T Minus Two

Moving...

2011-05-13T21:38:00.000-05:00

I am moving this blog to a new home, http://tminustwo.net. Please come visit!

The Meaning of 'Cure': An Open Letter to Health Marketers

2011-04-28T22:36:00.000-05:00

Sometimes, people and organizations use the word "cure" to describe what products or approaches they are promoting to people with diabetes will do. I'm not even talking snake oil salesman, but people who genuinely believe they're offering something of value.

On one such occasion I know of, the person promoting their approach as being a "cure" for Type 2 was challenged as to what, exactly, they meant by that. This person argued, in essence, that the medical community used the word "cure" as being synonymous with "effectively control".

I don't know whether that is true. However, scientific terms are very often more precisely defined versions of words that have been in widespread use for hundreds, even thousands of years. The word "energy", for example, has a substantially different meaning for a physicist than it does for a sleep-deprived student. However, the adaptation of such a word for technical use does not supersede the previous meaning: the student's understanding of the term is fully as correct as the physicist's. Those who fall back on technical meanings when defending the content of messages prepared for the public are muddying the waters, and are likely to be doing so intentionally. I'm remembering a certain former public official who attempted to defend a apparent mistruth by invoking an alternate definition of the word "is".

Therefore, if you're talking to the public, you need to use the word "cure" in a manner consistent with the public's understanding of the term. And so, though I am no more in charge of defining words than the former public official, I thought I would lay out what a "cure" for type 2 diabetes would be for me.

* I don't believe I ever gave any thought to my pancreas before I was diagnosed. If I were to be "cured", I would never give any thought to it again.

* If I were to be "cured" of diabetes, there would be absolutely no need for me to ever check my blood sugar again. If the condition could return, you could say it's "in remission", or use some other term, but I reject the use of "cure".

* If I am "cured," there are no limits to such a cure. There's no "sure you're cured, but you still need to be careful". Once cured, I could make a meal of a plate of lo mein noodles, a large piece of pecan pie with two scoops of butterscotch ice cream, and a liter of sugary soda -- and bear no short-term risk beyond indigestion.

* I don't expect that a cure for my diabetes would magically undo any damage that chronically high blood sugar may have done. However, any further damage would stop. Immediately. We're not talking lowered risk, we're talking no risk.

Know this: if you are promoting a product, service or philosophy for the treatment of Type 2 diabetes, and you choose to use the word "cure" in describing the benefit, you'd best be using the word as -I- understand it, and not as some lawyer told you that you could get away with. Otherwise, you will immediately forfeit every drop of credibility that you may have had with me.

Come on, folks. Don't overpromise. If what you've got is of genuine value and has some innovation to it, you don't need the "c" word to develop a market. I've bought a number of products that promise to assist with effective control, and I will never, ever, buy a "cure".

Until, of course, there is a cure. A real cure.

Grains Three Ways: Bulgur

2011-04-10T23:26:00.000-05:00

According to Wikipedia, bulgur is a cereal made from wheat. The grains of wheat have there bran partially removed and are parboiled (that is, partially cooked).

I have to say, bulgur was a surprise. I took it on for this project mostly because I happened to have some. I don't know where I got the idea, but I thought of bulgur as being rough and unpleasant, like some sort of allegedly-edible cleaning product. I don't happen to care for tabbouleh, the Middle-Eastern salad in which Americans are most likely to encounter bulgur, but my distaste has nothing to do with the texture of the grain itself.

However, when I cooked some bulgur up in my rice cooker with a little bit of oil, the result was light and fluffy. I've enjoyed putting some of the result in the bottom of a bowl with some meat and veggies on top of it. (Attention KFC: that's what a bowl should be.)

(I don't believe I've mentioned that I'm taking the directions for cooking my grains in my rice cooker from "The Ultimate Rice Cooker Cookbook, written by Beth Hensperger and Julie Kaufmann. The rice cooker can be an amazingly versatile tool, and this is an excellent guide to it's capabilities.)

My second dish was "Bulgur Pudding with Candied Ginger and Figs". Forget any idea you may have had this "pudding" means it will be smooth and silky: if you're like me, you can forget any idea that it's like anything else you've ever eaten. It's sweet, and fruity, and crunchy, and thick, and substantial, and savory. Amazing stuff. The recipe says it's 32g carbs per serving: if the serving size is more than a couple of tablespoons, I wonder a bit about that. If I make it again, I'll use a little bit less dried fruit and cut the figs into somewhat smaller pieces.

My third bulgur recipe was "http://www.foodnetwork.com/recipes/alton-brown/bulgur-gazpacho-recipe/index.html". Gazpacho is a tomato soup of Spanish origin and is served cold. I've wanted to try it both because it's really tasty and also to have something else I can eat during the hot and humid summers where I live. (For about four months, all I usually want to eat is bologna sandwiches and cold pizza. This year HAS to be different.)

Unfortunately, something went seriously wrong with my gazpacho: it's delicious -- fresh and tomato-ey and fully flavored -- but it's not soup. Essentially all the liquid in the recipe was absorbed by the bulgur as it cooked. I can think of a couple of things I might have done wrong, but doing those things differently would not have added enough moisture to call it a soup. But the comments on the recipe don't mention this issue at all. As the King of Siam might have said, it's a puzzlement. But it's a very tasty puzzlement.

Next grain in the project: brown rice. After that, I'll probably have several posts in a row about grains many people have never heard of.

(This is the third grain covered in my "Grains Three Ways" project, described here. I have previously written about http://wortheverypenny.blogspot.com/2011/02/grains-three-ways-pearled-barley.html and quinoa.)

It's just my job.

2011-03-23T11:47:00.000-05:00

I am a lancing device. My job is to wound.

You probably shouldn't know my name, but I'll tell you anyway: it's Vlad. They tell me I was named after Vlad the Impaler, thought to be the historical inspiration behind the Dracula legend. They tell me that's supposed to be funny -- I wouldn't know. I don't have a sense of humor. In my job, I don't need a sense of humor.

