Monday, March 31, 2008  

Glucose: Fasting, Post-Prandial 85, 86
Weight 185
Blood Pressure, Resting Pulse 127/75, 55

Now, there's a sign that my weekend in the country was a healthy influence: a post-prandial BG of 86! This was taken after lunch. It wasn't a high-carb lunch, but it wasn't exactly low-carb either. I had a big salad, with some starchy elements in it, and a sizeable wheat roll, and soy-milk that tasted pretty sweet. I went for a hilly 4-mile run before lunch, but for me that's pretty standard. 

It's odd that I dropped a few pounds since Thursday, even though I seemingly had plenty to eat while I was at the retreat center over the weekend. Friday, at least, was pretty much a party, and I had plenty of party munchies then. Maybe the fact that I was more active than usual (walking around the place, which was on very hilly terrain, and spending a lot of time working on music rather than listening to it) made a difference.

The thing about exercising is that, whenever we do it, we are trying to make up for the sedentary nature of the rest of our day in one brief, sweaty episode. Maybe it's more important to be up and around and doing things over the course of the day, even if we're not working up a sweat over it. I am often surprised to find that my BG and weight don't seem to get worse on vacation, even though I'm eating a lot of big meals in restaurants; maybe it's simply because I'm not spending so much time sitting in front of a computer when I'm on vaction. I'm up and around.

I still believe that it's important for anyone with Type 2 diabetes to get regular aerobic exercise, because of the cardiac benefits and the increase in insulin senstivity that result from hard exercise. (And I don't give up hard exercise when I go on vacation; I just don't do more of it than I would at home.) Even so, it seems that light exercise -- simply being up and around, and walking from place to place -- have a strong beneficial effect.

Sunday, March 30, 2008  

Glucose: Fasting, Post-Prandial 87, 105
Weight 186
Blood Pressure, Resting Pulse 119/76, 54

I've been off for a few days at a retreat center in the hills of Marin County. Here's a picture I took while wandering around the grounds before breakfast on Saturday:


I was there with a bunch of musicians to rehearse for a series of concerts we'll be doing next month. The concerts will be big, complicated productions requiring considerable rehearsal. Gathering for a weekend in the country, far from routine distractions, made it possible to devote a lot of time and concentration to the task.

It was a much more intense undertaking than the phrase "weekend in the country" tends to suggest. People emerged from the rehearsals feeling exhausted (myself included), as if we'd been chopping wood in there or something. I don't know how to explain that; a fiddle bow doesn't weigh very much, so the actual work involved in sawing away with it cannot be all that great; I suppose the fatigue factor has more to do with intense concentration than with physical effort. We're a big group of mostly amateur musicians, taking on a challenging project, and our music director (the Scottish fiddler Alasdair Fraser) tends to aim pretty high in terms of the musical results he wants to hear. When mostly-amateur performers take on a highly-ambitious project, the preparatory work is not going to be easy on anyone. Still, that work can be very rewarding musically -- so much so that a few musicians who can't participate in the concert because of schedule conflicts decided to participate in the rehearsals anyway. Tonight, I'm home and listening to a very different kind of music (Ravel's "Le Tombeau de Couperin", in the great old Vox recording by Abbey Simon), and I'm appreciating it more than I usually would, because I just spent three days focused intensely on the nuances of musical performance. There is always more going on in music than most listeners, or even most musicians, are ready to hear; the more sensitive you become to music, the more you find in it. I like to take opportunities to spend a stretch of time deeply immersed in music, because I always emerge from those experiences loving music more than ever.

The weekend also involved some serious physical demands, if only because the terrain there was so hilly (as my photograph above only begins to suggest). Merely walking from one's bedroom to the dining hall involved a longish climb. I stayed true to my principles, and despite the rehearsal schedule I managed to squeeze in trail runs each day that I was there. And very tough trails runs they were. In terms of distance covered they were nothing much, but in terms of exhausting climbs up steep grades they were about as hard as trail-running gets.

Anyway, I'm back from the hills and rejoining the everyday world. Seemingly my weekend had a healthy effect rather than an unhealthy one, if my test results are any indication, even though the event was to some degree a party, in addition to everything else it was.

Thursday, March 27, 2008  

Glucose: Fasting, Post-Prandial 87, 116
Weight 188
Blood Pressure, Resting Pulse 120/72, 50

Well, I guess that confirms it pretty clearly -- I'm in weight-gain mode again. It's frustrating, but I'll deal with it. I think that, with my recent focus on post-prandial testing, I focused more on what kind of foods I was eating (and particularly how much starch was in the foods I was eating) without thinking enough about overall calorie intake. My post-prandial BG results were good, and I allowed myself to think that meant I couldn't possibly be eating too much. Not true, evidently!

Today's satisfyingly low post-prandial test result followed, of all things, lunch at a sushi restaurant. It used to be that I couldn't eat at a sushi restaurant without spiking my blood sugar (because of all that sweet rice in the sushi rolls). Now I think I've learned how to eat at a sushi place without having that problem. I did have some sushi with rice, but the meal I ordered was centered mainly around non-starch items: sashimi (which is just fish), miso soup, and salad. I think we all have a carb threshold beyond which a meal is going to push post-prandial BG too high; the trick is to get a rough idea where that threshold is and stay under it. The other people at the table probably had two or three times as much rice as I did, and although none of them are diabetic, they probably pushed their BG levels higher than I did. So at least I've got something under control today. Well, come to think of it, my blood-pressure is looking pretty good lately as well. So I know what I need to work on!

Tomorrow I'm taking a day off work because I'm going to a weekend-long musical event at a country retreat (involving a lot of rehearsal for some concerts coming up in late April). I'm going to go for a long trail-run in the morning, perhaps burning off a little of the fat I seem to have been putting on lately, and then head down to the place in the afternoon. 

Wednesday, March 26, 2008  

Glucose: Fasting, Post-Prandial 87, 102
Weight 187
Blood Pressure, Resting Pulse 120/69, 64

So what's going on with my weight? My post-prandial BG results have been good this week, and you would think they'd go up if I was eating too much. Instead, post-prandial BG has been going down and weight has been going up, which seems a little paradoxical.

Here's a possible explanation: I've done some fairly long workouts lately (and in increasingly warm weather). That means I've probably experienced some fake "weight loss" from perspiration, which concealed the fact that I was adding fat; the workouts also pumped up my insulin sensitivity to the point that I could get a low post-prandial  result even after a meal that was bigger than it ought to be, so it looked as if I hadn't overeaten when in fact I had. Then, yesterday, I took a break from exercise, and also rehydrated myself (I drank a lot of water last night), and so I found out this morning what my true weight is. And if my true weight is rising, it means I've been eating too much. It's a familiar pattern: I lose a few pounds, and instantly start feeling entitled to eat more. It's not exactly a conscious process, but that is what happens. I'd better make it more conscious process, so that I can get better control of it.

I don't think I'm going to get better control of it tomorrow, though: I'm going to a long-delayed lunch with my boss and coworkers, and it's going to be at a sushi restaurant. I doubt I'll have any reason to brag about the results I get after that particular meal. I'm not good at practicing restraint when sushi is before me, but I'll do my best.  

The good blood-pressure reading this evening surprised me greatly. I thought I was stressed out today. Maybe I found a way to combine stress with normal blood pressure. If so, I'd better figure out how I did it -- it could be worth a fortune.

Tuesday, March 25, 2008  

Glucose: Fasting, Post-Prandial 84, 104
Weight 186
Blood Pressure, Resting Pulse 123/70, 48

It just occurred to me that I'm celebrating the one-year anniversary of my victory over a medical problem which caused me a lot of pain last year, and which may be relevant to diabetes. And if it isn't relevant, I will make it seem so. (If a thing doesn't cause diabetes, and it isn't caused by diabetes either, then it's probably a metaphor for diabetes.)

Anyway, the problem I had was adhesive capsulitis, also known as frozen shoulder (the word "frozen" is used here in the sense of "immobilized"). It's an inflammatory condition in the rotator cuff of the shoulder joint, which makes it painful (or impossible) to rotate the arm through its full range of motion. The problem tends to begin as a nagging but tolerable soreness, which you may experience only when you extend your arm in a particular direction. Then, one day, it suddenly flares up into a severe pain which can make it almost impossible to perform the simplest actions (maneuvering your arm into a coat sleeve, say, or simply lifting your arm high enough to put your hand on a steering wheel). The cause of the condition is unclear (it may be a kind of auto-immune response), but the incidence of it is higher in people with diabetes and other degenerative diseases. Supposely 20% of people with diabetes develop adhesive capsulitis, but I don't know what the rate is for people without diabetes, so I don't know what to make of this statistic.

