Monday, November 30, 2009  

My typical daily exercise consists of a 4 to 5 mile run during my lunch break at work. Since I mention that so often here, I thought it might be a good idea to do a little photo-essay, showing what these runs are like. Why not bring along a camera, and snap some pictures as I ran along? In the bright sun today, I could use a very fast shutter speed and not blur the pictures with my running motion -- so why not give it a try? Anyway, that's what I did, and here are the results.

We always start from this location -- a lawn with a flagpole in the middle of it, right in front of the building where I work.

I'll have to show this one to Michele, in case she doesn't know the tricks her hair can do when she runs on a breezy day.

We haven't even left the company property yet at this point -- the grounds there are pretty, but not big enough to fit a long run in, so we need to get out onto the public roads.

I handed the camera to Mike to take a picture of me. It's easier to smile when you're running downhill, I find.

Uphill is a little harder. You can't tell, but I promise you I wasn't smiling during this section.

It's to bad this part is so steep, because it's so pretty that I'd like to be able to say I like it.

I know it's immature of me, but when we're approaching this intersection, I'm always hoping the traffic light will be red when we get there and we'll have to take a little break. Today I was in luck!

This section isn't steep, so I had another shot at smiling for the camera.

Then the really hard part begins -- the biggest climb of the day.

After we get to the top, we're rewarded with a long downhill -- and it's a shallow downhill, so it doesn't hurt your knees going down it.

The territory we pass on the downhill includes the golf course of the Fountaingrove Club. It's too bad I'm no good at golf, but maybe by running past the fairways I'm enjoying the setting about as much as the people who are paying the big green-fees to be there.

In the picture below, that field to the right is where we saw the beige "log" which we afterwards realized had probably been a mountain lion. The mountain lion wasn't there this time. Neither was the log. (If the log had not disappeared overnight, we might have continued clinging to our hopeful interpretation of what we had seen stretched out on the grass).

Oh no -- another hill to climb before we're done!

And then the beloved final downhill, which takes us back to where we started.

Finishing the run always feels good, no matter how good or bad the run itself was. But the run itself was a good one today.

I don't know exactly what I'm trying to prove by showing you all that. I guess I'm trying to present a vision of "daily exercise" that seems less like an unpleasant chore and more like a bit of adventurous fun tucked into the middle of a workday. Not everyone has the opportunity to do something like this, I realize, but try to make the best of whatever opportunities you have. Surely most people have a chance, at least once in a while, to make something more enjoyable of their workout than jogging on a treadmill and going nowhere.

Sunday, November 29, 2009  

The weather was even better today than it was yesterday -- the same brilliant sunshine, but this time without the cold winds. It almost seemed a shame to spend any time at all indoors. Even though I did a very long trail run yesterday (9.1 miles), I felt like doing a long hike today in the same park, taking a camera with me this time. However, I did have an indoor event scheduled (an Irish music session) at 2 PM. And music is important, too.

If the purpose of exercise is to stay healthy and live longer, the purpose of staying healthy and living longer is to be able to play more music. I try not to let a conflict exist between the things I'm doing to stay healthy and the things I want to be healthy enough to be able to do. I didn't have enough time to do the hike and the music session as well, so I replaced the hike with a comparatively short run (5.3 miles) in my own neighborhood, which could be done in much less time.

Before the run I was not at all sure that I was ready for it -- I was feeling a little stiff and sore from yesterday's trail run. However, once I started running I soon began to feel better. That's how it usually goes with running. It's rare for me to start a run feeling confident that I can handle it, but it's even more rare for me to give up on a run I've started because it turns out I can't handle it.

Much later in the day, as I was getting up to leave the music session, I had a sudden pain (actually, it felt like a cramp) in my left hip. Walking around soon cured me of that feeling, and I'm not feeling it now. I don't know what the problem was, but at the session I was setting down for about as much time as it would take to watch Gone With The Wind. Getting up suddenly after spending so much time in a chair probably created a strain that my body didn't appreciate, but it doesn't seem as if there was any lasting effect from it.

However, if my hip is sore tomorrow, I may have to find a less percussive way to work out than running tomorrow. Maybe I'll need to go to the gym and use the elliptical trainer or something.

Saturday, November 28, 2009  

Okay, I've had my fun -- and my pie -- and now I must pay!

Thanksgiving, that traditional American one-day festival of overeating, was essentially a three-day festival for me, because I was visiting relatives in separate, distant locations. So now I have lots of indulgence to make up for. My fasting test result yesterday (the morning after the main holiday meal) was 94, which is not bad considering. I prefer to keep my fasting numbers under 90, but 95 or lower is acceptable to me under unusual circumstances (travel and holiday dinners being my usual "unusual circumstances").

Although I didn't sign up for an organized "Turkey Trot" race on Thanksgiving this year, I did the next best thing. Early on Thanksgiving morning, my sister and I did a 10-kilometer run along Ocean Beach in San Francisco, before we drove to my brother's place near Placerville for the big family dinner.

As it turns out, it isn't as easy to get into the spirit of the Turkey Trot when you didn't have hundreds of other people doing it with you, but on the other hand, when you aren't running in an organized race you don't have to pay a registration fee (and those fees aren't small these days). The Turkey Trot race in San Francsico used to be at Ocean Beach, but lately the race organizers have moved it to a disappointing location in Golden Gate Park so that the participants won't be running en masse over the nesting grounds of the Snowy Plover. According to the biologists, this is nonsense -- those birds don't nest anywhere near the old race route along the beach -- but San Francisco politics is San Francisco politics, and the race can no longer be run at Ocean Beach, and that's that. So we did our own version of the race there ourselves. Along the route, we found a dead seal, and also five dollars (we don't think the five dollars belonged to the seal, however). The early-morning view of the ocean was beautiful, but the surf was alarmingly wild. There were two incidents of boats capsizing in the area that day, with fatal results in both cases.