My job, as I said, is to wound. The purpose of the wound is to produce a drop of blood for a glucose test. They tell me I help this guy stay healthy, but I don't care whether he's healthy or not. Either way, the pay's the same.

Most of the time, they tell me, I don't hurt this guy much. Other times, he hurts like blue blazes. Whatever it is, it doesn't hurt me. I don't have a conscience. In my job, I don't need a conscience.

It's a living.

Non-recipe: Tomatillo Salsa

2011-03-22T21:53:00.000-05:00

One of my goals in my efforts to teach myself to cook is to have a bunch of "recipes" that aren't recipes at all, but just things I know how to do.

I have made "green salsa" from tomatillos using recipes two or three times. Yesterday, I just threw one together. It was really good. Here's what I did.

1. I cut three or four Anaheim peppers in half, lengthwise, and removed the seeds and white "ribs" - the seeds and ribs have most of the heat. Chiles seem to be named inconsistently: the chiles that supermarkets here call "Anaheim" are 4-6 inches long, pretty narrow in shape, and light green in color. Except for bell peppers, they're the mildest variety I know.

2. I peeled the papery husks off of five or six tomatillos and washed off the sticky gunk that holds the husk on. I cut each one in either two or four chunks to make them approximately the same size.

3. I cut a big tomato into quarters and lackadaisically removed most of the seeds.

4. I tossed the veggies in a bowl with some olive oil and salt to coat, then put them on a parchment-paper-lined baking sheet and then put the sheet in the oven. I was cooking something else at 350 degrees: had I been roasting the veggies by themselves, I would have gone to maybe 400. I roasted them for maybe 20 minutes, then threw some thinly sliced onion on top, then gave it maybe 10 minutes more. The tomatillos need to be soft. Had I been roasting at a higher temperature, I would have wanted some color as well.

5. After letting things cool a bit, I put everything in my food processor and pulverized it, then added a slosh of corn syrup. (Tomatillos are quite acidic. I would have used honey, but couldn't quickly find it.) I think I added some more salt as well, then chilled it.

The result was a lovely light green, and quite flavorful but not at all chile-hot. Next time, I'd leave some of the seeds in. Nonetheless, it was really really good.

Give it a go. Not counting cooking time, I suppose I spent about 15 minutes.

Grains Three Ways: Quinoa

2011-03-20T23:32:00.000-05:00

Quinoa is a grain (actually, according to Wikipedia, it is "grain-like") with an interesting history. It is very high in protein, and is apparently very close to a complete protein for humans, and appears to be low on the Glycemic Index for those who pay attention to that.

Uncooked quinoa is very small-grained, looking a bit like couscous (which is a pasta rather than a grain.) Cooked, it has a mild, nutty taste, and I read that it can be substituted for rice in many recipes.

As it comes off the plant, quinoa in covered with a bitter-tasting substance which must be washed off. When I first experimented with quinoa, I found that washing it is a total pain, so I'm glad that most quinoa is now sold pre-washed. (But, if you choose to try quinoa, which I encourage, check the package to make sure it's pre-washed.)

The first way I cooked quinoa was to do it in my rice cooker, using chicken stock as a cooking liquid. It was okay, but a little uninspiring. A few tablespoons on a plate as a side dish would be fine.

The second quinoa recipe I made was Quinoa with Tofu and Asparagus. (I used chicken stock rather than vegetable stock.) I liked the basic method of throwing some quick-cook veg on top of a cooking grain shortly before it's done, but this particular dish was too lemony for my taste. You may also note that the recipe doesn't call for any salt to be added: for me, the end product was almost inedible before salting.

My third dish was Fiesta Quinoa Salad. This was quite good. The friend I shared it with thought that a little more olive oil might be good, and I'd be tempted to add some tomato.

Next grain in the project: bulgur.

(This is the second grain covered in my "Grains Three Ways" project, described here. You can see my post on pearled barley here.)

Confessions of a Lapsed Techie

2011-03-08T01:27:00.000-06:00

Once upon a time, I was a pretty techie guy. I taught computer classes for a living, and in my own use moved seamlessly between MS-DOS, Windows, Macs, Vax/VMS, and Unix. (Except I could never keep straight which way the slashes in directory paths went in MS-DOS and Unix.) I'd been an Internet user for several years before most people had ever heard of it. (And we had to walk to the Internet in the snow! Uphill! Both ways!) I was never a hardware guy or a programmer - I just had a very strong set of user skills. Not an expert, but the most expert person a lot of people knew.

But that was a long time ago. My fringe IT job gradually morphed into an HR job. (Long story.) Technology moved forward, and I wasn't able to keep up. The scope of topics about which I was genuinely knowledgeable got smaller and smaller, and is now almost gone. (I can still say that my knowledge of the 2003 versions of Outlook, Word, and Excel is pretty strong - but that was two versions ago.)

All this makes me a little sad. Having that set of skills made me a little bit special, at a time when those skills were pretty rare. Those skills got me a graduate assistanceship and the respect of my grad school classmates and even the faculty. But time moves on, and I'm just as befuddled by a lot of the new technology as folks who have little of the background I do. I have other strengths, of course - having fallen off the leading edge hardly renders me worthless.

Still, though, I do miss it.

Personal Blog Posting Month Wrap-Up

2011-02-28T06:08:00.001-06:00

This is the final day of my Personal Blog Posting Month, and I completed my goal of posting every day. Actually, more than every day: one day had two posts here, I wrote three entries for my Diabetes Daily Blog, and I wrote a guest post for another blog that will appear in a few days.

I have mixed feelings about how it went. I expected the necessity to post every day to be something of a burden, but it proved to be even more so than I anticipated. One of my goals was to give up on feeling that every post had to be a little gem: I don't know whether I've achieved that or not, though I don't think so. There were a number of posts I simply would not have published under ordinary circumstances: I need to decide, I think, if I'm comfortable posting as much about cooking as I have been. Plus, it must be admitted, a few posts were simply fluff. However, I must be fair to myself and acknowledge that I'm proud of some of this months posts, and note that two of my most-viewed posts of all time came in this period.