I developed this problem in my left shoulder perhaps four years ago, and most of the time it was only a minor annoyance (I would have trouble pulling clothes out of the dryer, and doing a few other tasks which required a particular rotation of the shoulder, but most of the time it didn't get in my way). A couple of times, though, I had severe flareups, and for several days I would be in so much pain that it was all I could do to dress myself. Sleeping became difficult during these flareups, because I couldn't find a way to lie down that didn't make my arm hurt. I consulted my doctor; he identified the problem, and advised me to treat these flareups with a combination of Ibuprofen and ice-packs until the inflammation subsided. I tried that approach, and it worked well enough. The problem never went away entirely, but I could cope with it.

Then, a little over a year ago, I had a much worse flareup than anything I'd experienced before. I had to take a few days off work and more or less live in a reclining chair for a while (including sleeping in it, because I couldn't find a way to sleep lying in bed). But this time ice and Ibuprofen did nothing for me, and I became really frightened at how crippled I had become. I called my doctor, and the alternatives he presented were cortisone injections and physical therapy. At this point my shoulder hurt so badly (I couldn't even bear for it to be touched) that I think I would have jumped out a window rather than let him jam a needle into it. I chose the physical therapy option.

By the way, this crisis happened the week before I was supposed to run in last year's Napa marathon, and it forced me to drop out of the race after having spend the whole winter training for it. The new sports challenge I was training for was to regain the ability to raise my arm above waist height.

I had heard two things consistently about physical therapy: that it hurts like hell, and that it doesn't work. The reality, at least for me, is that it hurts like and does work. My visits to the physical therapist were always painful, even though I was making steady progress, because he always pushed me at least a little beyond the range of motion that was tolerable for me on a given day. He described adhesive capsulitis as kind of sticky encrustation on surfaces which were supposed to be able to slide smoothly past each other; to get rid of the encrustation you had to force those surfaces to move that way, even though it hurt, until the surfaces were polished clean. He gave me exercises to work on at home, and after a while I was able to give up the office visits and do the rest of the cure myself. I did everything I was supposed to do, and it worked exactly as advertised. Soon my arm not only felt better than it had before the big flareup, it also felt better than it had in years. (And it was great, earlier this month, that I actually did get to run the Napa marathon, and finally lay that piece of unfinished business to rest.)

I had asked the physical therapist what the likely cause of the problem was.  I was afraid he'd tell me it was playing the fiddle, and I even brought the instrument into his office and demonstrated the playing position for him, but he said he didn't think that had anything to do with it. Still, he had no alternative explanation for the problem; as far as he was concerned it just happens to some people.

Another practitioner I went in to see had another view of the matter. This was a company doctor that I was browbeaten into visiting, essentially for the purpose of getting on the record a medical opinion to the effect that this wasn't a work-related injury. I had never said it was a work-related injury, but my company pretty much insisted that I do an official work-injury report and get checked out. And I did, to my regret. I had never before had the experience of having a medical exam in which the doctor was transparently acting as my adversary. He didn't want to listen to anything I said to him, he made faces when I quoted anything the physical therapist had told me, and then he delivered his verdict: diabetes did this to me.

I pointed out that I'm not really diabetic, by any standard definition of the word -- my glucose levels are normal. He wasn't having any of it. He just kept repeating over and over that this is more common in people with diabetes, and he hauled out a book to show me a passage saying as much. The book seemed to be talking about serious degenerative illness, rather than whatever you want to call the medical status I'm now in, but he had his book and he'd been to medical school, and that was that. Diabetes. Case closed. He didn't specifically order me to wear a scarlet letter D on my shirt front when I reported back to the office, but I knew that the report he was writing up would do that for me.

I hated the man. Not that I wanted to file a workman's comp claim, or intended to sue anyone, or even believed that my work necessarily played a role in causing the problem. But I had been pretty much forced to visit him, and now he had written me up as somebody who is not only diabetic, but so diabetic that he's crippled by it. Just the sort of thing I wanted on my record. I still have a fantasy about meeting him somewhere, and demonstrating to him how fully I have recovered my range of arm motion, perhaps by swinging the long dowel I used in my therapy exercises in a smooth overhead arc, bringing it down on his skull.

Well, perhaps I'm not setting quite the right tone there. This was supposed to be a positive story, demonstrating that a serious health problem which medication can't cure can neverthless be eliminated through the patient's actions. Diabetes patients certainly need to hear that message. Unfortunately, even the best diabetes patients, who do everything they're supposed to do and get splendid results, can still become victims of typecasting and blaming by America's great health care prevention industry. That, too, is part of the diabetes story. I wish it weren't, but it is.

Whether we like it or not, the reality of the situation we face with Type 2 diabetes is that we need to be ready to handle it ourselves. We cannot look upon the health care industry as a reliable ally.  We need to solve this. That's the bad news; the good news is that we can.

Monday, March 24, 2008  

Glucose: Fasting, Post-Prandial 93, 120
Weight 185
Blood Pressure, Resting Pulse 125/72, 55

93 is a bit high for a fasting BG, considering that my current test strips seem to read consistently low; if I correct for that, the real value is probably 99, which is the upper limit of "normal". I'll have to watch that one. On the other hand, the post-prandial result of 120 is reassuring.

I've been a pretty good boy lately, so if my fasting tests are going up, it's probably not because I've been eating too much or exercising too little. Certainly not the latter, come to think of it -- I've been exercising quite a bit recently. (I even managed to fit in a 5.5 mile run today). It might just be that I'm too tense, or that I'm not getting enough sleep. Examine any week of my life closely and you will probably find a surplus of tension and a shortage of sleep; still, even though that is my nature, I suppose I'm worse at some times than others, and maybe I'm a bit worse than usual right now. I may have too many things scheduled. A looming software-release deadline at work, a night-class, preparations for the big concerts next month, my constant hobby of diabetes management, and my new hobby of website management. Still, I think it's often better to have too much scheduled than to have too little. That creepy phenomenon of guys retiring and then dropping dead must have some explanation. (I'm not arguing against retirement, just arguing against an approach to retirement that leaves you with time on your hands. People should be busy. Some people should, anyway, and I know I'm one of them.)

Making dinner tonight taught me a valuable lesson, which I offer to you free of charge: if you buy an orange chile pepper at a vegetable stand, and you think at first that it might be one of those super-hot Habanero chiles, but then you decide that it can't be, because it's too big... think again. I ate the spiciest dinner of my life tonight. I actually like fiery dishes as a rule, but tonight I pushed myself outside the comfort zone. Most people I know wouldn't have been able to eat it at all. Of course, it may be that the reason I like spicy foods is that eating them -- especially when you are eating foods that are too spicy for comfort -- releases endorphins. I usually try to get my endorphins from exercise, and I'm sure I did exactly that today, but once you're hooked on endorphins you always appreciate getting a little extra dose of them with your dinner.  

Sunday, March 23, 2008  

Glucose: Fasting, Post-Prandial 81, 106
Weight 185
Blood Pressure, Resting Pulse 119/73, 52

My fasting BG was down 10 points from yesterday, but I think that's just because I got up earlier and tested earlier today than yesterday (7 AM instead of 9 AM).

My post-prandial test (which I took after a substantial Easter brunch) was also low -- not because it was a light meal, which it wasn't, but because it was heavier on fat and protein than on carbohydrate. Also, I did a lot of running this week (including 8.3 miles yesterday), so my insulin sensitivity was probably pumped up to a pretty high level.

For once, I hit the blood-pressure gold standard! I'm almost never below 120/80. Actually, it's the systolic 120 reading that I can't quite achieve; the diastolic 80 is often within my grasp. I don't know why I have more trouble with one than the other, or what it means if your systolic is elevated and your disastolic is not.

Today was supposed to be my rest day, but in the afternoon I did some yard work, and for some reason that energized me instead of making me tired, maybe because the weather was even more beautiful today than yesterday. I ended up going for a hike in the hills, taking pictures of the trees and meadows glowing in the sunset light.

