Monday, October 31, 2011

I usually get a fasting result lower than 94, but yesterday was a rest day, and I probably indulged in too many carbs while recovering from the half-marathon on Saturday, so a bump has to be expected. Anyway, I got a low result after lunch today, so I assume I'm back on track!

The half-marathon went fine. I'm extremely relieved to report that my questionable right knee -- and all the other parts of me that could have let me down -- got through the race without any trouble. I felt fine all the way to the end.

The race didn't even feel all that long, strange as that may sound. During the thirteenth and final mile, I was certainly feeling ready for the race to be over, but I wasn't dying for it to be over. I wasn't exhausted; I just was taking the view (a reasonable view, I would argue) that thirteen miles of running is just about far enough.

Part of the reason I felt good to the end, very likely, is that I took more care about hydration than usual. I wore a Camelback water bag, and drank from it regularly during the race; also, at each of the water stops along the route, I drank whatever was in the Dixie cups that the volunteers were handing over to me (usually it was just water, but occasionally it was some kind of sports drink).

Thinking that this might be an event worth remembering, or at least blogging about, I decided to take a digital camera with me and take a lot of photos along the route. I knew that most of them would be blurred by running motion, no matter how fast I set the shutter speed, but some of them would be clear, and I could use them.

The race route was mainly in the Dry Creek Valley (just northwest of Healdsburg, California), which is a beautiful place:

But of course that's what it looked like later in the morning, when the sun was well above the horizon. When the race started, the sun was not yet a factor. The race started at the Francis Ford Coppola winery, and we assembled there in the dark. As we waited for the race to start (it actually started late, because of parking/transportation problems), the eastern horizon started to get a little bit of a red glow.

There were 2400 of us. I don't know if you've ever gone to a winery in the dark and stood in close quarters with 2399 other people to wait for the dawn, but it's a pretty atmospheric experience.

Finally the race started, and we charged out of the front gate of the winery, trying not to trip on anything in the very dim light.

Soon it became light enough for it to be fairly easy to see where we were going.

And then a warm glow started showing up on the hillsides. Could sunshine be far away?

Next: a few dramatic shafts of red light, like searchlight beams checking out these crazy running people.

And then the searchlight beam got wider...

...and wider still.

It was day, all right!

I've always liked the opportunity to cast a 100-foot shadow.

About 5 miles in, we crossed the Lambert Bridge...

...and headed over to the west side of the valley. By this point it was already starting to be clear to me that my picture-snapping was affecting my running pace, and I was definitely going to be slower this time than I was on my last half-marathon in July.

Oh, well. My real objective was to finish this race without hurting myself, and enjoy the experience. I achieved both of those objectives.

At the seven-mile point, near the Quivira winery, there was actually a booth set up, offering sips of wine to the runners as they went past. I knew better than to take them up on it. It sounds like it might be a fun thing to tell people you did, after the fact, but there is no worse mistake during a race than giving your stomach something it isn't asking for. And my stomach certainly wasn't asking for alcohol. I realize that the winner of the first modern marathon, in 1896, stopped for a glass of wine along the way -- but that doesn't mean it would be a good strategy for me.

Distance running -- a sport which used to be largely closed to female athletes -- is well on its way to becoming a female-dominated sport. The organizers reported that 70% of the runners in this race were women, which is pretty incredible. The reason for it, I believe, is that when women sign up to do something like this, they do it along with a bunch of their friends. When I got in the bus that took us to the race start, a half-dozen women got on the bus dressed as bees (the race takes place around Halloween, so a lot of the runners wear costumes). One of the bee-ladies expressed her concern about sitting down on the bus: "my stinger's going to get bent!", she said.

Around mile 10, a woman came by from the opposite direction on a bicycle, seemingly after having already passed hundreds of runners with race numbers pinned to their shirts, and asked us, "Are you guys all together?". We told her it was a family reunion.

Ah -- the twelve-mile point! Almost done. By this point we could actually hear the over-amplifed voice of the over-enthusiastic announcer at the race finish.

And then you have the unbelievable relief of crossing the finish line.

This being a wine-country event, there was a party afterward, with a wine-tasting.

Several local wineries (whose vineyards we had just run through) were pouring us samples of their wares.

I didn't over-do it, I swear. But you'd be surprised how much better a Dry Creek Zinfandel can taste after you've run 13 miles.

I was a couple of minutes slower for this half-marathon than I was for the last one in July, but I enjoyed this one a lot more, and I've decided that's what counts!

Friday, October 28, 2011

Okay, so tomorrow is the half-marathon race, and today I went down to the host hotel for the event, to go to the expo and pick up my bib-number.

You pin this thing to your shirt; it has a timing chip glued to the back of it, so that they can detect you going over sensors at the start and finish of the race, and capture your finish-time accurately. I know it looks like a piece of paper, but it's actually made of something more durable and sweat-proof (at the end of the race it will still be in one piece). 

I also picked up the running shirt that comes with the price of registering for the race. Picking up the shirt is always a suspenseful moment; you are very conscious of its being among the most expensive sports shirts you will ever own, as well as being a souvenir of the event -- and you want it to be a cool design. About 20% of the time it is cool. This one, I must say, belongs among the 80%. Here's a closeup of the art:

I find the figure at the upper right (apparently Frankenstein's monster) especially amateurish. If you have to mark it with an "F" to help people get the idea, something's wrong.

Also, the shirt is white -- and white running shirts, in my experience, tend not to remain very white for very long.

Yeah, yeah, you don't do the race for the sake of the shirt. But it wouldn't have killed them to come up with a cool design.

As the race tomorrow is an expensive one, it occurred to me to wonder whether any of the money goes to support a philanthropic cause. I looked it up today: the race supports (I don't know to what degree) Breast Cancer Fund, which works to identify and eliminate environmental causes of breast cancer, as well as two local programs which promote running for young people. I suspect that most of the money goes to support the continued existence of Destination Races (the organizers of this and other running events -- or, to quote their slogan, "Cool Races in Beautiful Places"). Oh, well -- somebody needs to keep putting on these events, and no doubt it's expensive to do so.

You're suppsoed to "carb-load" -- or at least eat more carbs than usual -- before an endurance run. Risking a spike, I had mashed potatoes with lunch today, and still (somehow) got only a 104 afterward. I'm not sure why that worked out as well as it did, especially as I didn't run before lunch today -- but I did do weight-training last night, and that may have a protective effect. Unfortunately, I don't have time to speculate further on this point. I'm not staying up late trying to create an interesting blog tonight -- I have to be up well before the sun for the race tomorrow.

Thursday, October 27, 2011

Meet the future of the Oral Glucose Tolerance Test:

Apparently clinicians have been finding that there is a practical problem involved in handing patients a cup containing 75 grams of liquid glucose and expecting them to yum-yum it right down. The problem, to be specific, is that 75 grams of pure glucose is absolutely disgusting, and when people try to swallow something like that they tend to become nauseated. Perhaps not nauseated enough to vomit it back up (most of the time), but certainly nauseated enough to be disagreeable company for those who must share close quarters with them in the clinic while the test is going on.

So now, someone has had the bright idea of asking patients to eat actual food -- something they might eat in the course of their daily lives -- to see how that affects their blood sugar. Obviously, it can't be some low-carb treat -- a plate of salami and cheese isn't going to be enough of a challenge to glycemic control. The food has to be something that has a great potential to drive blood sugar sky-high. And it also has to be something that people are used to eating, so that it won't make them throw up.

Well, what could be a better choice than the muffin -- a popular carbohydrate-bomb which, these days, resembles a basket of laundry not only in shape, but also in size?

