironic that I, of all people, could ever end up providing inspiration of this kind, when I spent so much of my life (or of the first 43 years of it) avoiding exercise whenever possible. I still see myself as a kind of impostor, a confirmed non-athlete who works out daily, an extremely lazy and sedentary middle-aged guy who occasionally does something out of character, such as running a marathon or riding a bike a hundred miles. In short, my transition from the inactive life to the active one still strikes me as somehow fundamentally comic. The joke is lost on a lot of people, either because they don't remember the old me or because they weren't around when he was here. Still, the sense I have of my current, athletic existence as one huge joke never leaves me. When I'm on a long trail run, literally miles from my starting point and with no way to get back to my car if I don't get there on my own feet, I never lose the sense of how strange this is, that I of all people am here doing this of all things. (I half expect the strangers I pass to demand an explanation.) Well, probably that's a good thing. It keeps life interesting.
Monday, July 21, 2008
|Blood Pressure, Resting Pulse||128/77, 44|
In the beginner's mind there are many possibilities. In the expert's mind there are few.
My fasting tests remained low through my busy weekend (80 Saturday, 81 Sunday); that was understandable, but I'm surprised my test this morning was so low. I went to a picnic yesterday evening and I certainly wasn't practicing any kind of self-denial. Not only that, I didn't really work out yesterday, except that I did a lot of walking. (For some people walking counts as a workout, but I usually need to do something more intense than that.) Maybe I picked up an exercise benefit at second hand, because I spent Sunday morning surrounded by about 2000 very serious athletes.
The event was the "Vineman 70.3" triathlon; I wasn't participating in it, but one of my running buddies was, and I went there to be a supportive spectator and to take some pictures. The "70.3" is the mileage covered, of which the swimming portion takes of 1.2, the cycling portion 56, and the running portion the remaining 13.1. Here are some slightly weary athletes running the final mile of the course:
My running buddy finished the whole thing in 5 hours and 26 minutes, a personal record for him, and afterward he didn't look exhausted, or even all that tired. He mainly just looked happy. Someone else I work with finished in under 5 hours. These people are operating at a level of intensity that I can't imagine matching.
I've never participated in a triathlon, even a short one (much less a monster event like this). I've done lots of running and cycling events, but never swimming events. I'm just not a swimmer by nature; I lack the coordination and tolerance of cold that are required. For this reason, no one has been able to talk me into getting involved in triathlons, but it still could happen. I have to admit I felt a little envious of the participants yesterday; it seemed like such an exciting thing to do. Of course, I'd have to start small. (Learning how to swim across a swimming pool rather than a river would be a good beginning point.)
Because the triathlon combines three different sports that use different muscles (and triathlon training works pretty much every muscle you've got), triathletes tend to be in fantastic shape. Most of them look like cartoon superheroes. It's a bit intimidating to be around them. On the other hand, I've found that hanging around with extremely fit people is beneficial; they talk you into doing things you've always been afraid to try.
Friday, July 18, 2008
|Blood Pressure, Resting Pulse||121/69, 57|
It is no use saying, 'We are doing our best.' You have got
to succeed in doing what is necessary.
Pretty good test results today. The low glucose reading is because of the long run last night -- or rather, it's because I resisted the temptation to reward myself for the long run with a big dinner. I had a vegetarian burrito (a small vegetarian burrito, I should say), and a few strawberries for dessert.
I guess that's one thing I should warn you about: when you do an extra-difficult workout, you feel so virtuous afterward that it seems only fair to treat yourself to a big meal that provides more calories than your workout actually burned. If you do a really big workout, and your fasting glucose the next morning is up instead of down, that's a pretty good indication that you gave yourself a bigger reward for the workout than you deserved.
It was another nice day, about 75 degrees, sunny, clear, no smoke. I went for a 4.3-mile run, and along the way I had a brief encounter with temptation. I wasn't carrying water, because the run was short enough, but I got thirsty along the way (I wasn't fully rehydrated from the long run last night.) So, about 3 miles into the run, I snuck on to the property of a golf course along the route to get a some water at a drinking-fountain that I knew to be there. Nobody was around, but just outside the small building where the fountain was located, I could see that someone was in the process of setting up for a big party later in the afternoon. There were multiple kegs of beer, and stacks of large plastic cups. It seemed like a perfect opportunity for a pint-break, free of charge.
Not that it would have been a lot of fun to run up the hill back to work after drinking a pint of beer, but the thought certainly did flash through my mind. Let's just say it's a good thing the temperature was 75 degrees rather than 95.
I'm going to have a busy weekend and may not got an opportunity to post anything here till Monday. I promise to be good in the meantime.
Thursday, July 17, 2008
|Blood Pressure, Resting Pulse||120/69, 67|
Habit is a cable; we weave a thread each day, and at last we
cannot break it.
It was a beautiful day: clear, sunny, low 70s. No smoke from the wildfires. I decided to go for a trail-run in the local state park after work. It was an eight-miler. During the hillier portions of it I was having vivid memories of how much harder it had been for me, when I first ran up those same hills. That was at least five years ago, but the memory is still fresh. Not that running up steep hills is easy for me now, but I do it without the thought that I'm going to drop dead within a few minutes even entering my mind, and that sort of thing makes a big difference to a fellow's attitude. My energy level rose and fell a bit during the run, as it always does, but for most of the way I felt good, and at the end I wasn't even very tired. I could have gone miles more if necessary.
I've been pondering the great question of how long one can succeed at controlling diabetes through lifestyle adjustment rather than drugs. Diabetes patients are given very little information about this subject, partly because not much is known about it, and partly for reasons which are not so easy to excuse.
When I was first diagnosed, I was sent to a night class on diabetes management, but the class didn't start right away. By the time I got to the first class session, I had already been working on my diabetes problem with diet and exercise for some weeks, and had already made considerable progress. So, when I was asked to introduce myself to the class and give a brief summary of my story, I reported what I'd done and what sort of good resuls I was getting -- fully expecting that the teacher would congratulate me warmly. She did not. In fact, she seemed almost panic-stricken by my remarks; I was stirring up trouble and she needed to nip it in the bud. She all but told the other students not to listen to me. She said that some people could do what I was doing and get good results, but they shouldn't expect that this should work for them, and they shouldn't feel bad about themselves because they needed to be medicated.
Apparently, the teacher saw it as her primary duty to build up her students' self-esteem (with the exception of mine, of course). She feared that, if her students got the impression that diabetes patients can control their glucose with diet and exercise, but they weren't able to achieve this themselves, they would be crushed. Best not to even mention the possibility.
Now, I realize that Type 2 diabetes varies from person to person. Some people have suffered a greater loss of insulin sensitivity, or insulin production (or both) than others have. For some people, achieving good control of blood glucose without medication is just not possible. Fine; but for a lot of people (probably the majority of Type 2 patients) it is possible, and we shouldn't cheat them out of that possibility by setting the expectation that they won't be able to do it.