The hike was about 5 miles, and I did it pretty fast in order to get back to my car before it got really dark, so I guess this wasn't a rest day at all. Maybe I'll make Tuesday my rest day, as my meeting schedule is so bad on Tuesdays anyway that I probably won't have time to run. 

Saturday, March 22, 2008  

Glucose: Fasting, Post-Prandial 91, 85
Weight 184
Blood Pressure, Resting Pulse 125/73, 59

A beautiful spring day here in Santa Rosa...

 ...sunny, clear, calm, and about 72 degrees. I knew I was going to want to take the opportunity to do a substantial trail run today -- at this point in my life I feel like a total loser if it's a beautiful day and I'm not outdoors and active, taking advantage of the opportunity.

However, I went to the farmer's market first.  I had picked up some really good vegetables from one particular vendor (Orchard Farms) two weeks ago, and I wanted to try my luck with them again. Once again, I pretty much cleaned out their modest supply of new Brussels sprouts, but they were so good last time that had to get some more. It's remarkable how much better vegetables can taste when they're in season and they're just picked at a farm in your own county. I made a great vegetable stew for dinner from some of the stuff I bought at that market today. Of course, when you're making use of fresh produce, you have to be willing to do the necessary food preparation, and although the peeling and chopping doesn't really take all that long, I am lazy enough and impatient enough to be tempted to reach for the convenience foods instead. It's a little battle I have to fight with myself all the time, to try to get enough fruits and vegetables into my diet. It's so much easier to eat packaged, processed foods, with the prep work done by anonymous strangers. The only minor problem there is that those anonymous strangers don't care if I die young, and their products reflect that reality.

I finally started my trail run around 2 PM, at Annadel State Park, a great local resource for outdoor exercise. The route I chose is an old favorite, with a distance of 8.3 miles. I had the good luck of not encountering any horses on the trails this time -- I have no problem sharing the trails with runners, hikers, and mountain-bikers, but getting safely around a horse on a narrow trail is a problem that tends to make me nervous, and it was nice not to have to deal with it.

The park is extremely hilly, and there is no such thing as an easy route through it, so I worked pretty hard today. Still, it didn't really seem like work. For me, it's so beautiful to get out in the woods and meadows, out of sight of civilization (even though I know a sizeable town is just over the next hill) that it seems like nothing but fun to be out there. For some people it wouldn't be like that, but my advice to everyone is to find some way to exercise that seems like fun. Your idea of fun exercise might be ballroom dancing or judo or wrestling alligators, or any of hundred activities it would never occur to me to try, but find something.

So why was my post-prandial BG lower than my fasting BG today? That's not too hard to explain. My fasting result was slightly higher than usual today because I slept a little late and tested an hour later than I normally do. My post-prandial BG was much lower than usual because my vegetable-stew dinner was pretty low in carbohydrates, and because I'd done a challenging run earlier that day.

Tomorrow (Easter Sunday) is going to be a rest day, and I expect it's going to be a high-calorie day as well, so it won't surprise me if my numbers are not so stellar tomorrow or the next day. I'm not planning to eat any chocolate bunnies though, so maybe I won't do myself too much harm.

Friday, March 21, 2008  

Glucose: Fasting, Post-Prandial 89, 121
Weight 185
Blood Pressure, Resting Pulse 125/71, 62

I finally managed to squeeze a 5-mile run into the midday break. For three weeks now, 4-milers were the best I could do. It helped that today was Good Friday (and also the Friday before spring break at the local schools), which meant that the office population was way down, and that those who worked today were not scheduling a lot of ad hoc meetings. Maybe I should have made the run longer than that. Tomorrow I will see if I can make time in my day for a longish trail-run -- about 8 miles. The weather is supposed to be nice tomorrow. I think I'll go in the afternoon, after it warms up a bit. This is a great time for trail-running -- the fields and hills are still green from the winter rain, but it's fairly warm in the afternoons. It's when I get out into the woods and fields that I really enjoy exercise. For me, exercise with a view is fun, and exercise without a view is work.

Thursday, March 20, 2008  

Glucose: Fasting, Post-Prandial 89, 123
Weight 185
Blood Pressure, Resting Pulse 125/74, 51

Another difficult day in terms of my exercise schedule; I managed to fit in a 4-mile run, but 5 miles wasn't practical. Maybe tomorrow.

It might seem as if, when I was training for the marathon, I always found some way or other to fit a big long training-run into my day -- but now that I no longer have the marathon hanging over me, I'm suddenly whining, day after day, about not having enough time for exercise. Well, there might be a tiny particle of truth in that, but for the most part things have changed simply because we're getting close to a project deadline at work, and there's a lot going on. Releasing a new software product is a very complicated business, and things get busy during the closing weeks. Suddenly there are more meetings being called, to solve problems that have come to light during QA testing.

Maybe it's time for me to talk about my blood-pressure test results, which in recent weeks I have started to post here. I should probably warn you not to take them entirely at face-value. Not that I'm lying about the results I'm getting, but on the other hand I'm mighty careful about when I take the measurement, and that's why they are as good as they are. They're not perfect anyway; the gold standard is supposed to be <120/80, and I never quite make that. But my results haven't been bad, either, and if they look a lot better than yours, keep in mind that you have grounds for taking a skeptical view of my results.

I usually measure my blood pressure when I'm sitting at my computer, writing these blog entries, and I usually don't take the reading until I have been sitting down here for a good long while, and have had a chance to get pretty relaxed. In other words, I'm as calm as I will be all day. I have to assume that my blood pressure is higher when I'm at work, or driving my car, or walking around. It is certainly higher when I'm at the doctor's office. I almost never get as good a reading there as I do at home. Once (two visits ago) I did, but usually my readings in the doctor's office are higher. At least they aren't so high that my doctor has felt the need to put me back on medication for it. I was taking Monopril (an ACE inhibitor) for years, but after I started my exercise program my doctor allowed me to go off it.

I certainly suffer from "white-coat syndrome" -- that spike in blood pressure that occurs in the doctor's office, simply because the patient is in the doctor's office. Doctors, who tend to regard a doctor's office as an ordinary and even rather boring environment, have no notion of the anxiety level that patients experience merely by being there. An actor or musician making a debut on Broadway or at Carnegie Hall probably doesn't experience any more pressure than a patient showing up for an annual physical. Like them, the patient is submitting himself to be judged (and probably found wanting).

Part of my problem in the doctor's office is that I simultaneously don't know, and do know, what to expect there. I don't know what lab results my doctor is going to report, but I know that he's eventually going to proceed to the rubber-glove portion of the festivities-- and why the hell can't he test my blood pressure after he's done with that?

Apparently the answer is that your blood-pressure reading should be taken when you're under stress. The idea is that any patient can get a good result when he's just sitting quietly at a computer, sipping Pinot Gris. What matters is the kind of result he gets while waiting for a doctor to show him a lab report which will tell him if he's going to live or die. What matters is the kind of systolic and diastolic readings he gets while he waits for the chat phase to end and the prostate-prodding phase to begin. If your blood pressure is high when you're stressed, it doesn't matter how low it gets when you're not stressed.

I have learned to hate hearing about blood pressure, and I try not to think about it very much. A very immature attitude, you may be thinking, and you are surely right, but I can't have a mature attitude about everything.

I am doing everything I can think of to keep my blood pressure down, and if the results (at least in the examining room) are not perfect, at least I'm doing my best. My best will have to be good enough!

Wednesday, March 19, 2008  

Glucose: Fasting, Post-Prandial 82, 120 & 157
Weight 186
Blood Pressure, Resting Pulse 123/73, 53

Post-prandial BG: THE REMATCH!

Two weeks ago, on March 5th, while having an ale-fueled, high-carb dinner with two friends at a brewpub, I recklessly agreed to do a post-prandial test in front of them, and was shocked to see that the result was 180. Since then I have been doing a lot of post-prandial testing, and on the whole the results have been very good (only 120 after lunch today, for example). However, in the interest of science, I repeated the experiment tonight. Same friends, same brewpub, same dinner (a focaccia dish that was like a mini-pizza), same drink (two pints of "Pliny the Elder", a strong ale). This time the result was 157 -- certainly better than 180, but my post-prandial target is supposed to be <150 (and given that my current test strips seem to be biased to read about 6 points low, the true result was probably closer to 163). The non-diabetic friend at the table tested a little higher than that. I guess what I conclude from all this is that combining a high-carb dinner with strong ale is likely to elevate anybody's post-prandial BG, and that I shouldn't do it very often.