The doctors in the Bronx who studied this found that they could get pretty much the same results by having patients eat a large muffin as by having them drink a bottle of glucose solution -- and the muffin was cheaper, and didn't make people sick. Everybody wins!

Unfortunately, the idea is being received with skepticism in some circles. A bottle of glucose solution contains a standardized quantity of carbohydrate. Who knows how much carbohydrate is in any one muffin, and how much of it is in sugar form rather than starch form?

After all, muffins aren't standardized! Some are chocolate...

...some are blueberry...

...and some are stuffed with everything the cook could get hold of, including tiny starchy bears -- or pigs -- or whatever those things are in the picture.

Who's to say what counts as a Standard Muffin? How do you know whether the muffin you've got hold of is Metric or not? Perhaps, if one patient passed the test and the other failed it, the explanation is that the patient who failed it had a higher-carb muffin.

As for me, I tend to see muffins as something I'm only entitled to eat after I've done an exceptionally long workout. After the half-marathon on Saturday, I may very well treat myself to a muffin -- but on more ordinary days I wouldn't dare. This morning someone brought croissants to work and offered me one, and I practically fled the building.

There's a time and a place for everything.

Wednesday, October 26, 2011

I know it's boring to keep saying how sunny and beautiful and perfect-for-running the weather has been around here lately, but that's how it still is. And the best part is that it's expected to keep on being that way for several days, so my Saturday-morning half-marathon race ought to happen under ideal conditions.

One of my running buddies is now trying to talk me into running another full-length marathon. What's going on, of course, is that he wants to run another one himself (the Napa Marathon in March), and he needs a training buddy. It's almost impossible to do this sort of thing on your own; I doubt many people run marathons who didn't train for it with someone else or some group.

He's pretty good at talking me into things (including marathons, as he was the guy who talked me into running my first marathon, back in 2005), but he's going to have a harder time than usual talking me into this one. I told him I haven't forgotten how much it hurt when I had to climb into his SUV after the last marathon we did. It was the 2009 Napa Marathon, and it rained the whole way, and my rain-soaked clothes were chafing me, and my discomfort over the soggy, clinging, abrasive clothes was affecting my running form -- which in turn made the running harder on my muscles and joints, so that I was hurting a lot more than I should have been. All in all it was such a miserable experience that it left me feeling pretty sour about the marathon concept in general. And the passage of nearly three years since then has not completely erased the memory.

A full marathon is 26 miles, and in case you're in any doubt about whether that is a long way to run, I can assure you that it's a long way indeed. Actually, 13 miles (which is what I'm signed up to do on Saturday morning) is still a long way to run, but it's something I can handle without too much trauma and without having to do an extraordinary amount of training. A full marathon is a lot more than twice as much of a commitment, because the training program for it is so difficult and takes up so much of your time during the three months or so leading up to race day.

The real challenge of marathon-running is not fatigue, if you ask me. (If you actually do all the required training, you can build up enough stamina to run 26 miles without becoming exhausted before you reach the end.) But exhaustion is a predictable and manageable thing; trauma really is not. You can't be sure how well your knees, hips, or quadriceps muscles are going to stand up to the strain; you can't know what will be hurting and how much. It's a safe bet that you'll be sore somewhere, but whether the problem is going to be something minor that you can laugh off, or something that is really going to make you hurt for a long while afterwards, is impossible to predict. You can only find out by trying it and seeing what happens. Which is scary, because what if you don't like what happens?

I think it's been good for me to be engaged in exercise that challenges me -- but I'm not sure it's really necessary for it to be that challenging.

I'm not sure why my glucose was so low after lunch (the lunch did include some carbs); my guess is that it was low because the run I did beforehand involved a lot of tough hill-climbing, and I ran it a little faster than I usually do. But post-prandial testing seems to be so volatile -- and is affected by so many factors -- that it's seldom easy to be sure why any one result was higher or lower than you thought it would be.

The folks at Google -- or at least their search algorithms -- have been referring people to this site, even when they were clearly searching for things which they are most unlikely to find here:

That last one is not only incorrect but insulting. We don't traffic in that kind of bigoted thinking here at Not Medicated Yet, and I'll thank Google to remember that in future.

A couple of other search requests seemed more relevant.

I'm not sure what level of hyperglycemia will sweeten your urine to the point where you become a superstar in the insect world, but any special interest shown in your urine by ants and bees is considered -- and has been considered for more than 3000 years -- a really bad sign. (Not many medical sites you visit will be as frank as I am about telling you that "diabetes mellitus" is best translated as "pissing honey", but that is unquestionably the idea behind this hybrid Greek/Latin medical phrase.)

If your hemoglobin A1c test result is 9.5, I have to assume that your urine is getting pretty sweet -- not quite sweet enough for evil corporations to want to market it to children, perhaps, but sweet enough for creepy little arthropods to take notice.

So, what it means if your A1c is 9.5, or if you can't take a leak on a camping trip without attracting the wrong crowd, is that your blood sugar is totally out of control. The first things you can do about it are to reduce (perhaps very sharply) your carbohydrate intake, and increase (perhaps very uncomfortably) your level of physical activity. But unless that gets you a lot closer to normal in a matter of weeks, you're going to need help from the pharmacy. Obviously I'm no fan of the pharmacy-centric approach to diabetes management, but when the bees start to think you're made of nectar, it is time to acknowledge that desperate times call for desperate measures.

Tuesday, October 25, 2011

Now that I can run without anything hurting, I have to decide how much running to do in advance of the half-marathon on Saturday. You're supposed to "taper" (gradually reduce the amount of training you're doing) during the last week before an endurance event, so that when race day arrives you'll be going into the race with energy in reserve and no sore muscles. All the same, it's hard to know how much to taper off, and hard to make yourself do it at all. You feel as if you're not training enough, and getting out of shape.

The four-miler I did today is what I would consider a minimal run; I guess I'll do a longer run tomorrow, and then start tapering.

Well, how's this for balanced reporting? Medscape ran both of these articles within 24 hours of each other:

Obesity Affects Influenza Vaccine Response
October 25, 2011 -- As the influenza season opens this month, researchers at the University of North Carolina at Chapel Hill warn for the first time that obese individuals may be getting less protection from vaccines than healthy-weight people. They reported their conclusions in an article published online October 25 in the International Journal of Obesity. In an ongoing study involving patients getting vaccinated at an academic outpatient center, results from the first 2 years indicate that higher body mass index (BMI) is associated with a larger drop in influenza antibodies 12 months after vaccination with trivalent influenza vaccine. Previous research had linked obesity to risk for influenza infection, but this is the first time researchers have tested for antibodies a year after vaccination.

Obese Individuals Respond Just as Well to Flu Vaccine
October 24, 2011 (Boston, Massachusetts) -- It appears that body mass and obesity do not adversely affect the immune response to influenza vaccine. In fact, seroconversion to one component in the vaccine actually increased, Laura Coleman, PhD, RD, associate research scientist at the Epidemiology Research Center of the Marshfield Clinic Research Foundation in Wisconsin, reported during a poster session here at the Infectious Diseases Society of America (IDSA) 49th Annual Meeting.

Medical research charges ahead at an ever-faster pace; as the article saying obesity makes flu vaccine less effective is newer by one day than the article saying obesity does not make flu vaccine less effective, I guess we are forced to conclude that obesity makes flu vaccine less effective.

This sort of thing drives me nuts. It's not just that different studies yield different results -- what bothers me is that contradictory studies are presented without acnowledgement of each other, even when they are published in the same place a day apart. It's up to us to sort it out, and guess who (if anyone) is right.