I see that Sarah Palin entered a "Turkey Trot" race in Kennewick, Washington. It was a 5K rather than a 10K -- only 3.1 miiles -- but she did not complete it. Her explanation for failing to finish was that she was trying to avoid the throng of eager fans that would be waiting for her at the end. Exactly why that was a problem (and a problem which could not have been predicted at the time she signed up for the race) is a little unclear. Well, it may not be much of a boast to say that you're better at finishing what you started than Sarah Palin is, but to the extent that it's anything to brag about, I'm bragging about it here and now. I finished my run! Ha ha, I finished my run!

My fasting number would probably have been lower than 95 this morning, if I had actually managed to work out yesterday, as I had intended. But I was on the road a lot yesterday, and by the time I got home I didn't feel ready to do anything more strenuous than napping.

Feeling the need to make up for that lapse today, I did a trail run, choosing the longest and hilliest route that I normally run outside of marathon-training. I didn't find the run easy -- I felt like I was hauling more than a few extra pounds over those hills -- but it was a good run nevetheless. The air was clear, the sky was solid blue, the landscape was green from the recent rains, and the wind was just cold enough to keep me from sweating too much, without being cold enough to make me wish I'd worn another layer of clothing. And, as major bonus, I encountered nobody on horseback during the entire run. Getting safely around the equestrians (many of whom have far less control over the beast they're riding than they imagine) is one of the biggest challenges of using the trails in that park. Any day when I can do a long trail run there and not have an alarming standoff with somebody's friend Flicka is a good day.

Earlier I went to a local farmer's market and bought some vegetables -- including some unusual types of winter squash, some peppers, and some eggplants of that small, white-skinned variety which stand as an explanation of how eggplants could ever have been given such an unlikely name. 

Most recipes for squash involve adding a lot of brown sugar or maple syrup, but when I baked one of the squashes for dinner tonight, I left out the sugar. I did add some cheese, so it wasn't a low-calorie dish, but at least it was a reasonably low-carb dish.

I expect my fasting number to be lower tomorrow, but if it isn't, I'll go to work on bringing it down. 

Wednesday, November 25, 2009  

Taking a break for the holiday -- I'll post again after Thanksgiving, and let you know what the consequences were!

Tuesday, November 24, 2009  

Part of the reason my fasting glucose was low again today is that I got up early again today. The project I'm working on is going to require a lot of early-morning phone conferences with people in remote places (mostly Scotland and China). I have a meeting tomorrow at 6 AM, for example. This sort of think is hard on me, because I'm a nocturnal animal and I can't go to sleep nearly early enough at night to be ready for getting up that early the next morning. But what has to be done has to be done. I just need to find a way to do it.

The weather has been sunny this week, and it looks as if we can expect good weather for Thanksgiving -- which is fortunate, because I'm going to my brother's for the holiday and it can be snowy in the hills where he lives. Not this week, apparently. No chains required.

My assignment for Thanksgiving is to make salsa (a specialty of mine) and a vegetable dish (which I believe will be stir-fried spinach with onions, garlic, and nuts, unless I change my mind before I go shopping tomorrow). The more traditional Thanksgiving dishes will be there, of course, but their preparation will be entrusted to more reliable cooks than myself. 

This morning, when I got to work, I was greeted by the sight of five male wild turkeys in the parking lot, all of them doing the big tailfeather-display thing. I thought, "Hey guys -- where are the females you're supposed to be impressing?". I also wondered whether this a good week for a wild turkey to drawing that much attention to himself.

This is a tough time of year for people who are trying to keep their blood sugar under control. What are they to do when they are at a celebratory feast in which the offerings are sure to include mashed potatoes, stuffing, pie, and other high-carb treats?

Unfortunately, communal meals in general (and holiday meals in particular) carry a heavy burden of symbolic significance -- if you aren't joining whole-heartedly in what everybody else is doing, this is seen as a rejection of your connection to those people. Sitting off in a corner on Thanksgiving, nibbling a sprig of parsley and feeling sorry for yourself, is not a practical solution to the holiday problem. (And even if you could get away with it, it wouldn't be much fun.) If you can't do that, what else can you do?

I'd almost rather not admit what I do myself, because I don't think it makes me a good role model for people with diabetes. But my two-phased approach to Thanksgiving is:

  1. Do a challenging workout on Thanksgiving morning, in the hope that this will help me get away with indulgent behavior a bit later in the day. In the past, this has meant signing up for an organized "Turkey Trot" race, but this year I think it's just going to be a do-it-yourself run, probably about 6 miles.
  2. Eat too much.

It's not a program I feel I can recommend to other people, but that's what I do. 

Monday, November 23, 2009  

I got up unusually early this morning, because I had to have a phone meeting with a coworker in Scotland, and as it happened I woke up very hungry. My fasting test is usually lower if I get up earlier, and lower still if I wake up hungry. So, I wouldn't have been surprised if my result was down in the high 70s. But the high 60s? That was a bit unexpected. Why was I that low?

I guess the reason is that yesterday I did a pretty heavy workout in the afternoon (a very hilly trail-run, with a distance of 8.3 miles), and I had a rather light (and early) dinner afterwards. I did have some home-made bread later; I guess my feeling at the time (that the long run earlier in the day made it all right to indulge) was correct. My muscles were probably a bit glycogen-depleted from the run, and they did an exceptional job of soaking up all the carbs from the bread.

Part of the reason I like to do endurance workouts on the weekends is that, if someone should happen to offer me a plate of homemade Irish soda bread with raisins, just out of the oven, still warm, crackly on the outside, soft and moist on the inside... pardon me, I'm under control now. If that situation should arise, as I say, I want to have an option besides explaining mournfully why I can't have any.

My exercise regimen is a little extreme by most people's standards, and it worries me that people probably think I'm saying they can only control their diabetes if they are willing to do long-distance running on the same scale that I do it. I don't think that's true. I could probably get away with cutting my exercise back by almost 50% -- provided, of course, that I also became far more strict about diet.

Eventually I might have to become far more strict about diet anyway, no matter how much I exercise. For now, though, my very disciplined exercise habits are allowing me to be less disciplined about my eating habits, and it feels like a reasonable tradeoff to me. Running up steep hills does not feel easy and pleasant to me while I'm doing it, but if it makes me feel good afterwards, and it allows me to say yes afterwards when I'm offered fresh-baked bread, it seems worth a little initial suffering.