My schedule turned out to be chaotic today, and I couldn't go running at my usual time, but I did manage to squeeze in a 4-mile run. I'll try again for a five-miler tomorrow; maybe I'll have better luck this time.

Tuesday, March 18, 2008  

Glucose: Fasting, Post-Prandial 87, 108
Weight 186
Blood Pressure, Resting Pulse 127/75, 56

Prepare to be shocked. Nicholas Bakalar in the New York Times reports: "Living past 90, and living well, may be more than a matter of good genes and good luck. Five behaviors in elderly men are associated not only with living into extreme old age, a recent study has found, but also with good health and independent functioning." And what are these five behaviors which are more common in men who live past 90? "The behaviors are abstaining from smoking, weight management, blood pressure control, regular exercise and avoiding diabetes. The study reports that all are significantly correlated with healthy survival after 90."

Well, can you beat that? Fat, sedentary, diabetic guys who smoke and have high blood pressure tend to be less likely to stay healthy and live past 90 than fit, active, non-smoking guys whose blood pressure and blood sugar are normal. Who knew?

I think that, if the researchers had looked hard enough, they might have found several other behaviors that are more common among men who live past 90. "Not eating glass" for example. (Was that one even looked at? If not, why not?) And let's not forget such prudent behaviors as "not using the same rented garage to manufacture illegal fireworks and methamphetamine at the same time". Also, if not developing diabetes, and not developing high blood pressure, fall into the category of behaviors, surely "not getting cancer" should have made the list of longevity-promoting activities to put on one's to-do list.

I guess the reason that scientists feel it is necessary to engage in research that can only confirm the obvious is that Americans feel pretty comfortable denying the obvious. The idea that bad habits such as smoking, overeating, and shunning exercise are bad for one's health is often regarded as a "fashionable" notion, based on no real evidence. Hence the need to gather and publicize unsurprising facts about the relative longevity of fat people who smoke and thin people who don't.

I have to admit that, after all this time, I still felt a little spasm of dread at seeing the behavior known as having diabetes presented as the destroyer of longevity. When will I learn? As always in these cases, I had to give myself a little pep talk. Diabetes means chronic hyperglycemia, and I don't have that. My glucose levels are usually well within normal bounds. If I keep it that way, I am indeed "avoiding diabetes" by any reasonable definition. I'm also exercising, controlling my weight, controlling my blood pressure, and not smoking. So I guess that means I have a fair shot at getting old (which in turn means that I should have made better investment choices).

My post-prandial test today was, once more, surprisingly low. It followed a dinner which seemed high-carb to me (a curry with a lot of potato in it, and some bread as well). One unusual detail was that, because of an awkward schedule today, I ate dinner and immediately went to the gym for a workout; the exercise occurred during the hour between the meal and the post-prandial test. Probably the result would have been higher if I hadn't exercised while I was digesting. I normally don't like to exercise immediately after eating, but I had to squeeze the dinner, the workout, and the blood test into the interval between coming home from work and going to a concert rehearsal. When you're trying to fit exercise (and other overhead associated with diabetes management) into your daily schedule, you do whatever you can think of to make it all work. Tomorrow, though, I'm hoping I can get in a fairly long run at lunchtime -- at least 5 miles. The weather forecast says there's a good chance of rain tomrrow, though -- which won't stop me from running, but might make me decide against running 5 miles.

Monday, March 17, 2008 (Saint Patrick's Day)

Glucose: Fasting, Post-Prandial 96, 89
Weight 187
Blood Pressure, Resting Pulse 122/70, 52

Well, that's strange -- my fasting test was unusually high, and my post-prandial test was unusually low -- in fact, lower than the fasting test! What does all that mean? Probably what it means is that BG is an erratic phenomenon, and every time I start to think I can predict it, I'm in for some kind of weird surprise.

That low post-prandial test did not follow a low-carb meal, by the way. It was a dish of stir-fried organic vegetables, mostly greens, but it was served over a generous plate of rice pilaf. A chef at the company cafeteria likes to buy vegetables at the farmer's markets on the weekends and then do a dish like this on Monday. I thought it was great, but because of the rice I thought my post-prandial BG might be over 150. Instead it was under 90. You never can tell.

I ate lunch just after a 4-mile run, and I'd done a 7.5 mile run the day before, so maybe the exercise had ramped up my insulin sensitivity. I also had a surprisingly low BG after a big dinner on Saturday (103). However, if my insulin sensitivity is so good right now, how come my fasting test got higher instead of lower?

A surprisingly high fasting test, occurring at a time when other test results are low, could be an example of the Somogyi effect (named after Michael Somogyi, a biochemistry professor who described the phenomenon in a 1938 paper). It is also called "rebound hyperglycemia". It refers to a reaction in which the body overcompensates for an episode of low blood sugar (typically occuring between midnight and dawn), by releasing too much stored sugar into the bloodstream, resulting in an elevated BG test in the morning.

My slightly elevated BG this morning could have been caused by this kind of rebound effect. It could also have been caused by my eating too much on the weekend; let's not forget that possibility. After the race yesterday morning in San Francisco, I had an Irish breakfast at Fiddler's Green -- which completely overturned the vegetarian diet I'd been eating lately. Maybe getting a subtantial dose of animal fat, after avoiding it lately, threw my metabolism off. Or maybe I just had too much food, regardless of what sort of food it was. Whatever raised my fasting test this morning, it certainly seemed to vanish by the time I was digesting lunch. I say it again: BG is erratic.

Today is Saint Patrick's Day, so as an Irish fiddler it was more or less my duty to go out in public somewhere and play this evening. I ended up playing with two other musicians at the Redwood Cafe in Cotati. Fortunately it was not the usual type of scene associated with this holiday in America -- nobody was rowdy or drunk; we had a modest but appreciate audience, and they didn't request any dumb fake Irish songs. It was nice. Every Saint Patrick's Day should be like this.

Sunday, March 16, 2008

Glucose: Fasting, Post-Prandial 87, 125
Weight 187
Blood Pressure, Resting Pulse 120/75, 58

The Golden Gate Bridge run was great. The weather was stormy yesterday (in the afternoon I was caught outdoors in a hailstorm, and the hailstones were big enough to hurt), but this morning it was sunny and very clear. When the race started it was cool but not too cold, and the winds were light. The views were splendid, of course. It looked as if you could see every blade of grass on Alcatraz. This is a picture looking back from the finish-line area in front of Ghirardelli Square, with the bridge and the Marin headlands in the distance. It's a little startling to look back at the start and realize how much distance you covered in a short time, on foot.

The bridge run is an annual event, but I hadn't done it in a long time, and it was a much bigger event than I had remembered -- huge numbers of runners (about 5,000 of them, according to one press release I saw). Not all of them were serious runners, though -- there was a lot of walking going on, too. People are starting to let go of the idea that athletic events are only for very athletic people. As a result, footraces and bike rallies are becoming hugely popular. This sometimes irritates the serious competitors, but not for the snobbish reasons which the not-so-serious competitors imagine. The problem is that, when you have hundreds or thousands of people running in narrow space (such as the bike path across the Golden Gate Bridge), the people who are going to be running slow, or even stopping to walk, need to keep themselve far enough to the right that faster people can get around them. It's not a difficult concept to grasp, but a lot of people have no notion of it, and some of them even seem to enjoy being in the way (or at least not to care if they are). Some of them even walk side by side with their friends, blocking anyone from passing them safely. I think it's a great thing for non-athletes to challenge themselves to take part in these events, and that's why I wish they would learn how to do it in a more considerate way, because the resentment they are stirring up is bad for everyone. Also, sooner or later they are going to get tossed off that bridge.

I felt good during the run, but I didn't really treat it as a race -- just a long fun jog in a scenic location. I'm long since recovered from the marathon in every other way; still, I'm not really in the mood to push myself. For now I want to ratchet down my exercise program to something I can do fairly easily, and enjoy. I've got other claims on my "spare" time, including a night class and rehearsals for a big concert next month.