Suppose we took this approach to another difficult challenge: learning to read. Suppose we told kids that learning to read is very difficult, and they probably won't succeed at it, but some exceptionally smart children manage it, so we'd like them all to give it a shot, just in case it turns out they're geniuses. What would the literacy rate be if this was the message kids were getting? But in fact we take it for granted that all kids can learn to read, and because we do, most of them learn to read.
Even if you succeed in bringing your glucose down to normal levels through lifestyle changes, the question remains: how long will this work? Most diabetes literature says or implies that it only works in "a few mild cases", and that even in those cases it's a temporary solution (because, of course, diabetes always gets worse -- that's the law). The most optimistic prediction I could find in the literature (when I was combing the literature rather desperately for encouragement) was that lifestyle-based diabetes therapy could work for "up to ten years".
Lifestyle changes brought my glucose levels down pretty quickly, so apparently I was one of those "few mild cases". But I was led to believe that it was a temporary solution, so for the first few years of my diabetes adventure I kept waiting for my system to fail, and wondering when it would happen. Any setback in terms of glucose control (and show me a diabetes patient who doesn't experience setbacks!) would scare the hell out of me, because I would think: this is it, this is how it starts; this is the point at which I lose control of my blood sugar, just like all the experts seem to expect. But then I'd get past that rough patch, and life would go on.
Now it's been more than seven years, and I'm doing fine. If anything, my glucose level is more easily controlled now than it was five years ago. Usually I don't worry about it so much any more, but from time to time I think about that claim that lifestyle adjustment works for "up to ten years", and I picture myself stressing out as I reach the ten-year mark.
Then I heard yesterday from someone on the dLife forum who has been doing what I've been doing for seventeen years, and it's still working for him! Not only that, he could hardly have been one of a "few mild cases", as his glucose was in the high 400's when he was diagnosed, and yet lifestyle therapy worked for him anyway. He thinks the reason the health-care industry doesn't put much emphasis on lifestyle-based diabetes therapy is that they can't make any money out of it. Cynical as that sounds, there has to be some truth in it. The pharmaceutical industry wields enormous influence over the health-care industry as a whole, and they certainly have nothing to gain by making it clear to patients that they have a good shot at controlling their diabetes without drugs.
The thing is, most doctors try their best to get their diabetes patients to lose weight and exercise regularly, but few of their patients actually do it. What choice do they have, but to start writing prescriptions? I don't think that patients are getting the pessimistic view of lifestyle-based therapy from their doctors; I think they get it from classes, and pamphlets, and diabetes literature, and websites, and journalism on the subject. To a disturbing degree, the pharmaceutical industry controls the terms of the debate. Articles about diabetes treatments often compare the benefits of various prescription medications, without even mentioning the word "exercise", and hardly anyone even notices the omission, even though exercise is the most effective treatment available.
Another thing that tends to be forgotten about lifestyle-based therapy for Type 2 diabetes is that it isn't optional. You have to do it whether you're taking the drugs or not. If you do it well enough, you may not have to take the drugs, but you have to do it anyway. Drugs alone aren't good enough. Too many people think of lifestyle adjustment as something they'll try, and abandon in favor of drugs if it doesn't work. You have to do it anyway, folks, even if you're taking the drugs! So why not do a really good job of it, and see if you can get by without the drugs?
Wednesday, July 16, 2008
|Blood Pressure, Resting Pulse||126/75, 45|
Many of life's failures are people who did not realize how
close they were to success when they gave up.
A nice day, sunny and clear but not too warm for midday running (about 72 degrees). I did a 5.3 mile route, this time with my running buddies. That meant I had to work harder than I did yesterday, when I was running alone -- I had to try to keep up with them. On the hill-climbs, I couldn't keep pace with them today, but on the downhills I was often able to put on enough speed to catch up, and when I couldn't do that they would do a little out-and-back detour onto a side street to give me a chance to catch up with them. So, for at least a sizeable portion of the run, I was with them and able to join in the conversation. Conversing while running is another challenge, of course, but I can do it if I'm not going uphill.
One of them (who used to be my boss, and who was the guy I ran my first marathon with) is training for a very difficult triathlon on Sunday. If I remember the details right, the swim is over a mile, the bike ride is 56 miles, and the run is 13 miles. Not an event for sissies, clearly; you do all three events with no break in between them. I'm not ready to attempt a triathlon (even one a lot shorter than that), mainly because I'm really lame at swimming. However, I thought I was never going to run a marathon either, until he talked me into it, so I can't rule out the possibility of doing a triathlon some day.
My long-term exercise plans are pretty fluid; they essentially consist of "whatever my friends can talk me into". I don't mean to suggest that they can talk me into absolutely anything, but if they can talk me into running a marathon after I'd spent years insisting I never wanted to do that, it's pretty clear that they can talk me into almost anything. And I benefit from that.
I think there is a strong tendency for society to segregate itself in terms of activity level. Active people tend to gravitate toward other active people, and inactive people seek their own kind as well. I'm not saying it doesn't make sense. It's only natural. After all, if you're a sedentary person, why would you want to have dinner with someone who is going to want to go for a walk afterwards? If you're an active person, why would you want to have dinner with someone who would be horrified if you proposed going for a walk afterwards? It's natural, as I say, but it has a bad effect on sedentary people whose social acquaintances tend to reinforce their bad habits.
My advice is: hang around with active people. Sooner or later, just to smooth your social relations with them, you are going to find yourself getting invovled in activities that you used to assume were not for you. And you'll be better off as a result.
I went to an Irish music session at a local pub tonight -- a nice one. It was a small group of musicians, so we could all hear each other clearly and keep together; the pub patrons weren't noisy, and they seemed to appreciate the music. What more could you ask for?
Tuesday, July 15, 2008
|Blood Pressure, Resting Pulse||125/76, 53|
It's not that some people have willpower and some don't.
It's that some people are ready to change and others are
Man, I take one day off from exercise, and both my weight and blood pressure go up a little overnight. Not that a blood pressure reading of 125/76 is bad, but it doesn't quite meet the new "normal" standard of <120/80, which I'm getting a little better at meeting. Sometimes I think I should just discard the rest-day concept, and make up my mind that exercise is something I need to do every day. (However, if I ever run another marathon, I'm telling you here and now that I'm not going to be exercising the day after that.)
I managed to get out for a run at lunchtime (a little over four miles). It was great weather for running: overcast and cool when I started, increasingly sunny as I went along (but never warm enough to be uncomfortable). My usual running buddies were unavailable today. Okay, I can keep myself company on a run whenever it's necessary.