But, most of all, I feel.....done. And that makes me happy.

Yay! A New Type 2 Blog!

2011-02-27T18:48:00.000-06:00

Kate, who I had the pleasure of meeting on Facebook the other day, has started a Type Two Diabetes blog, "Sweet Success: My life with Type 2 Diabetes", at http://kates-sweet-success.blogspot.com/. I encourage you to go take a look!

Sammy, the MinPin

2011-02-26T20:27:00.003-06:00

IMAG0026
Originally uploaded by rpederse_

This is my neighbor lady's dog, Sammy. Sammy is a Miniature Pinscher, or MinPin. I'm much more of a cat person than a dog person, but Sammy's a pretty nice little dog. He's not much of a barker, except when there's another dog in the hemisphere, and he's pretty affectionate.

Rock On

2011-02-25T22:02:00.003-06:00

IMAG0023
Originally uploaded by rpederse_

Not that the folks at Blünt Lancet are short of hard-rocking ideas, but something like this image might make a good album cover. Not this exact image, of course: the hand should have a spiked leather bracelet. And be hairy. VERY hairy.

Rogani Roti

2011-02-25T18:57:00.000-06:00

As part of my effort to bring more whole grains into my diet, I've been thinking about playing with some flatbreads. I figure they'd be easier to make than yeast breads, and pretty flexible as to how they could be used.

Tonight was my first actual effort, "rogani roti" ("rich bread") made from the second recipe on this page. I cut the recipe in half, and I used "white whole wheat" flour. The dough seemed to require quite a bit more milk than anticipated, but it's been a long time since I made bread.

They were actually pretty good. I had one with a little butter, and one with a sprinkling of cinnamon. They're pretty misshapen. They're supposed to be a much better oval than this. Oh, well!

The Most Awesome Thing

2011-02-24T21:47:00.000-06:00

The topic for this month's Diabetes Social Media Advocacy Blog Carnival is: “The most awesome thing I have done in spite of diabetes is ...."

I've been thinking about this inaugural topic for the Carnival all month. I don't think I has a good answer for it when it came up during DSMA's "Fill in the Blank" night, I know I didn't have a good answer for it when I was the featured guest on the following evening's "DSMA Live" webcast, and for most of this month I've assumed I wouldn't be contributing a carnival post this month at all.

See, at the current stage of my diabetes, my disease isn't what's going to stop me from doing awesome things. I've got plenty of barriers, but right now diabetes isn't a problem in that way. I thought of some responses that were close, but just didn't quite fit.

Until now.

In spite of diabetes, I am getting healthier. That's right: I have a chronic disease, but I'm getting healthier.

Even though diabetes is not a huge interference in my daily life at this stage, the fact remains that my metabolism is broken. Hunger and fullness, food and digestion, energy to do all the things I'd like to do, even my ability to maintain my body at a comfortable temperature: none of these work as well as they did a few years ago.

Yet, despite these and other challenges, I'm markedly healthier than I was at the time of diagnosis. My blood pressure stays comfortably in the target range. Most of my cholesterol numbers are well within the target range: my "good cholesterol" is still somewhat low but is climbing. My A1c has been steady in a good place for almost a year. And, I rarely experience the tingling in my feet that I had almost continually for months.

My increasing health is not just in these results, it's also in what I do. Though there's a lot of improvement, I've made very significant changes since diagnosis. I walk for half an hour almost every work day. I eat far fewer carbs than I did even two years ago, I eat much less fat, and I consume much more whole grain and vegetables. I've put considerable effort into increasing my ability to cook healthy and tasty food for myself, resulting in many fewer restaurant meals and much less processed food. I also feel that my active participation in the Diabetes Online Community enhances my health care. Additionally, I've made significant advances in my ability to manage my emotional health.

Because I failed so badly the make the big, immediate lifestyle changes I felt were expected of my when I was diagnosed, I have a little trouble taking credit for the small changes I've made. But these small changes, taken together, have become awesome. And I've done them despite diabetes.

This post is my February entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2011/introducing-the-dsma-blog-carnival/.

Habanero Cashew Brittle

2011-02-23T08:11:00.000-06:00

After the debacle of my attempts to make 'Coconut Drops", I wanted to try my hand at a different candy. I also, after eating this, wanted to experiment with habanero peppers. Besides, something in me is attracted by cooking that requires surgical gloves. So, I made this recipe for Habanero Cashew Brittle last night.

I appear to have cooked them not QUITE hot enough, because the candy didn't get as brittle as I'd have liked. But, the candy is good. It's a little bit hot on the tongue, and there's some chile heat in the back of the throat, but it's not overwhelming for me and I'm no chilehead.

Eat YOUR Way

2011-02-22T06:00:00.002-06:00

These days, there are many different approaches you can take in choosing what you eat. You may be convinced that you can best fuel your body by eating low carb, low fat, meat-free, HFCS-free, additive-free, gluten-free, raw, or prehistoric. Your ethics may lead you to chose to eat vegetarian, to maximize global food supplies, or vegan, so as not to cause suffering to other creatures. Concern for the environment may lead you to choose locally-produced items whenever possible or even to forage from what has been wasted by others. If your interest is in maximizing your culinary experience, you may insist on the freshest ingredients prepared to rigorous standards, or you may be concerned with cooking dishes that are authentic representations of foods eaten in other cultures.

I don't disrespect any of those choices. Science may eventually produce real guidance about what ways of eating are the healthiest, but it can't tell us what's most ethical or most delicious.

Each of these ways of eating has many adherents that live peaceably among us and have no interest in persuading the rest of us to make the same choices they have. But, the times being what they are, each way of eating also has some adherents that believe that their way is the only valid way, that feel (and express) superiority to the rest of us. And it's the shrill voices of the latter group that are most easily heard in the cacaphony.