I had a great deal of good food and drink in San Francisco -- too much so, if the uptick in my weight is any indication. BG is still okay, however, and I got a good blood pressure reading tonight. All the same, if I let my weight get out of control those other things will get out of control eventually, so I'd better cut the calories back down tomorrow.

Saturday, March 15, 2008

Glucose: Fasting, Post-Prandial 82, 126
Weight 185
Blood Pressure, Resting Pulse 123/72, 54

Pretty good results, especially considering that I went to a party last night. Maybe it will catch up to me later, though. That's an aspect of physiology I would like to know more about -- how much of delayed impact can a given day's indulgence have?  Does it ever happen that it takes the body more than a day to finish processing what it has taken in?

I have almost no time to write today, though, so I'll have to meditate on that one later. I just hope that, if I've taken in too much, I can burn up a lot of it in the Golden Gate Bridge run tomorrow morning.

Friday, March 14, 2008

Glucose: Fasting, Post-Prandial 87, 129
Weight 186
Blood Pressure, Resting Pulse 130/77, 48

The weather was supposed to be rainy today, but it seemed nice in the morning -- I figured I could run at lunchtime with no worries. Of course, once we got 2 miles from the office it started raining on us. But it was a fairly light rain, so it really wasn't that much of a hardship. I'm sure there are runners living in the midwest who would be delighted to experience such mild weather in mid-March as the "bad" weather we had today.

I went to a concert tonight, and a party afterwards (a lot of us in the audience knew the musicians onstage, and we all got together afterwards.) Many fattening foods were on offer. I tried not to overindulge, but eating anything at all late at night is something of an overindulgence. On the other hand, my doctor once told me that he wouldn't want me to come home from a big social celebration and think "I could have enjoyed myself tonight, but I couldn't, because I have this disease...". That's how diabetic burnout gets started. So, I don't play the diabetes martyr at parties. I imagine my BG and weight may rise a bit tomorrow. Okay, I'll cope. It's late now and I need to get to sleep.

Thursday, March 13, 2008

Glucose: Fasting, Post-Prandial 81, 115
Weight 186
Blood Pressure, Resting Pulse 129/72, 57

It rained last night, and rain was forecast for today, so I was thinking my lunchtime run might be a trying experience. Not at all -- the clouds started breaking up just when I got outside, and the air had that extra-clean quality that it only has just after a rain. The sky was a deep blue with a few brilliant white cumulus clouds; the wet grass and trees were glittering in the sunglight. One of the reasons I prefer exercising outdoors is that it keeps me in touch with these sensations. Most of the time we're so cut off from the natural environment that we don't even know if it's a beautiful day or not.

Okay, my blood pressure was 122/74 yesterday and 129/72 today. So what does it mean when your systolic pressure goes up and your diastolic pressure goes down?  Maybe the measurement process isn't precise enough for this question to be meaningful when you're comparing readings that aren't all that far apart. Still, it seems odd that my pressure could be both higher during a pulse and lower between pulses than was the case yesterday. I was a bit keyed up because I'd had to take a mid-term exam for a computer class earlier in the evening. Could that kind of tension have the effect of making systolic go up even though diastolic was going down? It's too bad that a blood pressure test couldn't consist of just one number, instead of two. I'm sorry if this sounds fussy, but it seems to me that if doctors are going to ask us to get control of two numbers that vary independently, they ought to be able to tell us more about the significance of each number, and what affects each of them.

My post-prandial blood tests continue to be low lately. I think this can't simply be because I'm eating more carefully now. I wonder if the high result I got last Wednesday, which scared me into doing post-prandial testing again, happened for other reasons. It was just after the marathon, and my metabolism may not have recovered yet. The main evidence I see in favor of that is that my post-prandial tests declined gradually for the rest of that week and then settled into the normal range. Of course, I can easily test this hypothesis by going back to the brewpub next Wednesday and repeating the experiment with the same kind of food and drink that pushed me up to 180 last time. If I do significantly better this time, it will make it seem more likely that my system was out of whack last time.

I've signed up for a footrace on Sunday, but a vastly shorter one than the marathon. It's a race from Marin, across the Golden Gate Bridge, to Aquatic Park in San Francisco. So far, the forecast of good weather on Sunday is holding firm. Still, I'm planning to dress warmly for it. I did it once before, and I remember how cold it was during the time we were on the bridge and exposed to a fierce wind off the ocean. It will be warmer after that, but I'll deal with it.  This picture shows part of the route, looking south from Marin.

Wednesday, March 12, 2008

Glucose: Fasting, Post-Prandial 84, 117
Weight 186
Blood Pressure, Resting Pulse 122/74, 51

I thought I had an open time slot at noon to go running, but a meeting that should have happened earlier in the day was delayed, so my window of opportunity closed. I always need to have fallback plans to make sure I get my exercise in; today's fallback plan was to go to the gym in the evening.

There was a time, of course, when I would not have had a fallback plan in readiness. When you first start an exercise program, your natural tendency is to react to any and every schedule difficulty by saying, "Aw shucks. I guess I can't work out today after all. Oh well, better luck next time!" Funny thing is, that's not how you react when a schedule problem interferes with, say, lunch. You might have to allow lunch to be delayed, and it might not end up being the same kind of lunch you originally had in mind -- but don't you usually find some way or other to get those missing lunchtime calories into your body? You aren't going to write those calories off -- even if you have to wait until suppertime till you eat, you're going to make it an extra-large supper to compensate for what you missed earlier. Eventually you learn that you have to do the same thing in terms of exercise. It's hard to fit exercise into your schedule, especially when you're new at it, but that doesn't mean you can decide you'll only do it if you've got time on your hands, any more than you would decide you'll only eat or bathe if you've got time on your hands.

Anyway, I went to the gym and did a 30 minute workout on a cardio machine (one of the kind that works the upper and lower body at the same time). That's kind of a minimal workout, but today I didn't have time for more than the minimum. Tomorrow I'm hoping to get in a substantial run at lunch.

Today's blood pressure reading is pretty close to the target value of 120/80. I measured it after I got home from the gym, but after a long enough wait to be settled down. The pulse reading of 51 is nice and slow -- not quite in the blue whale range, but slow. (Blue whales get down to about 10 beats per minute, but if I had a heart the size of a Volkswagen I could probaby do that too.)

Well, I'm supposed to be studying for a mid-term exam in my computer class tonight, so I'd better wrap this up.

Tuesday, March 11, 2008

Glucose: Fasting, Post-Prandial 82, 114
Weight 186
Blood Pressure, Resting Pulse 125/79, 60

The schedule at work was a bit difficult today, but between two meetings I managed to sneak in a 4-mile run. Good weather for running: sunny but slightly cool. I felt pretty energetic this time.

That post-prandial test was after a rather light dinner -- a mixture of vegetables I had bought at the farmer's market over the weekend, plus whole-wheat bread. The vegetables were great -- can it be that I'm finally learning how to cook vegetables properly? I thought I'd had some kind of extraordinary good luck in what I chose to buy this time, but maybe the trick is not so much buying the right vegetables as learning how not to ruin them in the kitchen.

Overdoing things is an old weakness of mine -- as a child, I thought a drawing was unfinished if there were any crayons in the box that I hadn't used. Carrying on the tradition, I still tend to commit three culinary sins against vegetables:

Underlying all this, of course, is a lack of trust in the idea that vegetables taste good in and of themselves. I doubt I'm the only who tends to think of vegetable cookery as a kind of rescue operation, in which the goal is to save the vegetables from themselves, by resorting to any kind of trickery might that might make them seem palatable. The result (like a drawing in which no crayon goes unused) tends to be a bit of a mess.

Lately I've been trying to simplify things. My current process is: saute some onions or leeks or shallots in a little olive oil, add the vegetables that need more cooking (Brussels sprouts, say), and add a little bit of broth to cook them in. After a while, start adding the vegetables that need less cooking (tomatoes, say), add a little more broth, add some spices, and cover to cook a little longer. Finally, add some greens and cover just long enough to wilt them. If you do this right, the vegetables are cooked enough that they don't taste raw, but they still have plenty of color, texture, and flavor. The result, at least in my view, is a satisfying dish that gives you a chance to appreciate the flavors of the vegetables themselves (and not the flavor of some intense sauce you've poured all over them).