I do realize that there's a possible flaw in the cost/benefit analysis I'm doing here: what if it only seems as if my exercise program is allowing me to "get away" with high-carb treats? What if my failure to adopt a very-low-carb diet is doing me some kind of hidden damage which will later cause my blood sugar to get hopelessly out of control? There's no guarantee that it won't happen that way. On the other hand, if I've been heading for trouble for very nearly 9 years now, you would think my numbers would be trending in the wrong direction by now, and they're not. So, I conclude that what I'm doing is working for me, at least for now, and I'll stick with it so long as it continues to work -- but I'll also be alert for signs that that it is no longer working.

Friday, November 20, 2009  

It was a rainy day, and my running buddies were uninterested in braving the elements at lunchtime. So, I had to go out and run in the rain, all by myself!

It wasn't all that bad, actually. The rain was slacking off by the time I got started; it was a light rain for the first and last mile, and two miles of no rain in the middle. So, I earned whatever extra points you get for running in the rain, without actually suffering much hardship. But it was a reminder that we're heading into that phase of the year when exercising outdoors becomes more of a challenge.

Okay, here it is: the story of my life, captured in one cartoon.

When a thing requires prior arrangement, it usually doesn't occur to me to make those arrangements until it is too late to do so. I'm the guy you see at the box office window, trying to purchase tickets for a concert which is already sold out (or even for a concert which, it turns out, has already taken place).

I'm not sure I can explain why I am that way. If I think about it (which, let's face it, I usually don't), I understand why people organizing such things as concerts and footraces need to get their ducks in a row pretty early on. Those are not the sort of events you can throw together at the last minute. And yet, they're the sort of activities I become interested in at the last minute. I am startled and almost hurt when somebody tells me "You should have signed up for this back in September". What? September? Me????

I seem to go through life on the assumption that I ought to be able to decide, every day, what I feel like doing that day. It is a habit of mind which can add a lot of disappointment to your life. It can also add a lot of expense to your life, because the people who organize things hate people like me, and they seize every opportunity to make us pay dearly for our last-minute decisions. Sorry, sir, the price you heard quoted was the early-registration price, and you're eons too late for that -- get ready to write a check for the staggering amount we charge jerks like you who traipse in here at the last minute and expect us to make room for them!

I doubt that I have ever paid the early-registration price for anything. By the time I look into signing up for an event, that ship has long since sailed. I'm always paying top dollar for the privilege of being a late decider. It's hard for me to imagine myself becoming an early decider, though.

For example, the people who organized the half-marathon in Healdsburg that I ran on Halloween also do one that goes from Napa to Sonoma. That one is more popular and it tends to sell out early (they only allow 3000 runners to participate). So, I got an e-mail message from them yesterday, asking me to sign up for that race (and pay them for it) in advance. Do you know when that race happens? On July 18 of 2010. They want me to sign up for it eight months in advance. Now, for heaven's sake. How do I know whether or not I'll be ready to run a 13-mile race on a day eight months in my future? Who knows what injury or illness or other issue in my life might become an obstacle on that day? In 2007, I had to drop my plans to run in the Napa Marathon (and lose the hefty registration fee I'd paid) at the last minute, because of an injury which occurred shortly before race day. The experience didn't exactly help me overcome my reluctance to sign up for things long in advance.

Still, there are things I am thinking of doing this year which I have to make decisions about pretty soon. The biggest decision is about the Napa Marathon in March, and the biggest reason to make the decision soon is that, if I'm going to do the race, I have to start training for it in a few weeks. My two main running buddies are thinking of doing it (which is important, because it's very hard to train for a marathon if you have nobody to train with), but like me they are hesitating about making the commitment.

Last year's Napa marathon was seriously marred for me by the rainy weather; I almost feel a need to get the bad taste out of my mouth by doing it again under better conditions. Not that there's any guarantee of better conditions this year, but historically speaking the odds favor it. Of course, regardless of how much sunshine there is on race day, training for the race all winter means that I'll be doing a lot of long runs in the rain.

I also have to make a decision about The Relay in May, but I think that decision is pretty much made -- I want to do it again this year. There, you see how decisive I can be sometimes? 

Thursday, November 19, 2009  

Until you actually try your hand at blogging, you feel quite sure that you could never find yourself without a subject on which you have opinions to share. This turns out not to be true; on some days you will be shocked to discover how little is on your mind. That's where readers come in -- they ask your opinion about something unexpected, and then you have to figure out if you have one.

I was asked today what I thought about the connection between low testosterone levels and diabetes. I hadn't heard that there was any such connection, but upon looking into it I'm finding reports saying that there is. Or at least there is a correlation: between men with diabetes and men with low testosterone levels there is a lot of overlap. Maybe the diabetes is causing the low testosterone levels. Maybe the low testosterone levels are causing the diabetes. Maybe both. Maybe neither.

Of these possiblities, the one with the most commerical potential by far is the one that says low testosterone levels cause diabetes. If you can get enough men thinking that they need to take testosterone as a medication to prevent or treat diabetes, you've created a multi-billion dollar market. Therefore, research is pretty sure to be biased in favor of the conclusion that low testosterone causes diabetes. The conclusion might not be wrong, but we need to view it with  suspicion, I think. A scientific hypothesis becomes less credible, not more, when it's worth a fortune to somebody.

So, my starting posiition on this is that I'm inclined to be skeptical that low testosterone causes diabetes. I can outline some reasons for doubt:

If the bias of researchers is likely to be in favor of the idea that low testerone causes diabetes, my own bias is in favor of the idea that being unhealthy in any way tends to depress testosterone levels. I think that's the real reason that diabetes and other chronic diseases are associated with low testosterone. I can't prove I'm right about this, any more than those who think low testosterone is a cause rather than a consequence can prove that they're right.

I think my way of looking at this is at least reasonable. Whether it's also right is something we might not find out for many years.

That's not a typo at the top of the entry -- my pulse really was 41 when I measured it tonight. It was late and I was sleepy, and occasionally my resting pulse does get that low. It's one of the results of exercising a lot for several years. Your body adapts.