I suspect that the New York Times would not report that a foreign leader gave a speech at the United Nations on Tuesday, after having reported his death on Monday, without feeling the need to explain the contradiction. In science reporting, this sort of conscientiousness is not considered necessary. But why isn't it necessary? Can it be that editors assume that scientific studies are mere expressions of opinion -- and that one opinion is as good as another? I thought the point of science was to arrive at a conclusion that is independent of opinion.

When two scientific studies disagree sharply, the issue of why the studies disagree becomes more interesting and important than either of the studies is on its own. If you're not going to address the reason for the disagreement between the two studies, why bother publishing either of them? 

Monday, October 24, 2011

Why People Live In California...

Here's the local forecast for the week:

Actually, I don't have a great deal of confidence that the weather is going to be exactly as forecast, but it's certainly been nice here lately. The weekend was spectacular; clear skies and temperatures in the high 80s. Lots of people outdoors enjoying it.

Not bad for late October.

Monday is not usually a rest day for me, but I feel more than entitled to it. I didn't have a rest day last week, and I worked out mighty hard on the weekend. 

On Saturday I did a long trail-run (10.4 miles). I knew I needed to get in another long training run, if I was going to be in any kind of condition for Saturday's half-marathon. But I was scared of doing it, because the knee I banged up last month had been so sore and wobbly after the 9.3-mile run the previous weekend. If that happened again, my ability to participate in the race was going to be very much in doubt.

Fortunately, nothing like that happened this time. My knee felt fine, both during and after the run. The only problem I really had was dehydration, from running in the warm weather. I carried a 1.5-liter Camelback with me and drank almost all of it, but even so I lost 5 pounds of water weight during the run. (Good thing the race next Saturday will begin at dawn; I'm sure I won't have that kind of heat to deal with.)

And then, on Sunday, I did a 22-mile bike ride. It sounds like overkill, and it was -- but I've been trying to get back into cycling, and events keep getting in my way. Sunday I had a chance to go for a ride with a friend of mine, in the Dry Creek Valley wine-growing region just northwest of Healdsburg. The weather was even more spectacular on Sunday than it had been on Saturday. It was a really beautiful ride. 

There's something about vineyards. The sight of them calms me in a way that the sight of other agricultural artifacts does not. A field of corn or cabbage leaves me feeling about the same way I did before, but a vineyard makes me feel as if humanity has a purpose.

22 miles really isn't long for a bike ride, but I'm out of practice and my cycling muscles were complaining, so I asked my friend if we could keep this one brief, just in case the ride was going to screw up my knee in a way that the run had not. Fortunately, my knee felt good after the ride, too.

I don't know that this proves I'm indestructible, exactly, but I'm no longer especially worried about being able to complete the race come Saturday. I'll get through it somehow! I probably won't be fast, but I'll get through it.

I've been reading a lot of angry complaints -- and jokes -- about the town of Hull, Wisconsin (population 5,500) which is supposedly trying to "ban" or "criminalize" pedestrians and cyclists.

A typical on-line summary of the situation: "In what is not an alternative draft of the screenplay for Footloose but an actual news item, a town in Wisconsin has moved to solve its bicycle and pedestrian safety issues by making a simple law: No more walking and biking. It looks like the city of Hull may just become the least green city in the entire world."

There are on-line petititons you can sign, if you wish, telling the city government of Hull what horrible people they are to consider such a thing.

Happy as I usually am to make fun of politicians with outrageous policy proposals, I like to find out first if they really are proposing what they are said to be proposing. Perhaps they're being misrepresented. Sometimes, of course, when you hear the politicians' own words, you have to admit that the charges of extremism seem pretty fair. Exhibit A: the inspiring words of presidential candidate Rick Santorum:

"One of the things I will talk about that no president has talked about before is I think the dangers of contraception in this country, the whole sexual libertine idea ... Many in the Christian faith have said, "Well, that's okay ... contraception's okay." It's not okay because it's a license to do things in the sexual realm that is counter to how things are supposed to be. They're supposed to be within marriage, for purposes that are, yes, conjugal ... but also procreative. That's the perfect way that a sexual union should happen. We take any part of that out, we diminish the act. And if you can take one part out that's not for purposes of procreation, that's not one of the reasons, then you diminish this very special bond between men and women, so why can't you take other parts of that out? And all of a sudden, it becomes deconstructed to the point where it's simply pleasure." 

You are free to decide for yourself how much you agree with a man who thinks the nation is endangered by married people having sex for pleasure; the important thing is that you know whether or not he actually does hold that view before you judge him for it (I was able to verify that he really did say that, with video cameras rolling).

However, do the folks in Hull, Wisonsin, actually hold the extremist views that are being attributed to them? Have they really proposed "a simple law: no more walking and biking"?

I haven't been able to locate the text of the proposed law, but the various press accounts I've read suggest that (1) yeah, they seem to be reacting rather stupidly to a largely-imaginary safety problem (there have been no accidents involving either a bike or a pedestrian in Hull in the past three years), and (2) it doesn't sound as if they are actually trying to criminalize walking and biking. It sounds as if they are trying to prevent groups of walkers, runners, or cyclists from using the busier streets of the town, without getting a special permit first. I don't know how much of a problem a town with a population of 5,500 could be having with groups of people walking, running, or cycling together down its busier streets. But it sounds as if groups, not individuals trying to get to work without driving, were the actual target.

No question about it, most city governments do tend to take it for granted that roads exist only for drivers to use, and every one else had better stay home. In many communities, getting around by human-powered methods of transportation is simply unsafe, because of the way the roads are either designed or maintained. (Any road obstruction or damage which blocks drivers is immediately cleared, because a thing like that is seen as an emergency. If it only blocks cyclists or pedestrians, however, nothing needs to be done about it.)

No doubt the city government of Hull is looking at this from the usual point of view -- that only drivers matter, and that any conflict between drivers and non-drivers must be resolved by chasing away the non-drivers -- but it doesn't appear that they are actually saying "no more walking and biking".

However, I do want to know how many people have to be riding bikes together, or walking together, before they constitute a "group" that needs to apply for a permit. Can families not walk or bike together? If not, would that not represent a threat to the family? Not as big a threat as married people experiencing pleasure, of course, but a threat just the same!


Friday, October 21, 2011

The world was supposed to end today, at least according to Harold Camping, the loon who persuaded a bunch of fellow loons that the Rapture was going to happen back on May 21. When that prediction failed, he said that the May 21 event was only a kind of spiritual Ratpure, with no effects visible to the naked eye; the real thing, the genuine end of the world, wouldn't happen until October 21.

Well, now it's October 21, and so far I don't notice any difference. Unless it's all going to happen just before midnight, I think he got the date wrong for the second time. The second time this year, I mean -- he's done it in years past, too. Apparently he operates by convincing people to give away their money -- preferably to him. With the world coming to an end, what's the point of holding on to your dollars?

What I want to know is, what's the point of not holding on to your dollars? If the world is ending, giving away your money won't benefit anyone else. And if it turns out that the world really isn't ending, giving away your money won't benefit you. Either way, no good can come of giving away your money.  

I'm not sure these people are thinking it through.  

Another lovely day here in Sonoma County; sunny and clear, but cool enough to be ideally comfortable for running. I decided to take my chances on trying a run, to see if my knee could take it. The strange thing, during the first half of the run, was that my knee was probably the most comfortable part of my body. After two weight-training workouts this week, I was sore pretty much everywhere else, but my knee felt fine.

After I got over the steepest hill, about 2 miles into the run, I did start to feel a little twinge of weakness in the knee, but nothing bad. I'll try a long run tomorrow, and see how that goes. If it leaves me limping, it won't bode well for the half-marathon a week later. I'm keeping my fingers crossed.