The only trouble with running alone is that it usually becomes too easy: when you don't have to keep up with anyone else, it's only natural (for me, anyway) to settle into a comfortable pace rather than a challenging one. Not that exercising at a comfortable pace is useless; it's still a good workout. However, my experience is that, in terms of its effect on my blood glucose and blood pressure, exercise gives me a bigger benefit when it's hard exercise. It's also my experience that, when no one else is around, my exercise is usually not hard exercise. It's good for me to go running (or cycling) with other people fairly often, so that I'm forced to work harder at it.
The other benefit of hard exercise is the endorphin rush that comes with it. Any exercise will give you a taste of the body's home-brewed morphine, but it's only when the exercise is pushing you well outside your comfort zone that your body rewards you with a major dose. I can certainly identify the biggest dose of that stuff that I ever received; I once joined a local running club and went to one of their evening workouts. They laughed a bit over the date I chose for my first workout with them: they were doing "hill repeats" that night, meaning that they were doing repeated exercises which consisted of running very fast up a very steep hill, returing to the bottom, and doing it again. It was the toughest kind of workout they did, and perhaps not the best occasion for a novice to join them. It soon became clear that I couldn't keep up with them on those climbs, and my attempts at doing so felt as if they were killing me. In the process, I somehow injured my foot (it hurt for a long time after that night), and I decided that my first workout with them was also going to be my last. If even an unsuccessful attempt at keeping up with them resulted in injury, they weren't the right crowd for me to be running with. But I still have vivid memories of the blissful overdose of endorphins that were coursing through my veins that night. It shouldn't have been legal for me to drive home, let's put it that way. If it hadn't been for my injured foot, I think I would have come back for more.
Anyway, that was my lifetime peak in terms of exercise intensity, and I'm not at all sure it would be safe to operate in that mode on a regular basis. But I do try to have at least some workouts that are at a challenging level of intensity. I know I get benefits from that which I couldn't get in any other way.
Monday, July 14, 2008
|Blood Pressure, Resting Pulse||120/71, 49|
Skepticism, like chastity, should not be relinquished too
Of late, I have been using Tuesdays as my rest day from exercise, simply because my meeting schedule at work on Tuesdays didn't leave me enough time for a lunchtime run. Now that my Tuesday schedule is altered so that I have time to run, I'm going to be making Monday my rest day.
The day is not absolutely exercise-free, because my yoga class is on Monday nights, but yoga isn't exactly a workout, or at least not a cardio workout. More of a strength-training workout, if anything. It certainly was a strength-training workout tonight, as my teacher decided to concentrate on poses that strengthen the abdominal muscles, including the dreaded Boat Pose, which looks like this:
If that doesn't look hard, try it, and be sure to hold it for six slow breaths. Not so easy, is it? My abdominal muscles are not very strong, I must admit, and I was trembling and making pathetic noises during this.
I have a hard time with abdominal exercises. They scare me, in fact. It's very easy for me to get an overstrain injury there, and then I'm sore for at least one week, more likely two. A trainer would argue that this just means I need to do abdominal exercises more often, but I'm sure you can understand why it makes me nervous about doing them at all. Why not just refuse to do them then, you ask? Because I long ago learned the secret of a successful exercise program: letting go of the idea that it matters whether I feel like doing it or not. I'm sure my running and cycling would benefit from greater abdominal strength. And anyway, if you have Type 2 diabetes it's always a good idea to work on your muscles.
When your body needs to put glucose somewhere, the two most important storage sites are the fat cells and the muscle cells. As a Type 2 diabetic, you definitely want as much of that glucose as possible to go into the muscle cells. The reason is that muscle and fat have different ideas about what to do with glucose. Muscles burn it, and then absorb some more of it to fill the gap. Fat cells use glucose to make more fat, which is not especially helpful. Use exercise to move more of your glucose into your muscle cells, and less of it into your fat cells.
Think of your muscle tissue as a giant sponge for soaking up glucose. You want to wring out that sponge regularly, so that it will have room to soak up more glucose. Obviously it wouldn't hurt to have a bigger sponge, so you want to strengthen your muscles if you can. I'm not talking about body-building of the grotesque variety; just a little bit of healthy expansion and refurbishment.
From the running and cycling I do, my leg muscles are pretty strong, and probably they've been giving me a lot of help in terms of glucose management over the last couple of years, when I've been doing no strength training apart from yoga. But now that I'm well recovered from my frozen-shoulder injury of last year, I'm feeling the need to do more strength training. I'm trying to proceed cautiously. No injuries so far, and that's the way I want to keep it.
Sunday, July 13, 2008
|Blood Pressure, Resting Pulse||108/69, 69|
Thoughts, like fleas, jump from man to man, but they don't
Oh dear, people are getting upset...
I was wondering if the Pixar movie "WALL-E" might trigger a backlash from fat people offended by the film's satirical vision of humanity's future. Apparently there was a backlash underway before the film was even released, and I just didn't know about it. Some people are claiming that they were deeply hurt by the film and went home weeping. I'm not too sure I believe them, as a lot of their specific complaints about the film are simply incorrect (there is nothing in the film to suggest that humans left earth because fat people somehow made it uninhabitable, the film contains no humor about fat people that seems especially mean-sprited, and the film makes it clear that the obese and infantile condition of the people on the spaceship developed during their long voyage as the result of an altered way of life). Anyway, taking offense at movies and other cultural products has become a competitive sport in the U.S., and as people become more creative at it, my interest in it tends to fade.
What does interest me, though, is the remarkable set of claims being made about obesity by some of the film's critics. Daniel Engber, in his article on the film at Slate.com, complained that the film equates obesity with environmental collapse:
But the metaphor only works if you believe familiar myths about the overweight: They're weak-willed, indolent, and stupid... It ought to go without saying that this stereotype of the "obese lifestyle" is simply false. How fat you are has a lot more to do with your genes than with your behavior. As much as 80 percent of the variation in human body weight can be explained by differences in our DNA. (Your height is similarly heritable.) That is to say, it may not matter that much whether you eat salads or drink "cupcakes-in-a-cup," whether you bike everywhere or fly around in a Barcalounger. If you have a propensity to become obese, there's only so much that can be done about it. That's not to say that our circumstances can't lead us to gain weight. But there's little evidence that overeating causes obesity on an individual level and no real reason to think that anyone can lose a lot of weight by dieting. (Most of us fluctuate around a natural "set point.") We also know that children who watch a lot of television are no less active than other kids and that pediatric obesity rates are not the direct result of high-fat diets.
These seem like bold claims at first glance, but notice the steady drumbeat of weasel-wording. It "may not" matter what you eat or how active you are. There is "little" evidence that overeating causes obesity "on an individual level". Obesity rates are not a "direct" result of high-fat diets.