Here's my point:

Don't be bullied.

If the way you've chosen to eat seems right to you and to whoever you've chosen to advise you, go for it, and ignore the people who want to put you down for it. Those eating in other ways are entitled to choose their own meals.

But they're not entitled to choose yours.

(Note: edited 2/22/11 7:15 to make a small correction.)

Poke!

2011-02-21T06:00:00.038-06:00

This is a tiny thing, but strikes me as worth mentioning.

The other day, somebody on Twitter was having trouble finding her lancing device. I jokingly suggested that she follow the example of my friend Kelly Kunik, who tests by lancing herself without benefit of the lancing device. (Because she rolls awesomely like that, you know: a fan of direct action.) And, as I typed, I realized that I was on the verge of saying, "I could never do that."

That would have been bad. For two reasons.

First, that comment is one of the things insulin users hear most often and hate to hear the most.

Second, it would have been telling myself that I couldn't do something that I might, in fact, really need to do some day.

In a flash, as I realized these things, it became apparent to me that I had to test without a lancing device. Right then.

So, having found a lancet, I figured out how to hold it so that my forefinger and thumb would (theoretically) keep myself from driving too deeply, took a breath, thought about the horrible old guillotine-style lancing device I've seen a picture of, and *poked*.

It was okay. It hurt more than my test usually does, but way less than it sometimes does. I could do it again if I needed to. I could do it that way every time if I needed to. And I even got a good number on my meter.

I felt absurdly good about having done this. By doing a manual test, I'd both shown internal respect for my fellow PWDs and I'd bought myself an option for the future.

Not bad for one little poke.

Grains Three Ways: Pearled Barley

2011-02-20T06:00:00.001-06:00

The first grain I've chosen for my "Grains Three Ways" project is pearled barley. Pearled barley cannot actually be called a whole grain, since a mechanical process has been used to remove the inedible hull, the germ, and some or all of the bran. However, cooked pearled barley has more than twice the amount of dietary fiber of cooked long-grain brown rice, so I feel comfortable in treating it as fitting my project. (This information taken from the "USDA National Nutrient Database for Standard Reference", which I learned about in doing research for this post.)

The first recipe I made for this project was "James Beard's Barley Casserole". (Although I took my recipe from a site that relies on contributors, I did have the opportunity to confirm the recipe as being more or less identical to that in one of Beard's cookbooks.) Even though I used a mix of moderately fancy mushrooms, I found the recipe somewhat bland. While I like the idea of cooking the barley in a casserole, I'll seek another recipe next time.

The second barley preparation I made was to just do it in my rice cooker. What made it a bit special was that instead of water I used the beef broth that had been the cooking liquid for a slow cooker corned beef last weekend. This was quite successful.

My final dish is "Barley Corn Salad"(pictured below), which I have renamed "John Barleycorn Salad", because, well, why wouldn't you?

I made two small variations: I used rice vinegar instead of white wine vinegar, because it's what I had, and I used a mix of white and yellow corn kernels, because it's what they had at the store today. It is delicious: bright, and refreshing, and complex. It'll make a great summer dish, I think. It's smarter than the average barley!

Jerk Chicken Wings

2011-02-19T14:56:00.001-06:00

This post is not (alas!) about something I cooked, but rather something I ate.

There's a small parking garage around the corner from my office that's got a tiny little storefront in it. There have been several different lunch-and-dinner type eateries in it over the last few years.

Thursday, I decided to give the current place another try. I'd had a breakfast there that was just a breakfast, and a pulled-pork sandwich that was okay but accompanied by beans that were pretty good. This time, I had the jerk chicken wings, expecting that they'd probably be too hot, but willing to give it a try.

See, I'm probably a touch more tolerant of spicy food than most people, but a real wimp compared to the true chileheads. It's not hard to get past my threshhold, and the "jerk" dishes I've had tend to do it.

These wings were spectacular. No, not merely spectacular: they were one of the best things I've ever eaten as an adult.* I'm serious: in describing this incident to a friend, I was only able to come up with three things I'd enjoyed more. I'm sure the true list would be longer, but I can't imagine there would be more than a few dozen things on the list.

Yes, the wings were spicy, but not overpoweringly so to my taste. There was a fruity element, almost like the orange chicken at the best Chinese restaurant on the planet. They were a touch saucy, but I didn't need more than the two napkins provided. They were sweet.

I'm serious: these wings tasted like sunshine.

And now I have to learn a bit about Jamaican cooking.

* I have a theory that there are food experiences we have as children that are forever unequaled. I really don't expect to ever taste anything as delicious as the A&W Root Beer Float I had on a really hot summer's day when I was about ten.

The Goodie Table

2011-02-18T06:00:00.001-06:00

We have monthly "birthday parties" at my workplace. I'm a little grumpy about them, for several reasons. But, I cooperate, at least partially. I show up, I join in singing "Happy Birthday", and I clap. Then I slink off, back to my desk. I think that's good enough, and other folks seem to think so, too. And that would be that, except for one thing:

The goodie table.

See, we take turns bringing treats to to the "party". There's a cake, and usually some cookies, perhaps some potato chips, and (oh, yes) the fruit-and-veggie tray. And after the party is over, this stuff is all left out for folks to nibble on.

Yes, it sits there. It sits there deliciously. And it mocks me.

"Bob", I hear it saying, "you can't hold out forever. Come. Eat. Enjoy."

And it's right. I can't hold out forever, and I do come and eat.

My own diet, the food I eat day in and day out, is getting better and better. It's still a LONG way from perfect, but I am eating many fewer carbs, much less fat, and many more vegetables and whole grains than I once did.

But the goodie table gets me. Every month.