My low glucose numbers lately are presumably the result of eating some mighty low-carb meals lately (meat or fish and vegetables, but very little in the way of starch). As I've said before, this approach is great for glycemic control, not so great for weight control. The other approach I try periodically (low-fat vegetarian) --  is great for weight control, not so great for glycemic control. Compromises between these two extremes tend not to be great at anything.

The strange thing is that the low-carb approach is always presented as if it worked great for gylcemic control and weight control; presumably it does work that way for some people. I guess I'm not some people. I think the problem is that giving up bread or potatoes in a meal leads me to make up for it (and then some) by eating more meat or cheese.

A lot of the reason for success or failure on a particular diet has to do with what it asks you to give up, and how you feel about that. Meat isn't something I particularly crave if I don't have it. If I go without it for a long period, I'm not spending that whole time drooling over the steaks I'm not eating. Bread and potatoes, though --  those are things I really miss, if I'm not having them. I can't walk past a bakery as calmly as I walk past a barbecue.

But for now, I think I'm going to stick with the low-carb approach for the glycemic benefits, and see if I can find a way to make it less fattening.

This week, psychiatrists at a conference of the Canadian Psychiatric Association were told that exercise is "an effective, but potentially underused, treatment option for mental illness".

Apparently there have been a variety of studies showing that exercise is an effective treatment against anxiety, depression, and even schizophrenia. Also, psychiatric patients have an especially high risk of "lifestyle" health problems which are relieved by exercise.

Incidentally, the word "schizophrenia" may be the most misunderstood term in medicine, because it is so often translated as "split personality" -- people think it means a person who alternates between two distinct personalities. Actually, it refers to a disintegration of the mind, in which various functions of the brain lose all coordination with one another. The result is that the patient's thoughts, feelings, and sensory perceptions are chaotic. The words and actions of schizophrenia patients are often so disordered that onlookers are unable to see any pattern in them -- as in this specimen of embroidery made by a schizophrenia patient:

It isn't about having two personalities -- it's about having one personality that has come apart into many little pieces.

But apparently exercise helps with it. At least, I exercise a lot -- and just look at how orderly my mind is!

Thursday, October 20, 2011

My knee felt even better today -- but I still figured I ought to give it one more day before I try running again. I'll run tomorrow and see how it goes. If it goes well, I'll do a long run over the weekend (so that I can get in one more really long training run before the half-marathon the following weekend).

I had a pretty low-carb dinner last night, and another one tonight. If you're wondering why my glucose tests were unusually low today, that is probably the reason.

Recently someone searched on the phrase "will flushing kidneys get rid of extra sugar in urine?", and Google referred them to my site. I doubt that the person who entered that question found a good answer to it here, but I feel like addressing the issue, now that I have been made aware that there is someone on the planet who thinks the answer to that question would be worth finding out.

The question makes my heart sink, of course, because of what it implies about that person's state of mind.

If your urine is sugary, this is regarded as a medical problem -- but it's not regarded as a problem because sugar harms your urine. (Staying healthy is not about protecting your urine from harm.) The reason that sugary urine matters is that it's an indicator of dangerously sugary blood.

When your blood sugar is extremely elevated, your kidneys try to get rid of it by transferring it from your blood to your urine. In order to get rid of it faster, your kidneys go into overdrive, and you produce urine at a faster rate than normal. One consequence of this is that you become unable to sleep through the night without urinating. When your doctor asks you if you've been getting up in the middle of the night to relieve your bladder, that's the reason for the question -- it's considered a warning sign of diabetes. (Being chronically thirsty is also considered a warning sign of diabetes -- it may mean you're not drinking water as fast as you're peeing it out.)

Once you have the symptom of sugary urine, the problem you need to work on actually has nothing to do with your urine. Drinking extraordinarily large amounts of water may make the concentration of sugar in a given volume of your urine a little lower, but so what? That would only mean you are diluting the sugar that your kidneys are extracting from the bloodstream, by adding more water to your urine. It wouldn't make the real problem -- high blood sugar -- any less serious.

There is a kind of magical thinking which patients -- and a lot of doctors, too -- are often vulnerable to: as soon as we identify a measurable indicator of trouble (such as high blood sugar, high LDL cholesterol, or sugar in the urine), we try to think of a way to make the indicator go away, instead of making the underlying problem go away.

If you have sugary urine, diluting the sugar by increasing your urine volume is not the solution -- because the problem you have is not really a urine problem.

Wednesday, October 19, 2011

My knee felt better today than yesterday, but I stuck to the program, and went to the gym instead of running. I probably need to give my knee one more non-running day for healing purposes.

My workout was on one of those flywheel exercise bikes they use in the spin classes. It didn't seem all that hard while I was doing it (although it did make me sweat), but my legs were made of rubber when I climbed off the thing.

Here's a word for you: presenteeism. Had you ever heard of that one before? I hadn't until today. In contrast to abenteeism (which is the problem of having employees who don't come to work because they're sick), presenteeism is the problem of having sick employees who come to work anyway. Presenteeism is considered a problem because people who work when they're feeling bad tend not to be very effective at their jobs.

Apparently American workers are pretty sick, and both absenteeism and presenteeism are common in the American workplace. That at least is the conclusion of an article titled "Ailing and overweight Americans cost billions in productivity". (The title is quite misleading, but I'll get to that in a minute.)

"Full-time U.S. workers who have chronic health troubles or are overweight cost more than $153 billion in lost productivity each year from absenteeism, according to a Gallup-Healthways study released on Monday. Compared with non-overweight healthy workers, the 86 percent of U.S. workers who have weight or health issues, or both, miss an estimated 450 million extra days of work a year, the study said."

I thought at first that I misread that last sentence. "The 86 percent of U.S. workers who have weight or health issues"? Are they saying that only 14% of American workers are neither overweight nor chronically ill? Well, yeah, actually -- that's what they're saying. 

If they are rating health in such a way that only 14% of the workforce is healthy, clearly they are applying some rather strict standards. Chronic health conditions as defined in the study included recurring physical pain (in the back, neck, or legs) during the previous year, and having ever been diagnosed with heart attack, high blood pressure, high cholesterol, cancer, diabetes, asthma, or depression. Obviously some of these conditions are extremely common, so it's not surprising that a large share of the workforce has at least one of them.

As for "overweight",  that was defined in terms of the ever-controversial Body Mass Index (if you don't know your BMI, you can easily find it using this on-line BMI calculator).

A BMI of 25.0 or higher qualifies you as "overweight" (30.0 or higher qualifies you as "obese"). According to the BMI I am slightly overweight, and need to lose 5 pounds to qualify as normal (by my bathroom scale, that is; I probably need to lose 10 pounds as measured by my doctor's scale). Anyway, I am flabby enough to be placed in the category of "Ailing and Overweight Americans" who are costing the nation billions in productivity, even if I were not already placed there by the diabetes diagnosis.

The BMI certainly has its failings, the most notorious of which is its tendency to categorizes men with big muscles as overweight even if they have very little fat on their bodies. However, I don't think I have that problem, so I am willing to accept the BMI as a good rough indicator of fatness, and I accept its judgment of me as being somewhat overweight. But if I am, so are an awful lot of other people -- so, once again, it's not surprising that a large share of the workforce is overweight, or has a chronic disease, or both.

Okay, so how sick are American workers? "The survey showed that over 30 percent of workers were overweight and had one or two chronic health problems, while nearly 18 percent were overweight and had three or more chronic health issues."

Okay, so how much difference did these problems make to the health of American workers?

"Full-time workers who were not overweight and suffered no chronic health conditions averaged 0.34 unhealthy days each month, or about four days per year, with a tiny rise for workers who were overweight with no chronic conditions.

At the other end of the scale, overweight workers with three or more chronic health conditions reported an average of about 42 unhealthy days per year, about the same as non-overweight workers with similar health woes. Poll results indicated that respondents missed an actual day of work for roughly every three unhealthy days."