And what do you know -- I'm finding that, if you allow vegetables to taste like themselves, they taste really good. At least, the ones I've been getting at the farmer's market do. Buying locally grown food, which is in season and hasn't been shipped long distances to reach you, is a good way to discover what real food really tastes like. I have heard it claimed lately that doing this is "elitist" (that word has been used in criticizing Michael Pollan's book In Defense Of Food, which advocates eating locally grown produce for health reasons). I'm not sure why it's elitist to patronize the farmer's market; if the issue is simply that you could have bought food cheaper at the supermarket, then eating at restaurants is surely more elitist than buying local tomatoes. Whether our budgets are large or small, we all have to decide how to prioritize our spending -- where to cut costs, and where to splurge. There are a lot stupider things to spend money on than fresh fruits and vegetables, especially when you know who grew those vegetables (and where, and how).

Monday, March 10, 2008

Glucose: Fasting, Post-Prandial 84, 108
Weight 186
Blood Pressure, Resting Pulse 131/82, 53

Format change: I decided that if I was going to disclose some of my daily test results, I might as well go ahead and reveal the others. We'll see if I have the nerve to continue doing this through thick and thin. Up to this point in life I haven't been in the habit of announcing my weight fluctuations in public. Just how public I'm being now is debatable; this site is still so new that hardly anyone knows about it. Still, in principle anybody could see it. Maybe the pressure of going public will help me make the right decisions, at those dozen or so moments in the day when we make little choices that have big consequences when they're all added up.

Both the glucose tests, and not just the fasting one, look good today. Blood pressure is not too bad, but not too good either -- the standards have becomes stricter in recent years and we're supposed to aim to keep it under 120/80. (Not only that, the experts are trying to downplay the idea that the first number is less important than the second; the official story now is that they both matter.)

My resting pulse is excellent (that's clearly a benefit of doing endurance exercise; until I started doing long runs and bike rides, my resting pulse was considerbly higher).

Considering that I weighed 250 pound at the time of diagnosis, 186 seems pretty light. However, it's not by any means ideal. For my height I should be at about 170. If I had got myself down to 170, I imagine the marathon would have been a lot easier for me to handle, and I would have had a better finishing time.

Sunday, March 9, 2008 -- FBG 74*

Another beautiful day. I did a trail run at the local state park -- but not a very long one. Most of the routes I run in that park are about 8 miles long; this one was less than 5 miles. It was quite steep, though, so it was a pretty hard workout. I went up a particularly difficult trail, remembering how punishing the experience of climbing it had seemed to me the first time I tried it, three or four years ago. It's still hard work running up that slope, and I don't do it very fast, but it's no longer a scary ordeal for me. When I run it these days, I'm not thinking "I'm going to die! I'm going to die!"; instead, I'm usually thinking something like "Is there anything I should pick up at Oliver's Market on the way home?". It's amazing what you can get comfortable with, if you work on it.

The park was a popular destination today. Large numbers of people were on the trails -- hiking, running, horseback riding, mountain biking. When I have the trails largely to myself, I enjoy the solitude, but I also enjoy seeing the place well-populated now and then, on weekends when the weather is beautiful and people feel the impulse to get outdoors and get active.

Now that Daylight Saving Time has started (and doesn't it feel weird to be starting it this early?), I'll be able to get back to my summertime routine of going to that park after work on Wednesdays for evening trail-runs. Sunset is my favorite time to be there, and Wednesday evenings are when some of my coworkers go there to run or ride mountain bikes.

I had a "Middle East" dinner with pita bread, felafel, hummus, etc. It was definitely a meal high in carbohydrate, but my post-prandial BG was only 115, so I must have been processing the carbs pretty well. Also, the meal contained a lot of fiber and fat to moderate the impact of the carbs. Whatever carbohydrate is present in a meal will have a bigger impact on your BG if it isn't accompanied by fiber and fat. That's why "fat-free" foods are not always a great thing for someone with diabetes; often "fat-free" is synonymous with "pure carb". (Next time you're in the grocery store, pick up a package of non-fat yogurt, and read the label; it is not unusual for a product of that kind to contain 28 grams of sugar -- which is more than 6 teaspoons of the stuff!)

Update on my test strips...

When I reported to the manufacturer of my glucose meter that the batch of test strips I bought last month seems to read about 6 points low, they sent me some test solution (with some other test strips) to check out the meter. The way this works is that you use a drop of the test solution, as if it were blood, and measure it; the test strips have a number range printed on the container, stating what results would be considered acceptably accurate when the strips are used in connection with the test solution.

So I did the testing, and here's what I found: evaluated according to the rules that were presented to me, the meter is acceptably accurate when used with either batch of test strips. However, I get lower results using my test strips which I thought were reading low -- and furthermore, the number ranges for the two batches are different! The test strips which I though were reading low have an acceptable range of 90 to 119. The new test strips they sent me have an acceptable range of 96 to 128.

Well, what do you know! The test strips which I thought were reading 6 points low have a range which starts at 90 instead of 96!

What kind of game are they playing here? Clearly, there is something wrong with a measurement process in which two batches of test strips, measuring the same test solution on the same meter, give different readings -- but we're supposed to consider this acceptable, because the label on the package tells us to expect it!

Why did they waste my time with this? I know, from working in the measurement industry myself, that equipment makers sometimes play a lot of complicated games with specifications, but it would have saved me and them a lot of time if, when I was on the phone with them, they had given honesty a try. If what they're doing is legal, they don't need to lie to me about it. What a bunch of weasels!

Saturday, March 8, 2008 -- FBG 79*

All arguments against living in a place as expensive as California collapse in the face of one fact: today, when the rest of the country is still coping with winter storms, the weather here is like this:

Which makes it a lot easier, if you live here, to get outside and exercise (like this family I saw). Today was more or less a rest day, but I did go for a short but hilly hike in Napa Valley State Park near Calistoga. The hills are green and wildflowers are appearing. That was in the afternoon; this morning I went to the farmer's market and bought some vegetables. 

Lately I'm trying to buy unfamiliar varieties when I go to farmer's markets; today my purchases included some Jerusalem artichokes. Baked, they're a lot like potatoes, but with a crisper texture. I don't know why I've never had them before, but maybe it's because they don't have the most promising appearance. If you saw them in a movie, and the camera zoomed in on them for a lingering closeup, you would expect a menacing alien species to hatch right out of them and leap onto somebody's face. They're not really artichokes; they're tubers from a kind of sunflower plant, and for that reason they are also called sunchokes. Although sunchokes are starchy, the type of starch they contain, which is called inulin (not insulin, inulin) is considered by some people to be a superior kind of starch for people with diabetes, because it breaks down into fructose rather than glucose, and a second stage of digestion is required to convert the frutcose to glucose. The idea is that this more cumbersome digestive process slows everything down, so that you don't get a steep glucose spike when you digest sunchokes.

I don't know that I find this digestive theory entirely convincing, but when I made a vegetable stew with the sunchokes (and with several other ingredients, some of them starchy), my post-prandial BG was 114. That's the lowest post-prandial test result I've seen since I got back into testing after meals recently, so I shouldn't be too quick to dismiss the idea that sunchokes are helpful in this regard. I also had a piece of bread, and strawberries for dessert, so the low result seemingly can't be explained by a lack of carbs in the rest of the meal.

It wasn't necessarily the sunchokes, though. I did go on a hike today, and for whatever reason, I've found that a hike usually seems to be highly effective at reducing my BG, often more so than more intense forms of exercise. I wonder why; I doubt I'll find out. 

Friday, March 7, 2008 -- FBG 82*

I followed up on the post-prandial testing issue today, taking a test after each meal. I can't continue doing that many tests, because my prescription for test strips doesn't cover testing at that rate, but I'm squandering some test strips for a little while to see if I can indentify a difference between results following meals at different times of day.

Today my results were: 152 after breakfast, 129 after lunch, and 137 after dinner. That's certainly better than yesterday -- only one result over 150, and only by a little. But why? I don't think I was eating a lot differently today, or exercising differently (I ran 4.3 miles, which was only a little longer than yesterday, and it was a less hilly route.)