The "Grains Three Ways" Project

2011-02-17T06:00:00.002-06:00

Years ago, long before I was diagnosed, I ate a vegetarian diet for about six months. (I was open to milk, cheese, and eggs, but didn't eat much of those.) I didn't lose weight - a vegetarian with limited cooking skills is likely to end up eating a lot of simple carbs - but I did feel better eating that way.

One of my secret, stealthy reasons for working so hard on my cooking skills is to lay the proper foundation for a possible return to a vegetarian diet. And an important aspect of that is to know a lot more about cooking with whole grains (or, sometimes, less-refined grains) than I have in the past.

So, I've decided to begin what I'm calling my "Grains Three Ways" project. Working with one grain variety at a time, I'll find and prepare three dishes that use significantly different cooking methods for that variety. To the extent possible, I'd like to vary the methods across varieties as well (so that I'm not making a faux-risotto all the time, for example), but a preparation in my rice cooker will probably appear about every time, because it's a very handy tool for cooking grains.

I'll be starting with barley. I'm using pearled barley, which has been partially refined: I may visit whole grain barley down the road some time. I'll be doing quinoa for sure, and bulgur wheat, and farro since I happen to have some. Beyond that, I'll see what the stores seem to want to sell me. (I use brown rice tolerably often, so may not do that one.)

I'll report back!

St. Patrick's Day Spring Rolls

2011-02-16T06:30:00.004-06:00

Over the weekend, I cooked a corned beef that came out a little tougher than I was happy with, so I started thinking of ways to use it. At some point in my woolgathering, my mind turned to the spring roll wrappers I'd recently bought in a spirit of adventure. And an evil plan began to form.

I started by putting a fairly fine dice on some green cabbage and slicing the white parts of a couple of scallions. I sauteed that mix, salting it as it cooked. I put the cooked mix in a bowl with some finely chopped corned beef, the green parts of the scallions (sliced), and some carroway seeds. This is what it looked like:

I prepped the spring roll wrappers as directed by soaking them each (as I was ready for them)in hot water for about 15 seconds, placing on a towel and blotting gently, adding a couple of tablespoons of filling, and wrapping. I found the wrappers difficult to work with, as may be apparent here:

I placed the spring rolls on a baking sheet, brushed lightly with oil, failed to find my sesame seeds, and put them in a preheated 375F oven. I cooked 'em for perhaps 10 minutes - a little longer might have given crispier texture.

Here they are plated up:

(That's Asian Sweet Chile Sauce in the little bowl, which is an heirloom, being in our family for a couple of months.)

They were surprisingly good. As I mentioned, I might have pulled them too soon. According to my grading level, they were a good solid B.

Not bad for an evil plan.

Grading My Cooking

2011-02-15T07:16:00.000-06:00

When I've cooked something that was in any way experimental, I tend to assign a letter grade. Here's my scale:
D: Edible, in the technical sense of not being toxic. Most "D" stuff gets thrown away. Fortunately, I don't have this happen very often. Maybe this just shows that my standards are low.
C: Edible, in the broader sense of being acceptable eating. When I'm trying something really new, this is my goal. There's nothing wrong with a "C" meal, and I'd hate to be in the position of having to have better than this to be happy.
B: "Hey...that's pretty good!"
A: Foot stomping good. I don't hit this too often. My pickled roasted red peppers hit this level. I did a pork roast recently that turned out quite well.

The Valentine's Day Post

2011-02-14T06:30:00.004-06:00

I've never been as inclined as some single people to resent St. Valentine's Day, because I'm happy for those in a relationship they're content with who can use the holiday to celebrate that relationship. But as someone who's never married nor even dated very much, the day used to be something to hide from, an annual in-my-face reminder of that missing piece in my life. Some years, I've even gone media-free for a few days to hide from the commercially-oriented mushiness.

I'm not sure if it's maturity or just resignation, but in my middle years I find that discomfort leaving. For one thing, I'm not sure of my ability to carry off a successful relationship. Sure, I've got some real strengths to bring to a relationship, but I'd bring more than my share of challenges as well. Describing me as 'set in my ways' would be putting it very kindly indeed. Yes, there are things about the single life that are a drag, even scary - but I think I'd rather have no relationship than the wrong one.

I don't know if there's a relationship in my future or not - I may meet someone tomorrow. I'm not too many years from the time when I'll be old enough for what I call a 'friendship marriage' - two older folks who marry after a relatively short engagement and without too much fuss. No grand romance - at least publicly - just a commitment to be there for each other as long as possible.

A Temporary Loss of Courage

2011-02-13T11:43:00.000-06:00

I've been struggling with symptoms of depression this week. It's still been a lot better than it's been at many times in the past, but it hasn't been much fun. This weekend, I've been experiencing perhaps my most crippling symptom: a surge of fear and anxiety that doesn't seem related to anything at all. But fear and anxiety aren't quite the right way to put it, though I fight with those too: it's more like a sucking loss of confidence, as if someone pulled the drain plug on the courage I need to get through the day.

Yesterday morning, I got up in good time and felt refreshed. I made my grocery list and got ready to go to the store. I was almost ready to go when I was suddenly seized by the feeling that I didn't really want to go, that it would go wrong. Why? I don't know. Although I did end up going to the store, I've been fighting with this feeling all weekend.

I've gotten done what I've absolutely had to, thus far, and a little more. And, I'm catching up with sleep, so I'm hopeful that will help. Also, the weather has turned much better here, so I'm hoping that will help also. Besides, as I've said before, depression is like a head cold: it's nasty right now, but it WILL go away in time.

Small Victories: Emergency Pizza

2011-02-12T06:30:00.030-06:00

(I apologize for the image quality - I really need to find my digital camera.)

One of my purposes in my pursuit of greater cooking skills was to have alternatives to expensive megacaloric pizza delivery when the cravings strike. Not I-guess-this-is-okay self-denying alternatives, but yum-this-really-hits-the-spot alternatives.

Just tonight I was thinking thinking how could pizza sounded. And then I thought about the fresh cheese I made last weekend, which won't last much longer. And a plan began to form in my mind.