Wednesday, November 18, 2009  

Rabbits need no longer fear impotence! I'm not sure they were fearing it before, but if any of them were, help is on the way. A team of scientists lead by Anthony Atala (of the Institue of Regenerative Medicine, at Wake Forest University Baptist Medical Center in Winston-Salem, N.C.) has demonstrated that it is possible to grow erectile tissue in the lab, use it to replace the real thing (at least in a rabbit), and end up with a fully functional organ of venery.

How does one go about solving a problem as delicate as that? Apparently, the trick is to make a "scaffold" of collagen, and use this framework as a site to grow the appropriate cell types. Once the tissue has been filled in, you transplant it into the patient, replacing the original (and presumably damaged) corpora cavernosa, and by the time the surgical scars have healed, Bugs is ready for action. At long last, the rhetorical question "What's up, Doc?" can be answered!

So far, the patients have all been bunnies, but if their success rate is anything like what the success rate in humans will someday be, there is great hope for sexually-injured men. The male rabbits in the study typically initiated copulation within a minute of being given access to a female rabbit, and the fact that many of the male rabbits soon became fathers indicates that the repaired organ was not just for show. (Incidentally, the scientists involved didn't go on a search for rabbits that were impotent already -- they were merely repairing damage which they had inflicted themselves, but at least they repaired it.)

Predictably, the whole story is being treated as a joke in most news outlets that have covered it. Anything that involves male sexuality is generally treated as a joke. The theory seems to be that men shouldn't think erections are important, and deserve to be ridiculed if they do think so. After all, women can get along without erections, so what's wrong with men that they can't do the same?

Well, silly as it may seem to the more enlightened members of society, men who have lost the ability to 'stand' (in the Shakespearean sense) really miss it and would like to get it back. Some day, when the procedure has been deemed safe enough for human subjects, quite a few men will sign up to boldly go where no man (but many a rabbit) has gone before.

Critics of this research complain that it won't just be used to help men who are suffering the consequences of war wounds or of chronic illnesses such as diabetes -- it will also be used to enhance normal functioning, in uninjured men who are merely seeking a competitive edge, so to speak, and are willing to pay through the nose for it (if I have not got the anatomical specifics wrong here). To which I say this: if your greatest worry is that some guys will use surgical methods to improve their sexual performance relative to your own, you have too much time on your hands, and you are also probably overestimating the number of men who would be willing to use genital surgery to fix what isn't broken.

I guess it's vegetarian time again! My weight gain since the trip last month as remained stubbornly in place, and I've never been able to lose weight before without adopting a vegetarian diet. I drifted pretty far from anything like vegetarianism while I was in Scotland, and I haven't really drifted back to my starting point since I got home.

This isn't the ideal time of year to try to be a vegetarian (and it would be silly to pretend I'm going to be a vegetarian on Thanksgiving or Christmas), but the rest of the time I'll shift the emphasis to plant foods and see what I can accomplish.

Tuesday, November 17, 2009  

Wow -- I was expecting my blood pressure to be down tonight, but not by that much. I got my three dreaded meetings out of the way this morning. The one which I dreaded the most turned out to be the easiest, and the one I dreaded the least was the hardest, but anyhow I got them done, and the relief is probably what brought the pressure down.

My running buddies were unavailable today at lunchtime, so I had to go by myself, but I had a really nice run. It was sunny, clear, and slightly cold. The world was beautiful. Not a cloud in the sky.

A few hours later it was raining. I lucked out on that one! I hope my luck holds up tomorrow -- it's supposed to clear.

Okay, what do you see in the picture below?

Most of us see seven yellow, sculpted columns, at least at first. Some of us never notice the three pairs of people engaged in conversation, until their presence is pointed out to us. After that, they seem so conspicuous that it's hard to understand how anyone could overlook them.

Optical illusions make us aware that perception, even when it seems to be a case of straightforward observation of what's in front of us, is really a process of making assumptions, interpreting clues, and jumping to conclusions. When we look at the picture above for the first time, we start from the assumption that the most brightly-lit and detailed areas of the image (the columns, that is) are the true subject of the picture; the darker and less detailed areas of the image are merely "background" and should therefore be ignored. We may ignore the dark areas of the picture so thoroughly that we don't really "see" them, in any meaningful sense, until we are asked to re-examine the picture with fresh eyes. Only then do we try to oppose the automatic process of assumption and interpretation which passed for "seeing" the picture the first time around, so that we can take in the information which we initially screened out.

Information, even simple observational information, has to get to us through such a thick filter of assumption and interpretation that it's hard to say whether we are much more than the sum of our prejudices. Our experiences and attitudes determine what we can perceive. Art teachers must admonish their students to "paint what you see, not what you know", because students will otherwise paint only what they know, or think they know, about how things look. For example, when children are asked to paint an outdoor scene, they often represent the sky by a strip of blue along the top inch or two of the frame; they know that the sky is up, so that's where the blue belongs. Until someone points out to them that the sky actually reaches all the way down to the horizon, they don't notice that it does.

If our assumptions influence even the seemingly simple act of looking at things, imagine how much they influence our reasoning about complex issues such as health care in general and diabetes management in particular.

Not that it's a problem for me, of course, since my assumptions are always so very reasonable. But you can see how the process could easily lead some people astray...

I can't pretend this biographical anecdote is relevant to anything, but I like it so I'm going to throw it in.

The composer Giacomo Puccini had a sometimes-friendly, sometimes stormy relationship with the hot-tempered conductor Arturo Toscanini. One December, Puccini sent Toscanini a loaf of traditional Italian Christmas bread, and then suddenly remembered that he and Toscanini were not, at that time, on speaking terms. Embarrassed by this memory lapse, Puccini sent Toscanini an explanatory telegram:


He received an immediate reply:


Monday, November 16, 2009  

I know why my blood pressure is up: I have to get up early tomorrow morning and attend three meetings in a row, and I am dreading all three of them. Each of these meetings is with someone who is going to want to know why I haven't concentrated more on what they wanted me to do than on what the other two wanted me to do. It's too bad I couldn't meet with all of them simultaneously and let them fight it out. Well, it can't be helped, so I'll just have to go to all these meetings and hope for the best.