Possibly what's going on here is that my metabolism is now settling back into a normal state, following a very atypical week (running a marathon on Sunday, no exercise on Monday or Tuesday). Still, I think it's likely that my post-prandial results are getting lower simply because I've started keeping an eye on them. I don't mean to suggest that observation has a magical influence on glucose levels, but I do think that paying attention to what your glucose levels are is bound to influence your behavior.

 For a long time I've been more casual about the amount of carbohydrate in my meals than someone in my situation really ought to be; I just figured that if my fasting tests were okay, I must be handling my carb intake pretty well. Actually, I think I was handing it fairly well, but not as well as I thought I was, and not as well as I could do (and had been doing before, when I was doing more testing).

Now that I know I'm going to be measuring the impact of starchy foods immediately after consuming them, I find myself more likely to take a hard look on them. ("Hmmm, if I'm already having rice, do I really need to have that hunk of French bread on top of it?")

Although the glucose spikes I've been experiencing after meals have probably been higher than they should have been, I don't think they have been prolonged -- I think my BG does drop down to normal fairly fast. Still, extra-high glucose spikes after meals does increase your average BG over time, which means more glycation -- and more glycation-related tissue damage occurring throughout the body. The body's healing processes have to work overtime to undo that damage, and sometimes they can't keep up. I don't think my average BG (or my Hemoglobin A1c value) has been up in the diabetic range lately, but it has probably been near the high end of the normal range, and that does make a difference. Even among people whose average blood sugar is in the normal range, the ones in the bottom half of that range are healthier and live longer.

From now on I think I'll test after only one meal per day, but I will vary the choice of meal, so that time of day does not bias the results I get.

Thursday, March 6, 2008 -- FBG 84*

The theme of the day was post-prandial testing (testing after a meal). I have been relying on fasting tests alone for a long time, on the assumption that if I kept those results low enough everything else would take care of itself. Not quite, I guess; when I made the foolhardy experiment of testing after eating a high-carb, ale-fueled dinner at a brewpub last night, I was alarmed to see that I'd gone up to 180. When I was doing post-prandial tests before, I hadn't had much trouble keeping them under 150.

Of course, when I was doing post-prandial tests before, I was trying to keep them under 150. When you're actually aiming for a particular target, you're a lot more likely to hit it. I used to think a lot more about the carb content of a meal than I have been doing lately. I guess I convinced myself that, because I do so much exercise these days, I can get away with anything. But apparently I can't!

So today I decided to do a test after each meal, and see what happened. The results were: 163 after breakfast, 146 after lunch, and 122 after dinner. One high result, one barely acceptable result, and one good result.

The downward progression during the day is interesting; I think some people show a pattern of dropping over the course of the day. However, there are certainly other factors that could have affected the results. Breakfast was certainly the most carb-dominated meal of the day (cereal & skim milk), so it makes sense that my BG went highest after that. Lunch was a vegetable curry with potatoes, carrots, and peas -- fairly high in carbs, but balanced with fat to slow down the sugar digestion. Also, I did a 4-mile run just before lunch (I'm quite recovered from the marathon now; running felt good). The aftereffect of hard exercise is an increase in insulin sensitivity, and maybe that's why dinner produced the lowest spike of the day (dinner consisted of a small vegetable burrito and an apple). None of my meals today could be called low-carb, but in the case of breakfast there was almost no fat to moderate the impact of the carbs. The other meals were more balanced.

So, although the results for the day were not as bad as I feared they would be, they certainly weren't stellar. I should be doing better than this, and I don't have much doubt that I can do better than this. So, I guess I'm back to doing post-prandial testing. Not after every meal, but after at least one meal a day. Since most people with Type 2 have to do post-prandial testing, it would be a little unfair for me to give myself such a big break on this issue.

Also, I might as well post an embarassing photo of myself in Sunday's race, taken by the folks at MarathonFoto. This was the most macho-looking of the ones they took.

Wednesday, March 5, 2008 -- FBG 79*

Further progress on recovery from the marathon: I walked down stairs today in the usual manner, without greatly hurting. I also went to the gym for a 30-minute workout today (my first exercise since the race). It wasn't at all difficult, and in fact my leg muscles felt better for getting used.

In the evening, though, I got a rude awakening. I went to dinner at a brewpub with two friends of mine. One has Type 1 diabetes, and always carries his glucose meter with him. The other is not diabetic, and seemingly not at risk for it, but very curious about the subject; we conducted a test of his glucose after we ate, and for purposes of comparison I volunteered to be tested myself.

The thing is, my non-diabetic friend tested surprisingly high (180), and when I volunteered to do the comparison test I was pretty smug about it, thinking my glucose would turn out to be lower than his. The glucose gods soon punished me for my presumption: the result turned out to be 180 for me as well.

That certainly took me down a peg. I haven't been doing post-prandial testing in a long time, because my fasting tests have been so good, and I assumed that the result this time would be under 150. I wasn't ready to see 180 as the result.

It was a high-carb meal for all of us (onion/spinach foccacia in my case), with strong ale added to the mix. Maybe anybody's BG would go high with that kind of intake. The fact that the non-diabetic guy at the table (who is fit and muscular -- not at all the usual Type 2 patient) measured the same as me may indicate that reaching 180 was not so unusual under the circumstances. Still, it worried me. I didn't think I ever went that high after a meal. Maybe I'd better start doing post-prandial testing again, to see if something has changed in that regard.

When I got home, I immediately did a glucose test, and found that I was now down to 98 (or 104, if you want to take into account the negative bias that my new batch of test strips seemingly have). That's reassuring -- at least I'm not going high and lingering there. But I didn't think anything like that was happening at all. I'd better start keeping an eye on it.

Tuesday, March 4, 2008 -- FBG 79*

The usual post-marathon situation: I'm feeling better than I did yesterday, but my quadriceps muscles are still complaining when I walk, and complaining louder when I get into or out of a chair, and yelling for help when I walk down a flight of steps. But none of this is as bad as it was yesterday, and by tomorrow I'm pretty sure I'll be recovered well enough to do a light workout in the gym.

However awful the last few miles of a marathon may be (and they can be pretty bad), the body recovers remarkably fast from the ordeal. I was a zombie when I crossed the finish line, and the race volunteers steered me to the first aid station as soon as they got a look at me, but after taking in some fluids for a little while I was feeling vastly better, and the inevitable soreness in my legs has been fading steadily ever since. I actually feel pretty good.

And come to think of it, there's another reason to run marathons (or to take on other extreme sports challenges) that I forgot to mention yesterday: the peculiar pleasure that is involved in getting your body really, truly tired. Most people who don't earn their living through manual labor have an oddly artificial notion of what "tired" means. The kind of fatigue they know is the result of job stress: the emotional frustrations that their work involves, not the exhaustion of their muscles. When people who take on big sports challenges come home from the event and stretch out on the couch, they are experiencing physical sensations which most people just don't have, and sometimes those sensations can be surprisingly pleasurable.

When I came home from the marathon on Sunday, I got into bed to take a nap, and every muscle in my body felt overheated and glowing. You could have made toast by holding bread over me, or so I felt at the time. And this feeling ws not by any means a bad one! There was an odd kind of ecstasy in it, difficult to describe, and perhaps impossible to describe to anyone who hasn't done something like that. I suppose that it is caused by a massive release of endorphins (those opiate-like hormones that the body releases after exercise, particuarly in the case of exercise that pushes the body beyond its comfort zone). Jogging in the park will give you a little dose of endorphins, but an extreme exercise challenge will give you a big dose, and I think I had a downright gigantic dose on Sunday. I felt fantastic. It was probably the best nap I've ever had -- I was not really asleep most of the time, yet I was floating around in a dream of perfect happiness.

Maybe that's what really makes people pursue marathons, triathlons, and other heavy-duty athletic challenges: if you want to experience that kind of high without actually injecting any heroin, you have only one place to go. 

Monday, March 3, 2008 -- FBG 84*

As usual after a marathon, I'm walking around rather stiffly and slowly today, but at least I'm walking. And as the day wore on I walked a little faster. Walking down stairs is the only thing I can't do without looking crippled. Well, getting into or out of a chair is also a bit embarassing (I have to rely heavily on my arm muscles because my leg muscles are not up to the task today). Looking on the bright side, the only part of me that seriously hurts are the quadriceps muscles (the muscles on the front of the thigh, several inches above the knee). My feet, knees, calf muscles, hips, and abdominal muscles are fine. The quadriceps muscles always hurt after a marathon, and I think that's true even for runners who are a lot better at it than I am. (And even the quads only hurt when I'm using them -- when I'm just sitting around, I'm not sore at all.)