What you see pictured (well, sort of see, anyway) is:
1 "sandwich thin", split
On each 1/2 thin:
~1 tbsp sun-dried tomato pesto (commercial, left over from another project
~1 tbsp pickled roasted red pepper, chopped
Sprinkling of salt
I put 'em on a cooking sheet and baked 'em at 350 F for maybe 5 minutes. (Could have used a few more, actually.)

There are probably a googol of variations on this procedure, which is itself a variation of the "English muffin pizza". It's not technically low-fat, since the cheese was made from whole milk, but the amount I consumed is a fraction of what I'd have eaten if I'd ordered pizza. (And I'd have been eating it all weekend!)

The result? It was hot, and creamy, and had TONS of flavor. I'm no longer hungry, and (this is key) I don't have a sense of deprivation that could lay the groundwork for trouble later.

We have to grab the small victories, friends, grab them and hold them tightly to our chests. Big victories don't come around often, but a number of small victories MAKE a big victory.

My Favorite Casual Games

2011-02-11T06:30:00.012-06:00

I'm a big fan of what are usually called "casual" computer games. Such games are typically designed to be accessible to a wide audience, don't require a lot of learning to play, and can be completed in a relatively small number of hours (most often 4-6, I'd guess.)

I compiled the following list of favorites for a friend who's just getting into them. I've been playing regularly for over two years now, and some of my older faves aren't as sophisticated as the best new games, particularly when it comes to graphics. I love 'em anyway.

(A lot of my little comments deal with how "dark" the game is. For perhaps a year, there's been a strong tendency for "hidden object games", as all but one of the below are, to be deeply suspenseful and creepy, even becoming almost horror. In my view, there's too much of this - but some of the games designed that way are really, really good games.)

Awakening: The Dreamless Castle
Lovely. Sequel "Awakening: Moonfell Wood" also very good

Dark Tales: Edgar Allan Poe's The Black Cat
Quite dark, quite good.

Drawn: The Painted Tower
One of the very best. Sequel "Drawn: Dark Flight" may be even better, but play this first.

Enlightenus
Lovely, interesting twist on gameplay. "Enlightenus II" not -quite- as strong

Lost in Time: The Clockwork Tower
Fun, a couple interesting twists, a respite from the darkness.

Magic Encyclopedia
This is one of the games that got me addicted. Sequels also good.

Mortimer Beckett and the Secrets of Spooky Manor
1st of 3, I like this one the most. Not sophisticated, but I've played it dozens of times.

Nightfall Mysteries: Curse of the Opera
This one's so dark, I haven't played the highly-regarded sequel. But very strong.

PuppetShow: Mystery of Joyville
Dark, but excellent: sequel, "Souls of the Innocent", also great

Royal Trouble
Fun, cheerful

Snark Busters: Welcome to the Club
Intriguing, funny

The Serpent of Isis
A bit dated, but one of my faves of all time. Sequel coming soon

Unwell Mel
The best "Match 3" game I've played

Broadening My Disclaimer

2011-02-10T06:30:00.002-06:00

Linked to from the front page, this blog has the sort of disclaimer appropriate to a health blog: I'm not a doctor, don't take anything I say as advice, and for heaven's sakes don't FOLLOW any advice.

I'd like to take this opportunity to broaden that disclaimer. There are a number of subjects in which I am interested, and have even thought quite a bit about, but in which I can in no way considered actually knowledgeable. This subjects include language/linguistics/usage, philosophy of the arts, casual computer games, and a kitchen sink's worth of other subjects.

I mention this because the temptation to use this space to write about some of these things has been getting stronger, and they're going to start showing up. I imagine it'll be obvious, but these pieces will just be my non-expert opinion.

I've Got A Lovely Bunch of Coconuts....

2011-02-09T06:30:00.014-06:00

I wanted to try a recipe Tuesday night that called for fresh coconut. (It was a miserable failure. Rookie mistakes.) The recipe thought I'd need two or three for the amount of coconut meat needed, so I bought four out of paranoia -- and needed less than one.

This is a picture of the three survivors, doubtless hoping that their post-dismemberment fate won't be an immediate trip to my kitchen trash.

Thanks, by the way, to my friend FatCatAnna for sending me the link to this great (and relevant) video, from which I took the title of this post.)

Say Cheese

2011-02-08T06:30:00.017-06:00

In the pursuit of almost any hobby or enthusiasm, it's possible to reach a point of wackiness, where one cuts one's ties with normality.

In case you're ever asked to testify at a hearing, you'll want to write down that I may have reached that point of wackiness this weekend and passed it with a whoosh.

If you follow me here or on Twitter, you know that since just before Thanksgiving, I've been cooking up a storm. I've learned a lot, and I've had a lot of fun. Somewhere along the line, I started getting interested in making homemade versions of some commonly purchased foods in order to pursue my own balance of taste and healthfulness. Perhaps, for example, I could produce a whole-grain pasta that didn't taste like a building material.

On Saturday morning, I made cheese.

Let me repeat, just for the convenience of the social services judge: I made cheese.

It was actually a pretty easy procedure (this is the one I followed). Heat the milk to almost boiling, turn off the heat, add vinegar, let it sit, drain it through cheesecloth. The result was something like a ricotta cheese. It was smooth, sweet, and delicious.

As is often the case when I make something for the first time, this was what I call a "proof of concept" effort, a sort of a trial run just to see if I can pull it off. This version certainly isn't low fat - I started with whole milk. Now that I know I can do it, I can start looking at low-fat and non-fat versions.

If you might be interested in trying this yourself, here are a couple of things I'd do differently next time. First, since the yield was around two cups, and that's a lot of cheese for a single person to eat in a week, I'd probably halve the recipe: this would also make the procedure a little more manageable. Also, I think I might add a little more salt, and stirring some fresh herbs in would probably work rather nicely.