Notice the near-total contradiction between the headline of the story and the content of the story. Overweight workers without chronic conditions had only a "tiny" increase in unhealthy days compared to normal-weight workers with no chronic conditions. Overweight workers with chronic conditions had "about the same" number of unhealthy days as normal-weight workers with similar chronic conditions.  On the evidence presented, it seems that chronic diseases are the problem, regardless of whether the employees who suffer from them are overweight or not.  Employees with no chronic diseases seem not to have many sick days even if they are fat, and people with chronic diseases seem to have a lot of sick days even if they aren't fat.

What, then, justifies the headline "Ailing and overweight Americans cost billions in productivity"? Clearly, a lot of ailing Americans are overweight -- because a lot of Americans, ailing or otherwise, are overweight as judged by the BMI -- but the data presented certainly does not seem to demonstrate that obesity alone, independent of chronic diseases, has any kind of strong influence on the number of unhealthy days experienced by American workers. The authors could have, with about as much justification, have used alternative headlines such as "Ailing and Right-Handed Americans cost billions in productivity" or "Ailing and Protestant Americans cost billions in productivity".

I realize that there is a possible way to make sense of this: perhaps the authors also found that overweight people were far likelier than normal-weight people to have chronic diseases. Well, if they found that, they should have said so. In terms of what is actually presented, though, it seems as if they wrote a headline which blames obesity for a workplace problem which, to judge by their own data, isn't weight-related.

Don't get me wrong: I think obesity does cause problems. I just don't think you should blame everything in the world on it, especially when your own data isn't backing you up.

This is only one example (although an expecially striking one) of health-related journalism in which the headline says one thing and the information in the article says something very different. We need to be careful about judging such articles by their headlines. For all I know, editors may simply discard accurate headlines chosen by authors and put something interesting but fictitious in its place.

Tuesday, October 18, 2011

Although my knee felt better today than it had yesterday, and it would have been a nice day for a run, I thought I had better stick to my plan, and do a gentler workout in the gym rather than go running. (I also sat in the hot tub there afterward, which cures all ills.) Probably I'll do the same tomorrow, and try to get my knee into a thoroughly happy state before I subject it to any more pounding on concrete. I just don't want to take such a long break from running that I'm not trained up for the Healdsburg half-marathon on October 29. It's one of the prettier race routes around, and I already paid a large non-refundable registration fee, so I'd like to go through with it...

...even though I'm honestly not that wild about having to start before dawn.

A reader suggested that, as there seems to be a disconnect between my most recent A1c test and the daily glucose tests that preceded it (seemingly the A1c should have been lower than 5.5, given the low glucose numbers I've been seeing), I might want to try buying another meter, to see if the new one gives me results in a different range.

I actually did all that, two years ago, and found that (1) the old meter agreed well with the new one, and (2) both meters agreed well with lab glucose testing when I went in for that and brought a meter with me. My own meter was only off by 1 to 2 points.

This year, my meter read 5 points lower than the lab test indicated (85 vs. 90), which is still a small error by the standards of home glucose meters. Still, you can get a One-Touch Ultra Mini for pretty cheap, and it's been 2 years since I bought one, so maybe I'll try buying another to see if it makes any difference.

My doctor's view is that the A1c result is a little higher than I expected because my glucose goes a little higher than I expect it to during times of the day or night when I'm not testing. Of course, he also thinks that 5.5 is fine, and he doesn't see why I should be fretting about a non-problem. But, as I explained to him, I didn't get this far by not caring about the details.

It's always fun to look at old magazine ads for food and beverages, to see some of the preposterous health claims that were made for these products.

It's funny to think of a group of people sitting around a conference table, concocting that ad and taking it for granted that the truth of their claims would not be seriously questioned. Didn't anyone burst out laughing during that meeting, at the sheer ridiculousness of what they were saying?

But I guess the ads of our own age, even if they are more stylish, are just as questionable...

...and in in some cases, there is reason to doubt that the ad was ever put in front of a group of people sitting around a conference table, because it seems impossible that no one would have burst out laughing if this browser-banner ad was shown at a meeting:

(This is only an illustration, not an active window, so if you want to "roll over and see what you can do", you'll have to do it without any help from this site.)

Bonus feature: using the apostrophe!

I knew the current plague of apostrophe-cancer on the internet had reached a crisis point when I read a blog yesterday in which someone spelled the word want as wan't .

Listen, folks: apostrophes are nice, but you only need them once in a while. There are only so many words that are spelled with an apostrophe. "Want" is not one of them.

Here are some handy rules for you...

  1. Plurals in English are created by adding an s to the end of a word. Not an apostrophe followed by an s -- just the s. The plural of truck is trucks, not truck's.
  2. A few plurals are sometimes formed with an apostrophe -- such as the plural of the name of a letter, as in Mind your P's and Q's. This sort of thing is rare and getting rarer; if in doubt, omit the apostrophe.
  3. Putting an s on the end of a word, with an apostrophe in front of it, indicates a possessive, not a plural: Sally's dog, Daniel's room.
  4. In contractions -- for example, shortening did not to didn't -- an apostrophe is inserted to symbolize letters left out.
  5. The one that nearly everyone screws up is deciding between it's and its. Here's how it works: it's is the contraction of it is, while its is the possessive of it. Example: It's time for the school to show its true colors.

I know this won't change the world, but I felt the need to say it. Now go forth, and user fewer apostrophes.

Monday, October 17, 2011

I have no idea why my post-prandial glucose was so low after lunch -- even though I tested after 80 minutes instead of my usual 60. The lunch had included some noodles, and I was wondering if it was going to spike me. Instead, I was lower than I had been when I got up this morning. I don't see how my lunchtime run could have had that big an effect -- it was the shortest run I've done in several days.

Sometimes you just can't figure this stuff out. The variables that affect blood sugar are numerous and sometimes unpredictable, and once in a while you just go higher or lower than you have any reason to expect. Of course, the variability is much higher in people who take insulin -- I'm sure that the glucose fluctuations which strike me as dramatic and puzzling would seem mighty trivial to most people with Type 1.

Our rather amazing Indian Summer continues; sunny and in the mid-80s. It was a very sweaty run today. I thought surely we were due for some cool and cloudy weather by now -- especially after the beautiful weekend.

I was down in Fairfax, California for a gathering of Irish musicians, and by the time we went to the Sleeping Lady pub for a jam session, it was more than warm enough to sit and play outdoors in the patio behind the place.

This is actually not what October is like in Ireland, but it was nice to be able to have the experience anyway.

Note the wide range of ages represented among the musicians. I guess one of the things I like about traditional music is that there is room in it for people who are at every stage of life. The same is not true of all leisure activities, I have noticed.

The musical gathering was Saturday; on Sunday I decided that it was about time I did a long trail-run.

Until I had my accident on September 22, I made it my practice to do a trail run of 7 to 9 miles every weekend. The soreness in my knee which developed after that accident made me afraid to do anything much longer than 5 miles. As my knee was starting to feel pretty good this weekend, and as I was beginning to look forward with some anxiety to the half-marathon race I signed up to do on October 29, I felt I had no choice but to try out a long run, and see how well my knee took it. The route I chose was 9.3 miles long.

My knee took it quite well during the run -- in fact, all of me took it quite well. I was relieved at how easy the hill-climbs felt. The only knee soreness I experiences was during the steep downhill parts, and those parts are always hard on the knees.