I was asked about why (in a dLife discussion of the "statin wars") I took such a sour view of statin drugs, which many people with diabetes are urged to take. I guess it comes from reading the disappointing later paragraphs of research reports which begin by saying that statin drugs have been proved to be very effective.

I'm not talking about effectiveness in terms of bringing people's cholesterol numbers down. Statins do that, I'm sure. But the reason people want to bring their cholesterol numbers down is that healthy people (people with low rates of heart attack and stroke) have low numbers. The assumption is that, if you can manipulate your body chemistry in such a way as to give yourself the same cholesterol numbers as a healthy person, you will become healthy. This assumption could easily be wrong.

What if healthy people have low numbers because they are healthy, when all along we've been assuming that people with low numbers are healthy because they have low numbers? It could be that manipulating your body chemistry to bring your numbers down amounts to nothing more than a means of faking out the lab. Maybe trying to make yourself healthier by that method is no more effective than trying to make yourself smarter by cheating on an IQ test.

I'd like to see some evidence that statin drugs don't just make your lab report look better -- they also prevent cardiovascular disease. Some studies purport to show that statin drugs do exactly that, but the details of these studies tend to disappoint.

For example, this report:

The headline says "Statins Reduce Risk Of Heart Attack And Stroke In Those Without Heart Disease", which sounds as if someone has disproved the idea that statins only benefit people who have already had a heart attack (and don't do much to help people avoid having their first one). If you read the headline and stop there, you can't help concluding that statins are strong preventive medicine for heart attacks and strokes. Why shouldn't everybody take statins, just to be on the safe side?

But statins cost money, and in some patients they produce side effects which make it very hard to tolerate them. So, it's necessary to do a little bit of cost/benefit analysis before we decide whether or not statins are worth it. And you can't do a cost/benefit analysis unless you know how big the benefit is.

So, if taking statins reduces the risk of heart attack and stroke, exactly how much does it reduce those risks? To get an idea of that, you need to scroll down to this passage:

"Assuming that individuals not taking statins have a 5.7 percent
chance of having a major heart event over a 4.3-year period, statins can reduce that risk to 4 percent, the authors write. 'Therefore, 60 patients would need to be treated for an average of 4.3 years to prevent one major coronary event.' Similarly, 268 patients would need to be treated to prevent one stroke or other major cerebrovascular event; 61 to prevent one non-fatal heart attack; and 93 to prevent one revascularization procedure. Statins are expensive and other therapies also may work to reduce risk, the authors conclude. 'Therefore, even though universal lipid-lowering therapy appears attractive, especially in an intermediate-risk primary prevention population, further studies are needed to clarify the cost-effectiveness of therapy in this group.' "

Now, call me hard to please, but a reduction of heart-attack risk from 5.7% to 4% over a period of more than four years just doesn't seem that dramatic to me, especially if you have to spend those 4 years taking an expensive drug and coping with its side effects. Surely the average patient could get a better improvement than that by exercising and laying off the junk food (and maybe they would actually do so, if they weren't being encouraged to believe that the statins would take care of the problem).

Also, the study notes in passing that "there were no statistically significant differences between the statin and control groups in the rates of patients who died from cardiovascular disease or from all causes". Now, that's what I call a wonder-drug: it prevents heart attacks, but the people who take it die at the same rate as the people who don't!

I don't see how the particulars of this study justify the optimistic headline under which they appear. But then, my income doesn't depend on believing that statins are great. It's only to be expected that I would fail to get with the program. I'm sure I could judge the matter more objectively if I were actually involved in the pharmaceutical industry! 

Saturday, November 14, 2009  

I went to a workshop this morning on Vipassana meditation, which comes from the Buddhist tradition. Vipassana is an untranslatable expression, but it means something like "discernment" or "seeing deeply". What interests me about it is that it is a technique for getting the mind to shut the hell up.

My mind needs shutting up, definitely. Robin Williams probably has less chatter going on in there than I do. This is both an argument in favor of my learning to meditate, and an argument against there being any chance that I could ever learn to do it well.

The human brain operates something like the Windows operating system. There are several application windows open at once, and sometimes an extra  "popup" window opens which you neither expected nor wanted (it may even try to evade your attempts to close it). All in all, too much is happening, and over time more and more things start happening, so that the situation becomes increasingly chaotic and hard to control. Vipassana meditation is about trying to shut down all those extra applications, and allowing only one window at a time (at most) to be open.

So, you sit up straight and close your eyes and relax. A window pops open -- something or other trying to get your attention. It might be a thought, an imagined image, a physical sensation. Whatever it is, you label it ("that's talk", say, or "that's feeling"). Whatever mental process is involved, you categorize it appropriately, and then you focus on it for a few seconds -- in an accepting spirit, forming no judgments about it. And it generally fades away once you do that. The window closes. Once it does, maybe you'll have brief period of mental rest, but probably it won't be long before another window pops open and forces some dopey thought or other into your mind:

I did my best to close all these windows as soon as they popped up, and there were a few brief episodes when I managed to get the screen entirely blank for a while. lt's a start.

I did manage to get something to eat on the way home, and I did manage to take a nap. The nap did last a little too long, and I did have a concern about not being able to finish my trail-run before sunset. I limited the run to a little over six miles, and that got me back to my car just as the sun was setting. It was a beautiful day -- sunny, clear, calm, and with temperatures in the 50s.

Sometimes my hands get numb after a long run, and they did today. I don't know the reason for this. It felt as if my hands were chilled; seemingly it wasn't cold enough for that to be an issue, but maybe it was. I took a long hot shower afterwards, and the numbness went away. Anyone with diabetes is bound to get nervous over any symptom that sounds like neuropathy, but I really shouldn't have to worry about neuropathy with the kind of numbers I've been having lately, and I doubt that neuropathy is the sort of thing that goes away when you take a hot shower. 