It's surprising how quickly you can recover from these things. It helped that I went to the yoga class tonight. I was a bit afraid to do it, but I knew that going would be better than not going. My teacher built the whole class session around poses that would be good for me to do (there was only one thing the class did that I couldn't handle, and she gave me something else to do during that one). I'm pretty sure I'll be feeling better tomorrow. My back feels better already.

Still, you might ask (and it's certainly a question worth asking) why I would do anything as hard as running a marathon, if I can control my glucose perfectly well without engaging in extreme exercise of that sort. So, if I didn't need to run a marathon, why do it? It's a question I asked myself many times, during the last 5 miles of the race, and I think it has many answers.

One answer is that, like a lot of people, I feel a need to have peak experiences now and then. Occasionally you want to do something out of the ordinary, something most other people wouldn't do (and would even be afraid to do). Getting up before dawn, to join a crowd of 2300 people who have decided to run the 26 miles from Calistoga to Napa, is that kind of experience. I've seen the Napa valley before, of course, but seeing it from the perspective of a runner rather than a driver, surrounded by other runners, at dawn, feeling the wind, feeling the cold in the air, seeing the sunrise, startling a coyote who hadn't expected to see a swarm of people running through his territory -- that's a very different thing.

Another answer is that my fitness program is based largely on peer pressure -- I hang around with active people, and I allow them to talk me into things. If that means that they sometimes talk me into things that are pretty far outside my comfort zone, then maybe that's the price I need to pay for the many benefits I get from my connection with them. Whenever they do talk me into something that's outside my comfort zone, that means I have to train for it -- and the training becomes an important part of my daily exercise routine. It gives me something to focus on, something to make a workout seem goal-oriented. Not everyone needs that, of course, but I seem to need it.

Yet another answer is that, like most people who have been diagnosed with Type 2 diabetes, I have spent too much of my life feeling that my health was something over which I had no control -- it was something which happened to me, rather than something influenced profoundly by my own behavior. I am trying to get over that. I need to teach myself to exert some control over what's happening in my own body. Taking on heavy-duty challenges and surviving them is one way to gain a sense of control over your own health.

Despite these considerations, we all have to make some kind of sensible tradeoff in regard to things which might benefit us and might also be dangerous. The last few miles of yesterday's marathon were a bit scary for me -- I felt that I was at the limit of what my body could do, and might be about to suffer serious consequences. Just before the end I felt light-headed enough to worry that I might pass out; this feeling was brief, and of course I didn't pass out, but if you're over-straining yourself to the point that you're seriously worried about passing out, you're probably pushing yourself harder than you ought to.

So, for the moment, I'm sticking with my feeing from yesterday, that I don't want to run any more marathons. Maybe later I will decide that I want to run another marathon and do a better job of staying hydrated this time, but in the meantime I will think of myself as an ex-marathoner. And then we'll see what my friends can talk me into next.

Sunday, March 2, 2008 -- FBG 85*

The marathon is done! It was beautiful, fantastic experience, at least during the first half of it. The race started right after sunrise, and the Napa Valley can look spectacular on a clear morning as the sunlight gradually spills into it. A truly beautiful place to run. And I felt good -- I was able to maintain a good pace without struggling.

Around mile 16, though, it started to get more difficult for me. I was still okay, but I was working a lot harder than I had been up to that point. I was fighting a losing battle to stay hydrated. It wasn't warm -- in fact, there was a cold wind most of the morning -- but wind evaporates sweat very efficiently, so you lose water rapidly without being aware of it. I seem to sweat more profusely during exercise than the average person, and this makes it very hard for me to avoid falling behind on hydration. Anyway, around mile 21 I really started running out of gas, and had no choice but to slow down. The last 5 miles of the race were extremely hard for me, and it must have been obvious that I wasn't feeling well because at the last few water stations the volunteers were asking me if I was all right. When I crossed the finish line, I was looking wobbly enough that a volunteer took me by the arm and escorted me to a first aid station. They took my pulse (they said it was 90, which is pretty good for someone who just finished a marathon), gave me water and Gatorade, and were eventually persuaded that I would be okay as long as I replaced the lost fluids.

My fastest finishing time in a marathon in the past was 4:31:33. I wanted to see if I could do better than that this time; I chose a goal of 4:20:00, and for the first 16 miles I was very much on track for reaching that goal. However, as I slowed down later in the race I knew that wasn't going to be possible. I hoped, though, that I would be able to be at least a tiny bit faster than 4:31.33. I was, barely: my finishing time was 4:29:57. In other words, over the past two years I improved my marathon time by a total of a minute and thirty-six seconds. One could argue that this means I'm not cut out for marathoning, and should find a more modest exercise challenge to take on.

It's funny: during the joyful first half of the race I was feeling ready to take on more marathons in the future, but during the last five miles the thought that kept popping into my head was "I never want to do this again!". At the moment, with memories of the awful final phase of the race still fresh in my mind, I feel as if I'm definitely through with marathoning. However, a lot of people finish a marathon swearing that it's going to be their last -- only to sign up for another one six months later. It's sort of like the amnesia that women develop about what childbirth is like. Anyway, I've learned never to say never.

After I got rehydrated I felt a lot better. I'm still tired, and my legs feel sore when I walk or bend over (although they've hurt more after previous marathons), but basically I think I'm okay. I plan to go to work in the morning. However, I'll make sure to bring lunch with me, because the cafeteria is two long flights of stairs away from my office, and I doubt I'm going to be ready for much stair-climbing tomorrow.

Saturday, March 1, 2008 -- FBG 83*

I went out to Napa today to pick up my race number for the marathon, and also to pick up the other goodies that are included in the deal -- including a shirt and a backpack. The backpack is nice, but the picture of a wine bottle embroidered on the back of it is a little misleading:

backpack from napa marathon

Trust me: the people who run in the Napa marathon don't do it naked. If you want to see a footrace that features nude runners, you'll have to drive down to San Francisco. Napa's a very different place.

The place where I picked up the goodies is the host hotel for the event, and the place was swarming with marathon-runners. The intensity of the atmosphere at an event like that is hard to describe, but it's an odd mixture of excitement, suppressed nervousness, and relief -- that is, relief that all that training is finally out of the way, and we can finally have the experience we've been preparing for all winter. But there's an added element in the buzz that's hard to identify at first, and I think it's the oddity of being in the middle of a big crowd of people who all happen to look healthy and fit. Ordinarily we don't experience that; when we're in the middle of a crowd of strangers, we don't expect them all to look strong or energetic, and usually we are right not to expect that.  I've heard it said that everyone should go to the county fair because it's such an easy way to boost one's self esteem. Maybe so, but everyone should also go to a marathon once in a while, to get a vivid picture of what our country would look like if everyone was exercising more and eating less. This afternoon I made a brief visit to an alternate universe in which that picture was reality.

Tomorrow I'll go get immersed in that alternative universe again. We'll gather in Calistoga around a bank of porta-pottties, shivering in the morning fog and eventually singing the national anthem. Then the starting gun will send us charging south on Silverado Trail past hills, trees, vineyards, and famous wineries. The real athletes will soon vanish around the next bend and I'll never see them again. The semi-runners will fall behind, and I'll never see them again either. But in the middle will be a big crowd of people like me, who can't run fast but can keep doing it for a long time, and I'll more or less keep pace with the same few people all morning, sometimes pulling ahead of them and sometimes falling behind. Sometimes getting into conversations as we run. The camaraderie is strong in a marathon. We'll know that we aren't remotely in the same league as the people who are going to finish in under 3 hours, but we'll also know that we're doing something extraordinary. Although marathon-running has become a popular sport, less than two-tenths of one percent of Americans will run a marathon this year -- but we'll be among them.

I've definitely been carb-loading today -- lots of pasta and lots of bread. I'm feeling stuffed now. I hope I didn't overdo it. I don't want to feel heavy tomorrow, just fully charged.

Well, I guess I'd better try to get some sleep -- which isn't easy the night before a marathon, but I'll do my best.