But this morning I felt as if I must have made a terrible mistake. Walking around, my knee felt about as wobbly and sore as it had right after I took that fall  in September. I did end up going for a run at lunchtime, and my knee felt better while I was running than it had while I'd been walking around the office. But after the run it felt bad again. Once, when I stood up abruptly at my desk, my knee felt as if it was trying to bend backwards intstead of forwards, and I yelped in a way which provoked a little bit of laughter from nearby coworkers.

My knee is now feeling better, especially after yoga class after work, but I think maybe it would be a good idea to work out at the gym for the next day or two, doing some kind of exercise other than running, so that my knee can get a little recovery time.

The problem is that I don't want to do the half-marathon on October 29 without having done an adequate amount of distance training -- that could make for a very unpleasant race day. But running 13 miles with a sore knee (or not being able to do the race at all, because of a sore knee) could make for a pretty unpleasant race day too.

It's awfully hard to judge these things right! I'm sure many people would tell me that I shouldn't ever do anything that makes me feel bad -- even a little bad, for a little while. If it makes you feel bad, it must be bad for you. This sounds sensible enough -- except that people who never do anything that makes them feel bad for a little while, never exercise. And the evidence against that plan being good for one's health is pretty overwhelming by now.

I don't mean to push the "no pain, no gain" principle to the point that it becomes ridiculous, but it does seem to me that good health requires us to do things which make us a little uncomfortable, on a pretty regular basis. The trick is knowing when you've gone too far. And knowing that is not as easy as some people think.

Friday, October 14, 2011

Once again: a beautiful day, clear and sunny and temperatures in the 80s. Had a nice run at luncthime.

Absolutely no time in the evening to do a blog post, but I thought I should at least post my results for the day, since they were better than average... 

Thursday, October 13, 2011

For a long time before I ever tried blogging, I always assumed it would be easy. I thought I was pretty good at improvisational writing, and I always had an opinion to share -- and what else did I need? I was sure I could easily sit down and bash something out every evening. But, at the same time, I also feared that it might not turn out to be that easy, if I actually tried it.

Probably it would have been easy, if my blog wasn't tied to a specific subject. But I don't just have to think of something new to say every day -- I have to think of something new to say every day about diabetes. I mean, it's a complex and controversial subject, and all that. But after a few years you've pretty much covered every complexity and every controversy a couple of times, if not a dozen times. And then what?

I've tried out various ways to get a new blog post together despite a lack of inspiration -- but it never occurred to me to try the simple expedient of having someone else write a blog post for me. Fortunately, someone else thought of it for me, and asked me for the opportunity to do a guest post. I'm not sure it speaks well for me that I felt so relieved when I got Jackie's offer, but I'm certainly not going to let the opportunity go to waste (especially as the subject of this guest post is one which I have not been writing about myself). So, thanks Jackie!

The Impact of Diabetes and Lifestyle on Cancer
By: Jackie Clark

As fast food restaurants and sedentary lifestyles have become widespread across America, diabetes has become a common disease. Over 8 million men, women, and children in the United States have been diagnosed with diabetes. Since the early stages of diabetes may not present any noticeable symptoms, there are many undiagnosed cases of diabetes too. Over 7 million people in the United States may have undiagnosed diabetes, and another 79 million are prediabetic.

Diabetes can have a negative impact on all facets of life, and can reduce an individual's life expectancy by ten or more years. Many diabetics may encounter related illnesses as they age, including heart disease, high blood pressure, gangrene in exterior limbs, and a loss of energy.

Diabetics are also at an increased risk for many types of cancer, such as Mesothelioma. Cancer is often caused by the uncontrolled growth of cells in a certain part of the body. All healthy individuals have some cancerous cells in their body, but the immune system is usually capable of killing off these cells before cancer becomes malignant. Since the immune system is impaired in diabetics, many of these individuals find themselves at an increased risk for cancer. Mesothelioma life expectancy can be significantly reduced when an individual is also diabetic.

There are several simple steps that diabetics and prediabetics can take to reduce their risk of a cancer diagnosis. Many of these steps are intended to improve insulin sensitivity, and can improve the quality of life for diabetics.

A healthy diet and exercise can help improve insulin sensitivity, and can reverse some cases of type 2 diabetes. By following a healthy regimen, many people are able to stop taking blood sugar medications.

It's essential to maintain a healthy body mass index. Try reducing calorie intake to approximately 1200 calories per day, while exercising regularly. A 30 minute walk twice a day can help burn calories, and offers cardiovascular benefits.

It's also important to stay away from foods that can increase insulin resistance in the body, and contribute to obesity. Fatty foods, carbohydrates, and refined sugars are energy dense foods, may spike an individual's blood sugar to unhealthy levels. Build a diet around fruits, vegetables, and a source of lean protein. While some carbohydrates are essential for a healthy diet, it's best to limit intake as much as possible.

Many supplements can be effective at controlling blood sugar. Vitamin B-12, folic acid, chromium, omega-3 fatty acids, and vitamin C can be helpful at preventing blood sugar spikes.

It's important to talk with your doctor before beginning a diet or exercise plan.

More beautiful and unseasonally-warm weather. It was in the high 80s. I did a long, hilly run at lunchtime, and maybe I should have carried some water with me -- but it's not something you usually think of in mid-October. Anyway, I made it through the run without passing out from dehydration. But I did need to do a fair amount of re-hydrating in the afternoon.

Soon this will be a non-issue -- the summery weather isn't likely to continue much further into autumn.

Wednesday, October 12, 2011

The British Medical Journal is reporting that, of the experts who served on 14 committees that wrote clinical guidelines for diabetes and hyperlipidemia in the United States and Canada, about half had financial conflicts of interest (sometimes undeclared). The experts in question were receiving speaker's fees, honoraria, and other forms of payment (such as stock ownership) from drug manufacturers with an interest in diabetes and hyperlipidemia. Six panelists who admitted to conflicts of interest were the chairs of the committees they served on.

An accompanying editoral by Dr. Edwin Gale scornfully dismisses the suggestion that these comittees shouldn't include any members with conflicts of interest. "Money from drug companies is the oxygen on which the academic medical world depends", he says. "Let us therefore forget the hand-wringing and confront the reality of the world in which we live... legislation won't change the situation." He isn't in favor of these conflicts of interest, mind you -- but he thinks the problem is hopeless of remedy until there is "a change of culture". Apparently his solution is to wait until human nature changes to such a degree that people don't want to take money from drug companies.

It seems to me that we ought to find a good place for these committee members to get together and undergo the change in human nature which Dr. Gale is hoping to see them experience some day. But where? I was thinking federal prison, but if Dr. Gale knows of a better place I'm willing to consider it.

Another gorgeous sunny day; temperatures in the low 80s. October in Northern California sometimes seem more like spring than autumn. After the recent rains, grasses and flowers are sprouting, and the hillsides are starting to look green in places -- after months of solid beige. I passed a small field that was covered in brilliant yellow-orange Coreopsis flowers.

I went running up to the Paradise Ridge winery today, because the air was so clear and I wanted to take in their panoramic view of the valley one more time. It's a tough climb to get there, but it always ends up being worth the effort.

Part of the reason I've been able to keep exercising regularly for the past 10 years is that I try my best to make exercise as enjoyable as possible, and I focus my attention on the pleasures rather than the pains that are involved.

Tuesday, October 11, 2011

As if to reward me for my willingness to run in the rain yesterday, mother nature gave me a perfect day for running this time: the clouds parted, the sun shined brilliantly, and the whole world was sparkling in the clear air. Temperatures were in the high 70s. This is what autumn in California is supposed to be.

Oh, look: the prevalence of normal body weight in the United States has increased from 35.6% to 36.6%! Of course, that still leaves more than 60% of the population in the "overweight" and "obese" categories.

The reason for this very small decine in obesity is thought to be that, in these hard economic times, people don't eat in restaurants as often as they used to. Instead they stay home and eat something they don't like as much -- so they aren't as tempted to overeat.