Two more cartoons from Zach Weiner:

Friday, November 13, 2009  

I didn't notice until just now that this is Friday the 13th, but it seemed to fit as soon as I realized it. I spent much of the day navigating corporate bureaucratic obstacle-courses (partly having to do with health insurance enrollment) which are too boring to describe here, but which kept me on the phone all afternoon to a series of phone-support people who couldn't help me with a perfectly simple problem. After all that frustration and mouting anger, I'm astonished that my blood pressure wasn't a lot higher than 121/69 when I tested it after dinner, but maybe it was the wine that did that for me. (Dutton Goldfield 2007 Chardonnay, Dutton Ranch Rued Vineyard -- I can't promise that it will do the same for you, but if it does, let me know).

I'm supposed to go to a meditation workshop tomorrow -- it will only work if I can manage to sit there for hours without the phrase "high-deductible" reverberating in my head. But that's the point of meditation as I understand it -- to clear the stupid crap you usually think about out of your head for a little while -- so I might as well embrace the challenge.

It looks as if a theme is developing on the web site This Is Why You're Fat, a photo-gallery of outrageous high-calorie recipes enjoyed (or at least photographed) by people who think they can make wholesome comedy out of unwholesome foods. It used to be that most of the pictures were of incredibly large and greasy meat dishes, but lately it seems as if the trend is toward high-carb recipes. Including, for example, such treats as cupcake kebabs...

...and chocolate-covered potato chips...

...and Powdered Pancake Donut Surprise....

...and chocolate pizza...

...and, finally, an assemblage of sugary ingredients known as "Triflebetes":

"Triflebetes" includes such things as sugar crystals, cotton candy, Butterfinger pieces, melted Caramels, Twinkies, peanut butter mousse, Rice Krispy treats, chocolate syrup, melted candy bar, peppermint cookies, Girl Scout Thin Mints, melted butterscotch... well, maybe I'd better stop there. (Hey, at least I didn't show you the Twinkie Casserole.)

But calling a dessert "Triflebetes" surely has to be significant somehow. It has to say something about our society that we consider diabetes a joke-worthy subject. This is not true of all diseases (we don't kid a lot about cancer, for example), but many disease which are certainly unamusing to those who experience them are nevertheless considered safe to make fun of. Alzheimer's, for example, is definitely a joke disease -- even though most people are living in fear that they, or their parents, will get it.

What determines whether or not a disease is safe to treat as a joke? It's hard to say, but I suspect that we are likeliest to joke about the diseases which we are likeliest to experience ourselves. The greater the risk, the greater the need to make comedy out of it. You only need to whistle past the graveyard if the graveyard is close at hand.

Thursday, November 12, 2009  

Well, the mountain lion didn't get me today either. We went running at lunchtime, and nothing pounced on us. My two faster running buddies got pretty far ahead of me today, so there isn't much doubt about which one of us wouldn't have come back, if any of us didn't.

There's a lesson from nature for you: it isn't necessary to be the fastest deer, but you sure can't afford to be the slowest!

I think it's been an advantage for me, in terms of diabetes management, that I have been working for several years in the test & measurement industry. Being familiar with sophisticated electronic measurement devices has made it easier for me to grasp certain concepts which are crucial to diabetic control -- and which seem to be poorly understood, or entirely misunderstood, by large numbers of people with diabetes.

A lot of people have naive expectations of how accurate a glucose meter is -- and then, when they find out the disappointing truth of the matter, they conclude that the meter's information is useless. Both views are wrong.

I am not so distressed by the limitations of meter accuracy. Naturally I would like it if, when my meter reads "100", I could count on the actual value to be 100, not 99 or 101, and certainly not 90 or 110. I can't count on that. Glucose meters have what is known in my business as a repeatability problem. Test strips vary, so if you use up ten of them testing the same blood, you might get ten different results varying randomly above and below the actual value. Because the variations are random, their effect all but disappears when you take the average of several results. That is why taking multiple data points and averaging them is a classic method of eliminating random noise from a measurement system. People who use home glucose meters must think in terms of averaging: they must learn not to worry too much about small-scale variations from one test to another, and instead focus on larger trends: on average, is my glucose up this week (or this month)? If you're 5 points higher today than you were yesterday, that might mean nothing at all; if your average is up 5 points, though, it could mean a lot.

But an even more important concept I've learned from my industry is the importance of error-correction mechanisms. You don't make an accurate measurement instrument by designing it so perfectly you eliminate all potential sources of error; you make it by determining what the sources of error are, and correcting for them. For example, a receiver is more sensitive at some frequencies than others, but you collect data on those variations in sensitivity, and save that data to the receiver's memory so that it can adjust itself to correct for this known problem.

Self-correcting mechanisms can be very powerful. Science is one gigantic self-correcting mechanism. Any published scientific finding is soon challenged; everyone looks for reasons why it might be wrong. The process can be traumatic for the scientists involved, but over time it allows science to make progress at a remarkable rate.

Diabetes management works best when the patient learns to get into self-correcting mode. If you measure your blood sugar daily, but you do nothing more than sigh over the results, things tend to go from bad to worse. On the other hand, if you measure your blood sugar daily and ask yourself "What can I do differently today that might give me a better result tomorrow?", great improvements become possible.

I guess that's why I'm frustrated by the mindset of so many diabetes patients, who don't grasp the importance of self-correcting mechanisms. They want to be given simple rules about what they can eat -- rules which might turn out to apply very poorly in their case. They have no idea how much more effective it would be to establish, by experiment, what they can eat and what they can't.

Wednesday, November 11, 2009  

A fairly routine day at work. At 2:28 PM, this e-mail was sent out to all employees at the office:

To: Santa Rosa Site Employees
Subject: Mountain Lion Sighted on Santa Rosa Site

A contract employee reported seeing a mountain lion Wednesday morning in the parking lot east of Building 4. The animal appeared to be moving in the direction of bushes near the ball field.

As a precaution, for the time being please avoid walking or jogging alone near the ball field as well as in other open space areas of the property -- especially at dawn or dusk. If you spot a mountain lion, report it immediately to security at X7-2022.   

I'm sorry that most of the overseas visitors we hosted last week were already gone; this little piece of excitement would have made their visit to California that much more memorable. They were from countries where humans are reliably placed at the top of the food chain, so it would have been interesting to watch them process this news. Visitors from Scotland and France might have feared that their California sojourn would involve them in an earthquake, but it probably wouldn't have occurred to them to worry that, when they left the office in the evening, they would have to walk through a parking lot in which a man-eating predator that hunts at dusk had been spotted earlier that day.