The iPod Alphabet Game

2011-02-07T06:30:00.006-06:00

My friend Kim recently did a blog post in which she compiled a playlist in which she tried to have artists for each letter of the alphabet. (She was missing only "X" and "Z".)

I decided to do something similar. By an large, I listened to only one song/piece per artist/composer. Also, I used artist in the case of pop or jazz and composer in the case of classical music.

I am missing FOUR letters: N, U, X, and Y. The N makes me crazy - such a weird letter to be missing, but I'm pretty sure. I almost downloaded some Yes the night I compiled this, but decided not to cheat.

(The rumor that I called Palestrina an "obnoxious brat" when his music started coming out is vicious and unfounded. I thought he was a pretty nice kid.)

America: A Horse With No Name (Remastered Version)
Brahms, Johannes: A German Requiem (7 movements)
Copland, Aaron: Fanfare for the Common Man
Dave Brubeck Quartet: Take Five
Enya: Caribbean Blue
Dave Frishberg: My Attorney Bernie
Gershwin, George: Rhapsody In Blue
Heart: Rock and Roll (Live)
Iron Butterfly: In-A-Gadda-Da-Vida
Elton John: Bennie and the Jets
Mark Knopfler and Chet Atkins: There'll Be Some Changes Made
Led Zeppelin: Black Dog
The Manhattan Transfer: Operator
Oldfield, Mike: Tubular Bells 2003 (17 sections)
Palestrina, Giovanni: Missa pro Defunctis (5 movements)
Queen & David Bowie: Under Pressure
Joaquín Rodrigo: Concierto de Aranjuez (3 sections)
Sibelius, Jean: Finlandia, Op. 26
Traffic: The Low Spark of High-Heeled Boys
The Ventures: Hawaii Five-O (theme from original TV series)
Williams, Ralph Vaughan: Fantasia On Greensleeves
ZZ Top: Cheap Sunglasses (Remastered Live Version)

Close the Locker Room Door, Please!

2011-02-06T06:30:00.033-06:00

Since this is Superbowl Sunday, it seems like a good time to take a stand regarding the information the media gives us about athletes:

There's altogether too much of it. Way, way, to much.

I like sports. Actually, I don't watch a lot of games, let alone actually go to them, but I listen to lots and lots of sports radio. And I'm tired of trying to decide if I can cheer for an athlete that's been shown to be a thug, or abusive to his family, or to have children by a dozen different women. Sports are one of my HOBBIES, darn it, and I don't need them to be awash in moral ambiguity.

I don't have to worry about this with the other people I appreciate. Nobody's gonna interfere with my appreciation of my florist by telling me that she's a kleptomaniac. Even if the butcher I like gets arrested for embezzling porterhouses in order to support his crystal meth habit, I'm unlikely to ever hear about it: there'll just be somebody else working there the next time I'm in.

It's pretty apparent that a pro (or major college) locker room is not an environment where I'd feel comfortable. So, I don't make any effort to spend any time there. I leave that door closed, and wish the press would, too.

I only want the good news. Does the quarterback go to visit sick kids? I'd love to hear about it. Does he stop at a strip club on the way home from the hospital? I don't want to know.

Yeah, I know: this horse has left the barn a long time ago. I'm not gonna get what I want. Anything these guys do that's bad - or can be painted to look that way - I'm gonna have to hear about it if I want to listen to any sports at all.

But I don't have to like it!

A Bit of an Odd Duck

2011-02-05T06:30:00.000-06:00

I have to admit to being a little, well, different from most other people. In some ways. Maybe in a lot of ways. When you get right down to it, I'm a bit of an odd duck.

(Some of you may have suspected this. Others of you had been sure of it.)

I enjoy humor, and chuckle at many of life's oddities as they come to my notice. Often, however, I have to explain just why I'm chuckling, and those closest to me tend to just let it go.

I didn't buy my first car until my mid-40's - and then discovered that I'm too distractible to be completely safe as a driver. I'm now back to carlessness, voluntarily.

I went nearly two decades during which I rarely saw a television show. I now own a TV and even digital cable - but don't really watch anything except cooking shows. And movies? As an adult, I've seen on average fewer than one a year, even including TV and videos - WAY fewer.

I've never found my "life's companion". This hasn't entirely been my doing - but somebody observing the infrequency with which I've dated over the years might justly conclude that I haven't tried very hard.

I don't really care for having my birthday celebrated, and especially don't care for having it celebrated at work. The coworker that arranges the monthly birthday party can't understand why I won't tell her which month I was born in. (Interested in astrology? I was born under the sign of Sanders.)

Most of the time, these things - and it's not a complete list - don't bother me much. Occasionally, though, they get in the way. For a short while a month or so ago, they got in my way with such frequency that I felt a bit like a freak.

Of course, we all have our own personality quirks, and the ways that I'm like other people in my culture and in my species are way more important than the ways in which I am not. Further, my unique characteristics are part of what makes me able to contribute in the ways that I do, in whatever part of my life.

Did I mention that I don't really like chocolate ice cream?

D-Feast Friday: You Say Frittato, I Say Frittata

2011-02-04T06:30:00.001-06:00

(OK, as far as I know, nobody says "frittato". It's my title. Deal.)

Breakfasts are a problem for me. For some reason, I want a breakfast to be breakfast, real breakfast - eggs, bacon or sausage, stuff like that. I can live without pancakes or waffles, but I don't really want yogurt. Breakfast cereals are okay, but most of them (meaning all the ones I've tried that I really want to eat) do terrible things to my blood glucose. A protein shake will have my tummy gurgling by 10:30. Plus, I'm not really organized in the morning, so I need breakfast to be fast to prepare and fast to eat.

A year or so ago, I started occasionally seeing a dish called a "frittata" on cooking shows. It's kinda sorta like an omelet, but (in the American version, anyway), there's no fussy turning or folding to screw up: instead, it's finished in the oven. And it can contain about anything that doesn't need additional cooking or will cook quickly.