If obsesity occurs because people are allowed to eat the sort of foods they like, this implies that the most healthy diet would consist of food that people absolutely hate. It's a depressing thought, but by this point we should be used to the idea that everything we read about healthy eating (right or wrong) will probably depress us. The people who write this advice always think we won't mind giving up, say, bread -- so long as we still get to eat, say, bacon. (Or whatever foods they have decided to demonize and idealize.) If the food that they allow you to indulge in turns out to be less important to you than the food they want you to give up, the opportunity to indulge may not seem all that precious.

Monday, October 10, 2011

I prefer to keep my fasting numbers under 90 if I can, but 93 isn't bad considering that I'm coming off a very social weekend that featured one round of party food (and even party drink) after another. I saw it as my weekend to celebrate the good results of my annual physical last week.

The weekend started on Friday night with a concert at the Plough and Stars in San Francisco, by the Irish fiddler Caoimhin O Raghallaigh (if it would help you to think of that as "Kevin O'Reilly", go ahead -- that's about as close as English speakers can get to rendering it) and the Irish accordionist Brendan Begley. Brilliant musicians both.


As I was staying in San Francisco for the night, my exercise opportunity in the morning turned out to be a 4.3-mile run in Golden Gate Park. It was a cool but sunny morning and the park was beautiful. Hundreds of other people were there running and cycling. (All the runners were faster than me, but they probably hadn't just got up from a late night at an Irish pub.)

Later I had a meet-up with family members on the other end of the Golden Gate Bridge, at Cavallo Point -- former military housing which is now a resort hotel. My brother and his wife, and many other extended family members, were staying at the hotel for the weekend (it's become a tradition for them at this time of year).

The central lawn in front of the hotel had a great view of the city, just across the Gate. It was Fleet Week, so there was a military air-show going on (including some loud low-altitude flyovers by the Blue Angels).

So, Saturday was one long picnic, with lots of high-calorie picnic food.

Then -- Sunday. Once again I did a run in the morning, hoping to burn off at least a little of the picnic food I'd taken in. In the afternoon, I drove back down to San Francisco for a party -- a very musical party. It was held in honor of another brilliant Irish fiddler (Martin Hayes). He had recently got married, and we had an opportunity to meet his wife. Later we had a great jam session in the living room. (If you're an Irish musician, an opportunity to play in a jam session with Martin Hayes is a pretty big deal.)

And, of course: lots more party food.

Considering the circumstances, I think my glycemic control this weekend has been remarkably good. But the weekend is over and now it's time to get things on a slightly more even keel.

It was raining today, so I knew it wasn't going to be an enjoyable day to go running, but I also knew that the Monday after a weekend of party-food was not a good day to slack off on exercise. So, I went out in the rain and got soaked.

The only real problem with running in the rain is that, once your shirt gets thoroughly wet, it clings to you and starts to have an abrasive effect on your more sensitive areas. As usual, I didn't feel it until I got in the hot shower afterward. Aiieeee! I guess I should have worn a bra. Nobody would have seen me: I can assure you I was the only runner out there.

Thursday, October 6, 2011

Today I came across an attempt to explain diabetes to the greater public by means of a comic book. Here's a sample panel from it:

The take-away message would seem to be that diabetes is caused by swallowing apples whole instead of chewing them -- a hypothesis which, so far as I know, remains unproved.

But even if we ignore the peculiar illustration, the message expressed in the text is not nearly specific enough to be useful. To the extent that it makes a point, the point seems to be that diabetes means getting sick from eating too much sugar -- which is a pretty crude and misleading way of explaining a complex and still-mysterious disease.

I think it is possible to explain diabetes to people who haven't been to medical school -- and I like to hope that my Kitchen Sink essay is a pretty good attempt at doing that. But if you dumb down the subject beyond all recognition, to make sure that you're not challenging people's ability to grasp the complexities involved, you end up with a bunch of people who aren't any better informed than they were when you started. And I'm not sure I see the point of an educational effort which doesn't make people better-informed.

Wednesday, October 5, 2011

You know, when I started my lunchtime run (alone, as my running buddies were all out of town, or out with an injury, or signed up to doing something else), the sun was still shining. How was I to know that a line of rain-clouds was about to sweep into town, and start drenching me while I was still a couple of miles from shelter?

Oh well -- it really wasn't that bad. It's actually easier to run in the rain when the rain catches you by surprise, half-way through the run, than it is to start out running while it's already coming down.

Anyway, there is one good thing to be said for getting soaked with rain while you're out running -- it makes the hot shower afterwards a truly wonderful experience.

It was a hard run, and afterwards I felt a bit depleted -- and I was craving a high-carb meal. I indulged in ravioli for lunch, hoping that the hard run would prevent that from driving my blood sugar very high afterward. It ended up being 132, which is within my doctor's guidelines, but is a little higher than I like to go. I try to stay under 125, and usually succeed at it, but obviously ravioli is not going to keep anyone's post-prandial result low. Still, I'm glad to know that it wasn't worse than that. Lately I've been eating a lot of low-carb meals, but I like to indulge in a high-carb meal once in a while.

So then, this afternoon, I went in for my annual doctor's appointment. That I only have to do it once a year is good news all by itself -- most diabetes patients have to see the doctor two to four times a year.

My doctor found nothing to make him lose confidence in me. He showed me the lab test results that hadn't yet been posted on line, and they were fine -- generally better than last year. Fasting glucose was 90; that's higher than what my meter showed at the same time (85), but not a lot higher, and not higher than normal. As for today's physical exam, it revealed nothing to him that he didn't want to find.

I asked him about the seeming discrepancy between my low fasting results and my hemoglobin A1c result of 5.5%. Not that 5.5% is abnormally high (a point which he emphasized to me, saying that there was no problem here for me to need to correct). Still, it seemed to me that I was getting a higher A1c result than I used to, at time when I was getting lower glucose tests results than I used to. Why should that be?

His explanation was more or less the one I was expecting: that glucose testing is a snapshot of a moving target, and that my blood sugar must go up a bit during times of the day or night when I don't test. What matters, as far as he is concerned, is that there isn't enough of that going on to push my A1c results above the normal range.

No doubt my perfectionist attitude is baffling to him, in part because so few of patients are even trying to achieve a small improvement in their results, much less perfect results. Anyway, if he's happy, so why shouldn't I be?

I always get so anxious about my annual physical, thinking it will reveal some terrible development of which I was unaware. It always turns out to be an anticlimax and a big relief. So now I'm drinking a toast to anticlimaxes! May all our doctor's office visits let us down like this!

Tuesday, October 4, 2011

The world wants to know -- or at least the portion of the world that follows my blog wants to know -- why the Hemoglobin A1c test result I revealed yesterday (5.5%) isn't more in line with the daily glucose test results I've been reporting in recent months.  (If today's results seem almost ridiculously low, I should point out that the after-dinner result isn't too mysterious when you realize that dinner consisted entirely of salmon, green vegetables, and almonds.) Seemingly a lower A1c result would be expected, under these circumstances. Why wasn't the result lower than 5.5?

I'm wondering that myself. During the first few years after my diagnosis, I tended to get A1c results in the range of 4.8 to 5.2, and at that time my glucose test results weren't as low as the ones I'm getting today. It doesn't seem to make sense that my A1c would be higher when my glucose tests are lower.

I plan to ask my doctor about this when I go in for an office visit tomorrow. However, it's possible that, in a brief office visit, I won't have time to ask, or my doctor won't have time to explain it, or he won't know what the explanation is.

So, I might as well lay out some possible explanations for you here.