Notice that the lion was seen in the morning, but the warning was not issued until mid-afternoon, long after my running-buddies and I had already gone running through the area which the message identified as the danger zone. Come to think of it, my run in the dark last night went through the same neighborhood (I live about a mile from the office). I thought at the time that that section of the run was pretty creepy, mainly because it was so dark. Now I have a reason to be even more creeped out in retrospect.

One of our foreign visitors is still here, so I had an opportunity to tease him about the mountain lion, and I didn't let the opportunity go to waste. That will make me look bad later if he gets eaten (or even if I get eaten), but I think the risk is actually pretty low for both of us.

The death rate from mountain-lion attacks in the US is about 1 per year. The death rate from dog attacks is more than 30 times that high. That we are able to get worked up about the danger posed by mountain lions is yet another example of the human tendency to brood about dramatic but unlikely threats, while ignoring the things that are more likely to get us. There are people who are terrified of plane crashes, but think nothing of driving without a seat belt.

This kind of skewed risk-assessment applies to diseases quite as much as it applies to animal attacks and transportation mishaps. Psychologists who have studied the matter say that most Americans are remarkably unafraid of becoming diabetic, even though they are terrified of diseases that are less likely to afflict them. Sometimes people even use fear of a purely imaginary health threat to justify taking a chance on a horribly real one --as in the case of those parents who have convinced themselves, against overwhelming evidence to the contrary, that vaccination causes autism. 

I'm not claiming that my own fear-based thinking is more realistic than other people's. Fear-based thinking is unrealistic in general. From time to time, we all ought to remind ourselves not to concentrate our concern on the least probable of the threats we face.

Tuesday, November 10, 2009  

Okay, blood sugar is down, and blood pressure is down. Weight isn't, but that takes longer to change.

It was almost a month ago that I left for Scotland, and I was there for two weeks. It was pretty much inevitable that I would be eating more while I was traveling, because every time I ate, it was in a restaurant. I didn't worry about it too much, because my blood sugar was staying under good control, but I figured I would probably gain some pounds as a result. The problem was that, during the two weeks I was away from home, I slid quite comfortably into the habit of eating more, and didn't snap out of it when the holiday was over. Also, after I got home I had several social dinners scheduled, including some parties related to work, and then a weekend out of town.

On the whole it is a blessing that I am capable of keeping my blood sugar in the normal range even when I'm eating more than I ought to -- but it is also a curse, because over the years since I was diagnosed, I learned to adopt a way of life in which my eating habits were dictated mainly by my glucose test results. I have been operating on the assumption that, so long as my glucose meter is happy, I can't be eating too much. That used to be a pretty safe assumption -- in fact, I originally lost a lot of weight because I was eating in such a way as to bring my glucose results down; the weight loss was a side effect of that. That I am now able to keep my glucose down, even when I'm eating enough to gain weight, is a sign of progress, of course, but the progress will be lost if I just let that trend take its natural course. It isn't enough to keep my glucose meter happy -- I have to keep my bathroom scale happy, too!

I wasn't able to run at lunchtime today, so I did another night run, and a longer, hillier one this time. I think the nighttime run is the reason my blood pressure is down tonight. I'm not sure exactly why, but a really hard workout brings your blood pressure way up while you're doing it, and then brings it way down as soon as you rest afterwards. It sounds as if the net effect would be no better than skipping the run entirely, but keep in mind that the run itself is brief, and the pressure-reducing aftereffect of it is lengthy. It's a net gain.

When I did a night run on Sunday, the experience seemed a little creepy but also beautiful. This time the creepiness held up better than the beauty did. That may have been because it was colder, or because the route this time included a neighborhood which was darker (replacing broken street lights is, to put it mildy, a low priority for the people who run my city). Also, the dark neighborhood included a long passage with no sidewalk, only a bike lane which had no physical separation from traffic. Maybe nighttime running isn't something I should do a lot of, at least on that route!   

Monday,  November 9, 2009  

Blood pressure and weight still up; blood sugar falling slightly. I have my work cut out for me.

A lot of newly-diagnosed diabetes patients post questions on the dLife forum about what the "rules" are. Questions such as "how much carbohydrate can I have in a meal?". To ask the question at all implies that it has a simple, universal answer which anyone can rely on. Why would you ask, unless you thought that such an answer existed?

To me, getting a question like that is like getting a cell-phone call from a driver who says "I'm lost -- should I turn right or left at the T intersection up ahead?". How can I tell you that, when I don't know where you are or where you're going?

To the extent that there are rules in the diabetes-management game, they are individual rules, not universal rules. How much carbohydrate you can handle is not the amount of carbohydrate I can handle. My rules wouldn't work for you, and your rules wouldn't work for me.

The rules of diabetes management have to be discovered experimentally, not looked up. Asking around is pointless. You have to see what works for you, and what doesn't. 

That a certain approach worked for somebody else doesn't mean it will work for you. There's no harm in trying it out (how else are you going to find out if it does work for you?), but there's plenty of harm in clinging to it after it fails you, simply because you imagine it must be the right thing to do. It's the right thing for somebody, no doubt! But if you can't find any evidence that you are that lucky person, be prepared to drop it and move on.

This applies to many questions that people ask about diabetes management. How much weight do I need to lose? How much exercise do I have to do? Is it okay to eat oatmeal? Sorry, but nobody can answer those questions for you on a purely theoretical basis. You have to answer them for yourself, on a purely experimental basis.

If you can eat oatmeal without getting bad test results later, great. If you can't, then don't eat oatmeal. Don't bother asking asking anybody else if it's okay to eat oatmeal. Ask your meter.

And keep on asking your meter from time to time! Situations change.