I'm especially intrigued by the comment about overeating not causing obesity "on an individual level". Isn't obesity the sort of thing that pretty much always happens on an individual level? If overeating can cause obesity, surely it does so in individual bodies. Is Engber suggesting that an individual can't get fat from overeating but a society can? (If so, I don't understand his objection to a film in which everyone is fat.)
Anyway, Engber includes links to some articles purporting to demolish the "myth" that fat people got fat from eating too much food. However, I'm not at all convinced that these articles, which are about the "starvation experiment" conducted in Minnesota in 1944 and 1945, lend much support to the notion that food intake is irrelevant to body weight.
The experiment was meant to uncover practical information about the effects of starvation (and recovery from starvation) which would be useful in postwar Europe. The volunteers were conscientious objectors who were asked to make this sacrifice as their own contribution to the war effort. The volunteers were so closely supervised that they couldn't sneak in any extra meals. The volunteers were all thin to start with, and the calorie restrictions placed on them eventually caused them to lose 25% or more of their body weight, as these before/after photos illustrate:
One might well ask why the men lost so much weight, if this experiment is supposed to have disproved the notion that food intake is relevant to body weight. Apparently we're supposed to ignore that aspect of the thing. What's more important is that, while they were losing the weight, they were miserable. They were anxious, depressed, and obsessed with food, and they felt awful. This is supposed to tell us that dieting is cruel and unhealthy. Well, wait a minute; these weren't fat men trying to shed excess pounds. These were skinny men being driven into a dangerously emaciated state; surely that is a different situation, and one which the body could be expected to resist very strongly. I mean, take a look at these guys: would you study what's going on in their bodies and claim that it's normal and it applies to all of us?
The other aspect of the study which is supposed to alter our view of body weight is the recovery phase. When the men were finally allowed to eat freely, they over-ate frantically (big surprise there), and despite their massive calorie intake they had a difficult time regaining weight (and particularly regaining muscle mass). When they finally returned to normal, they seemed to settle on a natural "set point", a weight which is normal for them and may differ widely from what is normal for someone else.
Well, it's long been known that starvation can do such serious harm that a rescue can come too late (that is, the body may be unable to recover even when food is provided abundantly). But I don't see that this tells us anything about the physiology of anyone who hasn't suffered any damage from starvation. And if the body tends to home in on a natural target weight, surely it does that by manipulating the things it can control (your appetite and your metabolic rate) and not by exerting magic powers.
In other words, nothing revealed in the starvation study seems to me to overturn any laws of physics. Weight goes up or down depending on the ratio between calories consumed and calories used. Yes, your body can influence your calorie intake by making you hungry, and it can influence your calorie usage by slowing down your metabolic rate. However, it's not as if you have no influence over those things. You can decide what you're going to eat, and how active you are going to be, so you have a greater range of control over calories consumed and calories used than the body's automatic processes do. If your set point is higher, dieting may be harder for you, but that doesn't mean it can't be done.
Having lost more than 60 pounds myself, I can testify that it's hard to lose a lot of weight and it's hard to keep it off. It requires vigilance, determination, and a certain willingness to resist natural impulses. Well, diabetes management in general requires those things too. In fact, life in general requires them. Resisting certain natural impulses is the price of civilization; that's why we have things such as sewers and incest-taboos. The impulse to eat whatever you can get whenever you can get it may be natural, but in our current environment it has become counterproductive. So, we have to add another item to the list of natural impulses that we need to resist. It's a pain, maybe, but it's hardly a tragedy. And to claim that it's a scientific impossibility is pretty ridiculous.
The air was much clearer today; the wildfire smoke must be blowing in some other direction. With no smoke filtering the sun, it was warmer, but not too bad, about 85 degrees.
Fortunately, I was feeling a lot more energetic today than I did yesterday. I went to the state park a little before noon and did a long trail-run (8.3 miles). This was the longest run I have done since that race on July 4 when my hip started hurting. I felt no pain in my hip at all during today's run, and I wasn't hurting anywhere else, either. There were a couple of points in the route when I started feeling a little weary and weak, but that passed. I was sweating enough that I lost 5 pounds during the run (even though I had a water-bottle with me and used it); that's normal for me during a long run in warm weather. Don't worry, those pounds will come right back over the next several hours as I rehydrate.
One of the nice things about getting into shape is that you can do something difficult (like today's run) and not feel wiped out afterward. I came home from the run, had a nice shower, ate lunch, and felt perfectly fine. A little tired, maybe, but I'm not even sure tired is the right word; lazy might be closer to it. I felt like relaxing. I was enjoying the afterglow from the endorphins I generated during the run. I felt no need to lie down and take a nap. Instead I went to a music session to play Irish fiddle tunes for a few hours, and I think I was more energetic than anybody else there. In fact, I was a bit frustrated by the slow tempos most of them were adopting. I tend to think Irish music should be played without the training wheels on. If they'd been on the trail-run with me, perhaps they would have been a little livelier.
Saturday, July 12, 2008
|Blood Pressure, Resting Pulse||106/68, 60|
Drawing on my fine command of the English language, I said
Although the smoke from the wildfires certainly hasn't gone away, it seems to be concentrated in the upper atmostphere now. It was a little hazy, and the sunlight was weak (so the temperature never get above 75), but the air didn't smell or taste of smoke. People were outdoors getting their exercise (including, eventually, me.)
I was a little behind on sleep; I didn't sleep late but I felt the need to take a nap around noon, and I had a hard time getting energized. I meant to go for a run early in the day, but I kept feeling like I wasn't ready for it. In the end I went running at 5 PM (it was a 4-mile run around Spring Lake). There are always lots of other people there, walking and cycling and running. That's where I take most of the pictures of people exercising that I put at the top of these web pages. Seeing other people exercising always inspires me to do the same, so when I'm not feeling in the mood for a workout I go where I know a lot of other people will be doing one.
You can call it silly, this herd-mentality thing that makes us want to do something because we see someone else doing it, but it seems to be a pretty important aspect of human nature. They say that an artist doesn't paint a picture because he has seen a tree, but because he has seen another artist's picture of a tree. Seeing someone else do something gives us permission to do it ourselves; suddenly it seem like an interesting thing to do, and maybe we can do it better than they're doing it, so why not give it a shot? (Surely you've noticed how, within a social circle, one wedding is soon followed by several engagements, and one birth is soon followed by several pregnancies.)
It seems to me that our society is rather sharply divided between the active and the inactive. If you hang around with one set of people, you will seldom be reminded that such a thing as exercise exists. If you hang around with a different set of people, you will get the impression that life revolves entirely around footraces and bike rallies. When active people are setting the standard of what is "normal" it begins to seem downright weird not to be outdoors doing something energetic if it's Saturday and the weather is good.