  1. I've been lying to you about my glucose test results; they were actually higher than I've been claiming. Perhaps this was your first guess. It happens not to be the case -- and anyway, if I was lying about my glucose test results I would also lie about my A1c results in order to make my story seem consistent.
  2. My glucose is low at the times when I test, but it's going high at times when I don't test. This is certainly a possibility. Although my 1-hour post-prandial tests are usually pretty low, and my 2-hour tests (on the rare occasions when I do them) are usually lower still, it's possible that I'm having hyperglycemic peaks between meals or in the wee hours of the morning, and I don't catch them because I don't test at those times. I would have thought that people who go high in the wee hours of the morning would also have high fasting results (which I don't), but maybe I'm an exception.
  3. My glycation rate, for a given level of blood sugar, has been rising lately, and this causes my A1c result to be higher than expected. It has been found that people of different ethnic backgrounds experience different rates of glycation even if their blood sugar levels are the same. Some people are "high glycators", in other words. If this sort of thing varies between ethnic populations, perhaps it can also vary for one person over time. Maybe I'm more of a high glycator than I used to be.
  4. The A1c test method has changed over the past 10 years, and the results I'm getting now are changed for that reason (in other wrods, if the old methods were still used, the test results I'm getting today would be lower). Maybe, but would only explain why my results have changed -- it wouldn't explain why my A1c results are not tracking my glucose results. There is supposed to be a fairly good agreement between A1c and average blood glucose; the A1c results I've seen this year and last year don't seem to be in agreement at all with glucose results during the same period.
  5. Something else I haven't thought of. Perhaps there is a factor, unknown to me, which causes A1c results and glucose results to diverge. If so, I hope my doctor knows about it, and can explain it to me tomorrow.

Monday, October 3, 2011

My lab test results came back! Some of them, anyway. Maybe all of them -- there is some unclarity about this.

The big lab result, of course -- the one that diabetes patients are likeliest to lose sleep over -- is the Hemoglobin A1c test, which provides a numerical index of how well you're doing overall in terms of glycemic control. My result this time was:

Last year I was disappointed to find that I was as high as 5.6, even though that was still within the normal (that is, non-diabetic) range. This time I was a just slightly lower, at 5.5. I would still like to bring it down farther than that, but I suppose that I should just be glad that, after 10 years of managing diabetes without medication, I'm seeing anything other than an upward trend in A1c.

My cholesterol numbers were also in the normal range:

Comparing these results to last year's results, I see that triglycerides and HDL cholesterol are a little better than last year, and LDL cholesterol a little worse. But I guess the main thing to focus on is that the results are all within the normal range, so maybe the minor fluctuations aren't worth paying a great deal of attention to.

Another test which showed a normal result was the "PSA" (Prostate-Specific Antigen) test, which apparently provides an early warning of prostate cancer:

Unfortunately, I don't think that getting a normal result on this test will buy me anything in the examining room: doctors still gotta do what doctors gotta do.

What's missing from the test results -- at least the test results that are available for me to look at online -- is the "Comprehensive Metabolic Panel", which my doctor has always ordered in the past, and which includes blood glucose and various elements of blood chemistry which, so far, have not shown abnormal results for me. I am pretty sure my doctor did order this test, so either the lab failed to perform it or there has been some mysterious delay in posting the results. However, that test doesn't worry me as much as the others do, so I'm more or less content to wait and see what happened here.

Not having watched the weather forecast, I was startled to find that it was a rainy day today. I went running anyway (alone, of course -- my running buddies hate running in the rain more than I do). Well, somebody has to set an example of dedication around here!

I don't know what this says about me, but I think there is nothing funnier than prose which has either been translated very badly into English, or has been written by someone unfamiliar with English.

In India, a country which must cope somehow with the existence of hundreds of native languages, English is used as a kind of "neutral" language for government purposes, and people who wish to get a job in the Indian government must prove to the UPSC (Union Public Service Commission) that, among other qualifications, they are sufficiently fluent in English. Apparently the UPSC asks applicants to write essays on various topics. Here is one that was submitted to the UPSC; whether it resulted in the applicant being hired I do not know, but you can't say it doesn't provide entertainment value.

Indian Cow

He is the cow. The cow is a successful animal. Also he is 4 footed, and because he is female, he gives milks. He is same like God, sacred to Hindus and useful to man. But he has got four legs together. Two are forward and two are afterwards. His whole body can be utilised for use. More so the milk. Milk comes from 4 taps attached to his basement.

What can it do? Various ghee, butter, cream, curd, why and the condensed milk and so forth. And he is also useful to cobbler, watermans and mankind generally. His motion is slow only because he is of lazy species, and also his gober is much useful to farmers, plants and trees and is used to make flat cakes, in hand and drying sun.

Cow is the only animal that extricates after eating. Then afterwards she chew with his teeth whom are situated in the inside of the mouth. He is incessantly in the meadows and the grass. His only attacking and defending organ is the horns, especially so when he is got child. This is done by knowing his head whereby he causes the weapond to be paralleled to the ground of the earth and instrantly proceed with great velocity forwards. He has got tails also, situated in the backyard, but not like similar animals. It has hairs on the other end of the other side. This is done to frighten away the flies which alight on his cohesive body hereupon he gives hit with it.

The palms of his feet are soft onto the touch. So the grasses head is not crushed. At night time have poses by looking down on the ground and he shouts. His eyes and nose are like his other relatives. This is the cow.

Saturday, October 1, 2011

I didn't do a blog post on Friday, because I went to a party and stayed late, so maybe I should do a rare weekend blog post to make up for it.

My low fasting test of 76 is a little surprising, not only because I went to a party on Friday, but because Friday was a rest-day from exercise. Well, I did eat some snacks at the party, but I went for the low-carb, high-fat kind of snacks. And the low post-prandial result of 86 was after a hilly hike, followed by a very low-carb dinner.

So, both of the low test results today were only a little surprising -- not bizarrely surprising. Probably things will be different tomorrow, though: no glycemic trend lasts very long, at least in my case.

I had been worried that I was trying too hard to force my sore knee to recover, with the running I was doing last week. So, in addition to taking a rest day on Friday, I decided to have my workout today be a hike in the woods.

It's hilly enough to count as real exercise, but if you're walking rather than running, you're not forcing your knees to absorb a lot of shock. 

It was a nice hike, with some surprises along the way. One surprise was running across a former coworker whom I haven't seen in years. He hadn't been in this park in years, either, and the odds against this encounter would seem to be pretty high. But there he was. We paused to spend some time catching up.

Another surprise was finding a cluster of very large mushrooms -- a couple of days after a heat wave, and well before any serious rain had fallen. I like to do a mushroom hike in the park at least once a year, but that seldom happens before January.

Of course, the reason I like to look for mushrooms is that I like to use the macro lens to look at them from the ground up, so that they look like gigantic diseased beach-umbrellas.

The third surprise was a set of tracks in the dirt. They looked like bird tracks, but they were so large (3 to 4 inches in length) that I couldn't imagine any bird in the park that could have produced them. There are plenty of wild turkeys there, and they're pretty big, but they're not that big. 

My current theory: velociraptors.


It's my anxious time of year: the time when I go in and give blood. Not a pint of it, for the good of society, but a few ounces of it, for medical analysis. I went to the lab Friday morning, on the way to work, and gave them what they asked for. Now all I have to do is wait and worry about what sort of data is going to come back.

It might seem to an disinterested observer that, if my daily glucose tests look good and I'm not feeling sick, there is no reason to worry that the lab tests might reveal any unwelcome news. However, if that were the case, nobody would bother with the lab tests in the first place. The only reason they are done at all is that they sometimes do reveal problems which hadn't been anticipated.

I try not to worry about that, but I never succeed...

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