Sunday, November 8, 2009  

91 is a pretty good fasting result, considering that yesterday I did a lot of eating and drinking, without doing any exercising. I spent the weekend at my brother's home, in the hills east of Placerville, California -- very near the site where the nugget was found that touched off the California gold rush. The region used to be referred to as "gold country" -- but it's wine country these days, and we spent yesterday visiting wineries in the area. It was interesting to compare the wine country of El Dorado county with the wine country I'm more familiar with, in Sonoma and Napa counties. One obvious difference is that the altitude is much higher.

The elevation difference means that the climate is a good deal cooler, so there is a lot more in the way of fall color in the vineyards up there.

The cooler climate also means that certain grape varieties which don't grow very well in Sonoma County can be grown more successfully up there. In the tasting rooms I saw a lot of Mourvedre and Rousanne, and one place even had a Sauvignon Vert (a grape which is cultivated in a few regions in Italy, but is almost unknown in California).

Another difference I couldn't help noticing is that the wines of El Dorado are a better value than the wines of Sonoma County. For whatever reason, you don't have to pay as much for quality wines up there. Maybe that's just because land doesn't cost as much there. But it very well could be that wineries in Sonoma and Napa charge more simply because they can get away with it. The better-known a wine region becomes, the more expensive its wines become. That's why wine-lovers are always looking for up-and-coming wine regions that haven't been "discovered" yet. Once the wines of a particular region start winning a lot of awards and start receiving a lot of attention from wine writers, it becomes a lot harder to find any bargains there. So please forget that I told you they're making good wine in El Dorado county!

As yesterday was a rest day from exercise (and a very self-indulgent rest day at that), it wouldn't have been a good idea to skip exercising today as well. However, by the time I got around to addressing the issue, my gym was getting ready to close early (as it does on Sundays), and exercising outdoors didn't seem feasible, because it was getting dark. However, when I stopped to ask myself why I couldn't go for a run in the dark, I realized that there wasn't any good reason. From my house it is possible to go for a very hilly, but perfectly safe, night-time run. I would be on sidewalks almost all the way, and I had a head-lamp that I could wear. I still felt vaguely uncomfortable with the idea, but ultimately I was able to talk myself into it.

Once I got out there, of course, it was great. The cold night-air, the stars, and the great views of the city from the road along the ridge were all magical. My headlamp only illuminated a small area immediately around me -- beyond that was blackness. It reminded me of a night-time scuba dive I did once. The shark risk was much lower this time, however.

My blood pressure's been up lately, probably because of some work stress I'm going through right now. I'll see if I can get it under control.

Wednesday, November 4, 2009  

Blood sugar up and weight up -- not good trends, but I'm sure I can get both of them turned around.

Last night was a kind of business-social dinner. A bunch of employees from Scotland, Germany, France, Japan, China, Taiwan, Korea, Mexico, and Brazil were visiting the office for a training event, and many of these people I will need to collaborate with on the project I've joined. To help us all get acquainted, the company put on a dinner for us at a local hotel. The food that was provided was good but definitely high-carb, and exercising restraint at social dinners is not one of my strong suits.

I tried to make up for it today, a little bit, by doing an unusually difficult run today, with a very steep hill-climb. I also cut the carbs down today. We'll see if there's any reduction in fasting glucose tomorrow. Weight won't be down, though -- that takes time to correct.

I've always liked this Bizarro cartoon:

I'm not sure fast food will ever become quite so generic that it has no definite price, but most of it is generic enough that it might as well be sold as "hot food, a big drink and dessert". 

Tuesday, November 3, 2009  

No time tonight! I came home late from an evening out with a bunch of visiting employees from Scotland and other distant places. (We're having a big training event at work and people are there from all over the globe.) Maybe I'll have time to post something more substantial tomorrow.

Monday, November 2, 2009  

Yesterday I was still feeling sore (mostly in the quadriceps muscles) from the half-marathon on Saturday, but the soreness was much reduced by this morning, and I saw no reason not to try going for a run at lunchtime today. So I tried it, and it wasn't a problem. My hips were protesting a little during the first mile or so, but as I settled into the run my hips started feeling better rather than worse. The run seemed to be therapeutic. Whatever soreness and stiffness the run didn't cure, the yoga session in the evening did.

So, I have no real regrets about running a half-marathon without training for it. I just don't think I'll do it that way next time.

The weather was warmer than I would expect at this time of year -- sunny and 80 degrees. It was hard to cool down after the run. At work we have several employees visiting from Scotland this week, and they're a good deal more startled by the warm weather than I am. They're finding themselves eating outdoors, in their shirtsleeves, in November, and calling home on their cell phones to report this surreal experience to family members.

Even though I am a strong advocate of regular glucose testing, on the theory that any data is better than no data, I think we need to be aware of the limitations on what glucose testing can tell us.

Of course, most of us are fully aware that a glucose test result is only a snapshot of a moving target, and that it can't tell us what is going on during all those other moments in the 24 cycle when we aren't testing. But the test's limitations are more severe than that.

A glucose test which says that your blood sugar is in the normal range does not tell you anything about how hard your endocrine system had to work to get you into the normal range, or how close it came to failing in that effort. How insulin-resistant are you? How much extra insulin did your pancreas have to produce in order to overcome that insulin resistance? How much trouble does the pancreas have in producing that much insulin? How close is your pancreas to being unable to produce that much insulin? A glucose test answers none of those questions.

Being told that your glucose measured normal this morning is sort of like being told that the company you work for was able to make its payroll last Friday. That's good news, as far as it goes, but you can't assess the financial health of a company just by asking whether or not it was able to make its most recent payroll. (How much trouble did the company have making its payroll? Did they just squeak by?) The fact that a company was able to pay its employees recently without writing any bad checks doesn't mean that the company is financially sound; it doesn't mean that they can make the next payroll.

In terms of managing Type 2 diabetes, the three things we would most like to know are: (1) how insulin-resistant are we, (2) how much insulin does it take to overcome that amount of insulin resistance, and (3) how much "headroom" is there between the amount of insulin we need to get by and the amount of insulin we are actually able to produce? Unfortunately, glucose testing is not able to answer any of those three questions directly. We can guess at the answers to those questions, and the glucose test results allow us to make informed guesses rather than wild guesses -- but guesses they remain. All we really know is whether or not we were able to make payroll. It doesn't leave a lot of room for complacency!

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