Therefore, to keep myself on track with my exercise program, I have found it extremely helpful to be around active people, and not just socially. Even when I'm running alone and not with any of my running buddies, I like to go to places where I know I'll see lots of other people running, walking, and cycling. It just makes things esier ("If they can do it, I can.") And there's a peculiar feeling of solidarity that develops among people who enounter one another exercising outdoors; they are moved to exchange greetings, or even the occasional exclaimed encouragement, as they pass.
That feeling of solidarity is, of course, stronger between athletes who actually know one another. On most weekdays I run with friends from work; it's a regular appointment, and I don't have to ask myself whether I "feel like" doing it or not, because what I feel like doesn't enter into it. I meet them at 11:45 AM outside Building 4, no matter what mood I'm in. We agree on a route, and if the route they want to do is tougher than I had bargained for (longer distance, or steeper hills), I try to be a good sport about it. I get a lot of health benefits from working out with them, and the more I go along with them when they feel like raising the bar, the more health benefits I get.
I'm planning to do something more ambitious than a 4-mile run tomorrow -- either a longer trail-run or a bike ride. I'd better decide early in the day what it is I'm doing, because I'm playing music with some friends in the afternoon.
I'm glad to see my blood pressure down so much from yesterday, but I'm unable to account for it. Just a moody guy, I guess.
Friday, July 11, 2008
|Blood Pressure, Resting Pulse||132/79, 52|
Some people are born on third base and go through life
thinking they hit a triple.
The atmosphere is still smoky from the wildfires:
Still, it wasn't as bad as yesterday, and I felt okay about running outdoors at lunchtime. Because the sunlight isn't fully penetrating the atmosphere, it was surprisingly cool (about 70 degrees, when the forecast was for a severe heat-wave). Despite the cooler temperature, I wasn't in the mood for another 6.5-mile adventure, like the one we did on Wednesday. Fortunately, my running buddies weren't in the mood for it either. We did a nice 4-miler. I kept up with them better than I usually do; I'd like to think it was because I was fast, but I have good reason to think it was because they were tired. Anyway, I was able to cool down pretty easily after the run, and when I got back to the office, I wasn't experiencing a humiliating sweatstorm. My shirt was downright dry. In the winter, when that isn't an issue, I tend to forget how much harder daytime running is in the summer. Running in the cold isn't that hard if you're dressed right for it, but running in the heat is hard no matter what you do.
I'm happy with my low BG reading this morning, but not so happy with my blood pressure this evening, which is way up from last night. I ran today, but I din't do weight training or ride my bike to work (two things which seem to drive my blood pressure down). Not that 132/79 is all that bad, but I've been doing better of late and I'd like to be able to do better consistently. Maybe I need to make time for more yoga relaxation or something. The new "normal" is <120/80, and for a long time I thought I could never get there, but now that I can get there sometimes, I'd like to be able to get there regularly.
Thursday, July 10, 2008
|Blood Pressure, Resting Pulse||119/74, 56|
We have too many high sounding words, and too few actions
that correspond with them.
Today the wind did not keep the smoke from the wildfires away from Santa Rosa; apparently it gathered up the smoke from the fires in Mendocino County and delivered it right here. Officially, the air quality was rated "moderate" rather than "unhealthy", but I had to disagree with that assessment. The air was foul. It tasted and smelled of smoke. The hills were almost invisible, and at high noon the sun was the color of a baby aspirin. I decided that this was not a day for outdoor exercise.
I went to the gym instead. I did a strength-training workout on the weight machines, followed by 30 minutes on the stair-climber. I'm still feeling my way a bit cautiously with strength-training, which I haven't been doing lately. I'm trying not to hurt myself. When I did it last week, I worked out too hard and was sore for days. Today I probably swung too far in the other direction; I don't feel as if I did much of anything. With strength-training, you should feel a little soreness in your muscles afterward, just enough to confirm that you did yourself some good, but not so much that you're afraid to go back to the gym and do it again. The point of strength-training, oddly enough, is to cause a little bit of overstrain injury to some of your muscle fibers, so that your body will replace them with newer, stronger ones. This is a beneficial result for anyone with Type 2 diabetes, not only because it increases your muscle mass (which serves as a sponge for soaking up glucose), but because when muscle tissue is refurbished in this way, the new tissue is more insulin-sensitive than what it replaces.
I did a lot of strength training when I was first diagnosed, because my doctor recommended it. Later, when I developed a problem with my left shoulder (adhesive capsulitis, which can be very painful), I stopped doing strength training because it hurt too much, and because I felt I was doing just fine with running and cycling. Last year, when I got rid of the adhesive capsulitis through a program of physical therapy, I never resumed weight training, but recently I've decided that it's time to start up again. Not only is it good for Type 2 diabetes, it's also good for blood pressure and stress reduction. (For whatever reason, strong people don't stress out as much.) Anyway, I just need to figure out what's the right level of intensity for strength training for me -- not too much, like last week, and not too little, like today.
I heard an interview on the radio today with Andrew Stanton, the director of the Pixar movie WALL-E. He was talking about the film's portrayal of future humans in the film as sedentary space-passengers who look like overfed babies. He said the idea grew out of NASA's research into the problem of "disuse atrophy"; during prolonged exposure to the weightless conditions of space travel, the physical condition of astronauts declines dangerously; bones and muscles waste away. He originally planned to portray the people in the film as blobs of jelly with eyes, but this seemed too grotesque and silly to work in the film. Giant infants seemed the next best thing.
The interesting thing to me about disuse atrophy is the mystery of why it happens at all. Yes, I understand that someone floating around in a spaceship has little need for the bones that support the body's weight, or for the muscles that aid us in our constant struggle against the force of gravity (on earth, even the heart works against gravity, moving blood up from the feet and legs). Still, it seems perverse that the body would actually erode these parts of the body, so that they're no longer available to you when you return to planet earth. Why does the body follow this harsh and simple-minded "use it or lose it" principle?
Apparently, the body has to work out a compromise between two opposing demands: the need to keep the body strong enough to do what it needs to do, and the need to keep the body alive when there's no food available. The compromise it usually follows is to build up those tissues that are being used, and sacrifice those tissues that aren't being used. If you use your muscles a lot, the body concludes that they are important to your survival and it expands them. If you don't use your muscles a lot, the body concludes that they are unimportant to your survival, and it starts "burning" muscle tissue for the chemical energy that is in it. (Protein contains just as much energy as sugar does, so if it's not being put to any other use, the body might as well extract some calories from it.)
Although the use-it-or-lose-it rule does work, in the sense that it keeps organisms alive in the wild, it obviously isn't very well adapted to life in modern society. You don't have to go into earth orbit to experience disuse atrophy. Sedentary living, even in full gravity, has much the same effect.
To a large extent, Type 2 diabetes results from the disconnect between the life we're designed for and the life we live. For people living in a state of nature, the genes for insulin resistance do no harm, and apparently do some good during a famine. For people living in states of California, New York, and Texas, it's a different story. When we're hungry, we don't track buffalo on foot and hunt them with weapons we made ourselves; we buy hamburgers at a drive-through window. Not quite the same thing, physiologically.
Once your muscles and bones have been weakened by disuse atrophy, it can take a lot of work to reverse the process and start building them back up again. The body doesn't "get the message" immediately. You may have to work out for a long time before the body decides that you're serious about this and it had better do something about the altered situation. You have to hang in there and act like you really mean it. Eventually, the body accepts the altered situation and changes its priorities accordingly. The trick is to hang in there long enough for that to happen.
Wednesday, July 9, 2008
|Blood Pressure, Resting Pulse||102/67, 61|
Death is more universal than life; everyone dies but not
Yesterday was a rest day; today was decidedly not. I went running at lunchtime with two of my running buddies at work, and half way through the route one of them proposed a detour onto another route I had never run before.
As my exercise program consists largely of letting athletic friends talk me into stuff, I went along with this suggestion, even though the temperature was 88 degrees and I wasn't sure how much mileage or hill-climbing this change would add to the run I had been prepared to do. It turned out to add about 2 miles, and they were hilly miles. It was a pretty demanding run (the final distance ended up being 6.5 miles), and I completely drained the water bottle I was carrying. Still, it was a good run. My stunningly low blood pressure reading tonight probably reflects the intensity of that mid-day workout. Further good news: my right hip, which I had trouble with in last Friday's race, didn't bother me during the run. I felt good afterwards, except that I couldn't seem to cool down.
Despite taking a cool shower, I returned to my desk wearing a shirt that was so sweat-soaked, I might as well have been wearing it during the run. I didn't have any meetings to attend in the afternoon, and hardly anyone saw me, so it didn't cause me any real embarassment; I just I hate to doing anything (including sitting around) when I'm that sweaty.
It's my good fortune that I have a job with a lot of time flexibility, so I can often make time for a long run at midday. A lot of people with Type 2 aren't so lucky, and they have one hell of a time fitting a daily workout into their schedule. I'm glad that's not an issue for me. Circumstances can change, though; it might become an issue for me later. If it does, I hope I find a good way to get my exercise in; I know I can't stay healthy without it.
From time to time I try to remind myself that I've been comparatively lucky in my diabetes. If a lot of people aren't doing as well as I am, maybe it's because they are facing a tougher challenge than I am. Maybe their diabetes was farther along than mine was at the time of diagnosis, so by the time they started trying to get the situation under control, it had already got very far out of control. Maybe their insulin sensitivity or insulin production had already dropped lower than mine ever did, so they have to work harder than I ever did to get even a small improvement.
Naturally, I would like to think that I've succeeded because I was smarter or more hard-working than others, not because I was lucky. Rich people think that, too, no matter how little they did to earn their wealth or deserve it. Those probably aren't the sort of people I should be choosing as my role models.
Tuesday, July 8, 2008
|Blood Pressure, Resting Pulse||122/74, 55|
Our own physical body possesses a wisdom which we who
inhabit the body lack.
Oh, great: the ADA is hailing a new movement to push pills more aggressively at diabetes patients. "More meds, more quickly" reads the headline. "Instead of starting with lifestyle changes and one drug and adding more later, physicians would treat patients swiftly from the start with multiple drugs, in addition to encouraging diet and fitness changes." This approach was strongly recommended (at the diabetes conference in San Francisco last month) by Dr. Ralph DeFronzo from the University of Texas Health Science Center.
Apparently there is a growing concern that "physicians let patients try diet and exercise alone for too long, when maybe they need oral therapy or insulin".
The anonymous author of the ADA's article adds: "Lifestyle changes do work -- for a few".
For a few? This statement is followed by a revealing quote. "DeFronzo acknowledges the benefits of lifestyle changes. 'If you could get type 2 patients close to an ideal body weight, my guess is you could control 60% of them with just diet and exercise, no medications,' he says."
So now we know what "a few" means! It means 60% of patients. Lifestyle changes do not work for the vast majority of patients (that is, 40%). The handful of patients for whom lifestyle changes are effective (that is, 60%) are too small a minority to be worth taking into account, in serious matters such as this.
Now, I realize that Dr. DeFronzo has his reasons for giving up on lifestyle changes as a viable treatment option. He points out that, although 60% of patients wouldn't need medication if they could just lose enough weight, 80% to 90% of them won't lose the weight. Therefore, lifestyle change "is not the reality".
I also understand Dr. DeFronzo's concern that, if patients who could succeed without medication fail to do what's required, those patients will suffer harm (loss of beta cells in the pancreas, for example) during the interval before they start taking meds.
But let's look at this from another angle. Suppose that, by giving patients the message that lifestyle changes are ineffective except for "a few", and that drug therapy is the only real therapy, you discourage more patients than ever from changing the habits that are making them diabetic. Won't that have some harmful effects on the patient population? I mean, for heaven's sake -- it's not as if diabetes drugs, by themselves, are going to be enough to keep patients safe and healthy. Leading people to expect that they will is irresponsible.
It seems to me that an extreme bias in favor of pharmaceuticals dominates nearly all discussions of diabetes. Sometimes the bias is brazen, as when the 60% of patients who can get by without drugs are described as "a few". Sometimes the bias is subtle, as when a clinical recommendation is made to "treat" patients with drugs while "encouraging" diet and fitness changes (note the enormous difference in priority suggested by those words). The message to patients, overt or coded, is the same: "Let's not kid ourselves. You're not going to get healthy by exercising and losing weight. You might as well sign yourself up for a lifetime of multiple drug dependence, right here and now."
If doctors are going to attack diabetes with multiple drugs from the start, let them at least explain to patients why they feel forced to do this (and also explain, while they're at it, that for a lot of patients this isn't the best solution). I'm afraid that, when newly diagnosed patients emerge from their first consultation with a fistful of prescriptions, they will all be under the impression that this is the best treatment available -- that drugs are essential, and lifestyle changes are optional. The truth is that the lifestyle changes are essential even if you're taking the drugs. That being the case, you might as well do a good job with the lifestyle changes. Who knows? You might turn out to belong to that tiny 60% minority for whom lifestyle changes work.
Maybe what really bothers me about all this is that I'm afraid my own doctor will be forced to prescribe drugs for me which I don't need (and have worked very hard to avoid needing). Considering how bureaucratic medical care has become, it wouldn't surprise me if this happened.
The heat wave continues; it got up to about 97 in the afternoon. It didn't affect me much because this is a rest day for me. I didn't even ride my bike to work. The forecast for tomorrow is 101, and 103 the next day. I'm planning to run at lunchtime tomorrow, but I'm trying to clear my schedule to get a slightly early start, before the heat is at its worst.
The smoke from the various California wildfires is again filling the atmosphere; the air quality was officially "unhealthy" today. I hope it's better tomorrow, though I'm afraid it will be worse. I might have to do my running indoors tomorrow if the air is bad.
Monday, July 7, 2008
|Fasting Glucose||Oops! No data.|
|Blood Pressure, Resting Pulse||130/79, 56|
To be interested in the changing seasons is a happier state
of mind than to be hopelessly in love with spring.
After all these years of doing a daily fasting test, you would think it wouldn't be possible for me to forget to do it, but I managed to forget it this morning. The only explanation I can think of is that I got up earlier than usual today. I was planning to ride my bike to work today, and I wanted to give myself a little extra setup time. Was there enough air in the tires? Did I have my bike helmet? Somehow, focusing on those things made me skip doing the one thing I normally do before I do anything else.
I don't plan to make a habit of this.
Saturday and Sunday I avoided running, to give my hip a chance to heal from whatever was wrong with it during the race on Friday. My workouts on those days were done on stair-climbing machines at the gym. I didn't feel any hip pain during those workouts, and I didn't feel any pain while walking, either. This made me wonder today whether the hip problem, whatever it might have been, was a short-term problem that was already over and done with. So, I thought I would risk going for a run at lunchtime, to see if I could do it without feeling any pain in my hip. It wasn't a terribly long run (4.3 miles) and I didn't try to do it fast.
It turned out that my hip didn't hurt at all. At no point in the run did I feel any of the pain I had been feeling on Friday. So now I'm more puzzled than ever as to what, exactly, was the problem that flared up so dramatically during Friday's race. The way the pain kept appearing and disappearing was especially odd. It almost felt as if my hip was somehow slipping out of its socket, and then slipping back in. Now, I don't see how that could be literally true; I don't think even Superman could walk around on a dislocated hip and not know it. I wonder if the real problem was cramping of a muscle near the hip. If so, that only raises the question of why I was getting cramps there.
All I proved today was that I can run 4.3 miles without hurting, if I don't go too fast. More demanding runs might not go so well. I still need to be cautious about ramping up the intensity.
It was hot today (92 degrees at midday), which made the run a little challenging. I carried a water bottle, and I emptied it, too. To be honest, sometimes I actually like running in the heat, although I would be hard pressed to explain why. Maybe the heavy sweating and the prolonged cooling phase afterwards make me feel as if I've had more of a workout.
Riding the bike home in the heat was a bit of a challenge, but I'm getting to the point where the hill climb is not so hard on me. Not that the climb involves less effort; it just involves less self-pity.
Sunday, July 6, 2008
|Blood Pressure, Resting Pulse||114/71, 62|
As for me, except for an occasional heart attack, I feel as
young as I ever did.
It was hot today, and it's expected to get hotter throughout the week. My inclination would normally be to do a long trail-run on a Sunday, and despite the heat I was tempted to do that today. However, because I'm trying to give my right hip a little time to recover from whatever was making it hurt during the race on Friday, I decided to do another workout on the stair-climber at the gym. I haven't felt even a twinge in that hip since the race (which is odd, because anything that hurts a lot when you run usually hurts at least a little when you walk). Anyway, if I've got a minor injury and it's healing, I'd better give it a break from running so it can heal.
My fasting glucose today was sort of at the top of my normal range. I slept a bit late today, which always raises my fasting test. However, I need to keep in mind that these gym workouts I'm doing are not as long or intense as the sort of thing I do outdoors. I should adjust for that in my meals. The amount of exercise I get determines what I can get away with eating, and I'm not exercising quite as much right now.
In the evening I played at an Irish jam session at Murphy's in Sonoma; that's not exercise, but it relaxes me, so I'm counting it as therapy. My blood pressure reading after I got home from it was nice and low.
Saturday, July 5, 2008
|Blood Pressure, Resting Pulse||120/76, 54|
Boyhood, like measles, is one of those complaints which a
man should catch young and have done with, for when it comes in middle life it
is apt to be serious.
I started my July 4th holiday with the Kenwood Footrace, a hilly 6.2-mile run among the vineyards of the Sonoma Valley. It was my 5th year in a row of running this race. I was hoping to run it faster than I ever had before (or at least to finish in under an hour, which I only managed to do once in the last four years). Instead I ended up turning in my slowest performance to date: 1:01:54. The reason was that, between miles 2 and 3, I had a sudden flare-up of pain in my right hip. It wasn't a cramp exactly, but it was like a cramp in that it would come and go, suddenly and unpredictably, every minute or two. Whenever I tried to put on a burst of speed, my hip protested and forced me to slow down again. The first little burst of pain caught me by surprise; it made me gasp loud enough that the guy running next to me asked if I was all right. He recommended that I take it easy. "There's no hurry" he said, apparently overlooking the fact that we were running a race. Well, I did take it easy, at least a little bit, but I didn't want to disgrace myself entirely, so I ran as fast as I felt I could run without harming myself further.
The pain (or rather the intermittent bursts of pain) faded in the last two miles of the race, and my hip didn't feel sore when I was walking around the rest of the day. I don't know exactly what was going on. My running has often been hampered by mild hip pain in the past, but this year I've been free of it until the past week or two. Maybe I've been doing too much running. I'll have to back off on that a bit, and do some milder workouts -- on gym equipment, or riding a bike. Today I went to the gym and did a workout on the stair-climber; my hip felt fine the whole time. I haven't even felt a twinge all day. I wish I understood hips better; it seems to be a mysterious part of the body.
It's a delicate business, figuring out how to strike the right balance between the harmful effects of exercising too much and the harmful effects of exercising too little. Having spent so much of my life erring on the side of "too little", I am now in the habit of compensating for that by erring on the side of "too much". However, if I get too reckless in that way, I could hurt myself enough that I won't be able to exercise at all. If I let that happen, my system for controlling diabetes without meds will collapse completely.
It certainly was a nice day for a race; it was clear and sunny but (in the morning) comfortably cool. As always, the wine-country landscape made a picture-perfect backdrop. Here's a nearby scene, from later in the day: the lavender garden at the Matanzas Creek winery.
After the race, the day was devoted to tasting and picnicking at the wineries in the area. The strange thing was that, because I got my exercise out of the way so early in the morning (the race started at 7:30 AM), it felt like a rest day to me. That afternoon, while sipping Chardonnay at a picnic table in the shade at Chateau St. Jean, I felt as lazy and self-indulgent as the humans of the future in the new Pixar movie WALL-E.
So far as I know, Pixar wasn't trying to make a satirical movie about Type 2 diabetes, but for many people with Type 2 the movie might cut a little close to the bone. The human characters live in a spaceship that's much like a shopping mall, and they spend all of their time in mobile reclining chairs. They can't walk, or at least they never attempt it. They look like overfed babies. They take their meals in liquid form, from giant soft-drink cups brought to them by robots.
Although the movie tries hard to end on a hopeful note, with the humans staggering onto their own two feet and trying to start things over on a different basis, movie audiences may doubt that they're going to succeed. Doctors in the audience will probably be especially skeptical, having seen how hard it is for people to adopt a new lifestyle even when their survival depends on it. If you have Type 2, you are surely aware that other people have pessimistic expectations about you. Defying those expectations, and turning out better than anyone ever thought you could, can be one hell of a lot of fun. I recommend it highly; it would be worth it for the entertainment value alone.
Thursday, July 3, 2008
|Blood Pressure, Resting Pulse||121/71, 61|
An expert is a person who avoids small error as he sweeps
on to the grand fallacy.
Well, here's the good news that someone somewhere must have been waiting for:
A company with the somewhat misleading name of Oramed Pharmaceuticals is planning to make insulin suppositories. It's the perfect solution for people who... well, actually, I'm not sure what sort of people have been waiting for someone to invent insulin suppositories. But it's clear that this family, at least, can hardly wait.
This kind of advertising photography intrigues me. I'm sure we're supposed to read something into those grins. Did all three of them just get a dose of the new product? Or did two of them just administer it to the other one? The fun-for-the-whole-family aspect of this publicity campaign should have been thought through a little more, if you ask me.
The insulin suppositories are apparently still in early clinical trials, but it's not too early to start thinking about a product name. Maybe "Insuendo". (If sulfonylureas are made in this form, I propose calling them "Up-ureas".)
The air smelled of smoke a bit today, but it looked reasonably clear, so I went for a run at lunchtime. Four miles -- I didn't want to do any more than that because I'm signed up for a race tomorrow morning.
This will be my 5th year of running in the Kenwood 10K race. That's a distance of 6.2 miles. It's a hard race because it involves a lot of hill-climbing. These were my finishing times over the past four years:
In other words, the difference between my best and worst performance in this race was only two and a half minutes. For runners, of course, that's a huge difference. In running, it takes a major increase in perceived effort to go just a little faster.
Not that any of my performances were fast, mind you. In 2005, my best year, I finished 397th out of 607 runners (and the guy who won the race finished in 32:38!). But I was excited because I was able to finish in under an hour, which I hadn't managed to do before. I haven't managed to do it since, either, although I nearly made it last year. I'm hoping I can do better tomorrow.
From the standpoint of diabetes management (which is the only thing that ever could have gotten me involved in running in the first place), it doesn't matter how well I do in tomorrow's race, or any other race. I'd probably get almost as much of a short-term health benefit from running the race if it took me 90 minutes instead of 60. So why take part in races at all, especially as I have zero expectation of winning?
There are several reasons, none of them easy to communicate, and all of them related to the psychology of motivation rather than the physiology of diabetes. Let's just keep it brief and say that taking part in a big organized race (with hundreds of other runners, and sometimes thousands) is exciting, and fun, and motivating. It makes me work a little harder in my daily exercise, so that I'll do a little better in the public events. For a long time I had a conscious goal of doing one organized running or cycling event each month. I no longer make that a schedule-planning issue, but I still end up participating in events about that often, except maybe in the winter.
My exercise program has gradually evolved into a wonderfully simple program: hang around with extremely active people, and go along with almost anything they propose doing. I'm not sure it's a program I'd recommend to beginners at exercise, but once you're in shape enough to have some chance of keeping up with active friends, start letting them talk you into things. That approach can take you very far. My first 10K race, my first 100-mile bike ride, and my first marathon all came about because I allowed someone to talk me into doing them.
Wednesday, July 2, 2008
|Blood Pressure, Resting Pulse||125/76, 54|
An expert is a person who has made all the mistakes that
can be made in a very narrow field.
The air was much clearer today (no smoke at all, really), so I thougt it was safe to do a long run outdoors. It was a tough run (6.5 miles, with extremely steep hills). I felt very good afterwards.
Today at work I went to the employee fitness center's relaxation class, which I looked into because this month is going to be stressful on the job and I'm trying to get better at coping with that. It turned out to be a yoga relaxation session of a type I'm pretty familiar with, but with a lot more spoken instructions to guide us in using mental imagery to relax one part of the body at a time. Unquestionably it was relaxing (I was half-asleep for much of it), and I'm sure my blood pressure was very low at the time. However, it wasn't the sort of thing you can easily adapt to regular office use. I was lying on the floor during it, for one thing, and it lasted a long time. It was supposed to be 45 minutes, but actually ran 65. The woman leading it didn't have a watch (or, if my guess is right, a lot of respect for time as an institution). I knew we were running overtime, but I didn't think it would be in the true spirit of the class to interrupt and demand a time check.
I don't know if I'll attend more sessions of the class. It takes place once a week. During the rest of this busy month I have my doubts that I will be able to attend, especially if it runs 20 minutes over on a routine basis. Anyway, I don't think this is exactly what the cardiologist whose lecture I attended was recommending. He had some kind of brief breathing breaks in mind, which could be performed inconspicuously in the office whenever circumstances required it.
I do like this kind of lengthy, intense relaxation session, but I'm not sure if it has much lasting impact on me. I'm quite capable of building up my stress level again an hour later. I will have to pursue more practical, everyday, short-term methods of reducing stress. (A total personality change might help, but I haven't figured out how to make it happen.)
Tuesday, July 1, 2008
|Blood Pressure, Resting Pulse||129/82, 50|
People find life entirely too
The smoke started coming back a bit today; there are still plenty of wildfires burning, and the wind from the Pacific that was blowing the smoke away from here has stalled a bit. Still, so far the air is not nearly as smoky as it was last week, so I hope it will get no worse.
Today was a rest day; no workout. I give myself one day off exercise each week, but sometimes I feel uncomfortable about that. Especially now, when my blood pressure (which was amazingly low for a little while) is creeping steadily back up. I feel as if I need exercise now more than ever, and I'm asking for trouble if I skip it. The counter-argument is that people who exercise a lot need at least a little rest; their joints and muscles need recovery time, to heal whatever minor damage has been done to them lately. So far this year I've been unusually free of aches and pains, and I shouldn't blow it now by giving myself an over-training injury.
As we head into the tunnel of the software release process at work this month, I'm worried about getting stressed out as the problems and schedule pressures build up. I'm planning to go to a class tomorrow on deep-breathing relaxation exercises. I don't know how much I can actually counteract the effects of the stressful situation I now see heading my way, but probably anything I can do is better than doing nothing, so I'll give it a try.