A couple of weeks ago, having acquire an oven-safe pan, I tried it and loved it. I've now made three, and anticipate making many more.

Here's a real recipe. My procedure, adapted from Mark Bittman, is as follows.

Preheat the oven to 350 degrees F. Mix 6-8 eggs up with whatever you want to add, remembering the no-cook/quick-cook rule above. I use a pint carton of Egg Beaters. My mix usually has salt, pepper, some cheese and some cooked potato -- see other suggestons below. Melt two tablespoons of butter in an oven-safe skillet (that is, one that has a handle that won't melt). (It would probably help to start with some cooking spray in the pan: I have yet to remember to do this.) When the butter is melted, pour in the egg mix. (At this point, you can toss in any fillings that you want to add evenly, like the bits of kimchee I tried once, or maybe capers.)

Cook on the stove top until the edges seem set - in my pan, anyway, the edges pull a bit away from the edge of the pan. Put it in the oven until the top is just set and remove from oven, remembering that the pan handle is now very hot.

(Note: I understand that in Italy, they flip the thing in the pan using a plate as a temporary landing place rather than using the oven. If that interests you, go for it.)

Carefully remove the frittata from the pan with a spatula. I tend to work around the thing from the outside edge. I have yet to do this maneuver perfectly, but it's always gone reasonably well.

Since I started doing this, my breakfast on most days is a quarter frittata placed on a "sandwich thin" and put in the microwave for 30 seconds. Very satisfying.

My fillings so far have been kind of random, but I'm eager to try the following combinations that I've thought of:

"Greek" frittata -- slices of a nice olive or two, feta cheese.

American Dinner frittata - a sprinkling of cooked diced potatoes or hashbrowns, a little cooked sausage and/or bacon, onion.

Lox Special frittata - bits of smoked salmon, bits of cream cheese, onion, maybe a bit of diced tomatoes, capers.

Give it a try.

What's a Blog Post Best For?

2011-02-03T06:30:00.001-06:00

One of the fool notions I like to play with from time to time has to do with the relationship of different types of ideas to the ideal format for their expression. That sounds pretty high-falutin', but it's really pretty simple. Books (of the nonfiction variety) are good for extended examinations of a subject. Explorations of some aspect of the human condition might be best presented in an essay, but also might find their best form in a novel or a short story. And, of course, all sorts of things can find their way into poetry. (There are also, of course, ideas that don't belong to the word at all, and are developed into a piece of music, a painting, or some other artistic expression.)

So what's a blog post best for? For most of us bloggers, a blog post is likely the only means we have available to get an idea out to an audience. But suppose you had plenty of choice?

Suppose, for a minute, that you're a popular and critically-acclaimed author. Your publisher is likely to accept any book you send them, fiction or non-fiction. A magazine editor would be delighted to get an article from you. Even a newspaper editor would likely be pleased to get a guest editorial from you. Under what circumstances might you choose to put an idea in a blog post?

I don't have a good answer to the question, though I've got a guess or two. Blog posts make it very easy to link to something that's already out there and comment on it. It's not only easy, but intellectually honest: you can write a blog post vehemently disagreeing with something you've seen, but your link to the original item so that readers can decide for themselves.

Blog posts also carry the potential to be a marketing tool. A magazine editor is unlikely to print your explanation as to why everyone should run out and buy your latest novel (now in paperback!). But, you can do that in a blog - especially if you provide enough actual content to attract and keep an audience.

I think that blog posts are good for a quick exploration of a relatively narrow subject - why your team's manager should be fired, why a particular politician is an idiot (or a saint), or why Art Garfunkel's work on "Bridge Over Troubled Water" is the greatest male vocal performance in pop music history. (It is, you know.)

Blog posts are also great containers for "how-tos" for relatively simple procedures, from cooking an omelet to installing a new hard drive.

What do you thing? What are blog posts the ideal format for from your perspective?

A Test Strip's Tale

2011-02-02T06:30:00.021-06:00

March 14: Suddenly, I burst into consciousness. It seems that I am a test strip for a glucose meter, a small miracle of technology precisely engineered for an important task. Within minutes of my awakening, I find myself in a small plastic container with 24 of my compatriots. I am puzzled, however, because I am the only strip in my container that appears to be sentient. This is especially unfortunate in the case of the rather attractive strip right next to me - I could share some thoughts with her, if you catch my meaning!

April 7th: After weeks of sitting in warehouses and being bounced around in trucks, I have arrived in a pharmacy. I wonder how long the wait here will be?

May 2nd: I have been purchased. I confess to feeling a little swell of pride at the amount of money paid for me: I am easy, but not cheap.

May 14th: I chafe at the length of my wait. My compatriots have been disappearing one at a time, naturally, that cute strip next to me was the first to go. I must say, the rate at which we're being used is somewhat slower than what I understood to be optimal. Nonetheless, I feel a strong affection for the man who bought me, and look forward to playing my part in supporting his health care goals.

May 18th: The day for which I was created has at last arrived! The container is opened, and I am removed. I am placed into the meter: the fit is perfect. I am touched to a drop of blood, and I process it according to my engineering and deliver the good word to the meter, which promptly displays the result. (163? As a fasting reading for a meds-only T2? What did he EAT last night????)

My joy is complete, my destiny is fulfilled. The man whose very life I have helped preserve has left me in the meter, presumably to contemplate the excellence with which I have perfomed.

May 19th: I begin to wonder, now that my purpose is complete, what my future holds. This morning I was removed from the meter and replaced with another strip. Rather than being placed with dignity in the luxurious final resting place I expected and deserved, I was casually tossed into a pile of other strips that have given their all. It's dusty, too.

May 23rd: My existence gets worse and worse. This morning, the pile I was in was swept into a wastebasket. I, however, fell outside the basket onto the floor. A few minutes later I found myself adhering to the bottom of the man's foot and thus carried into his shower, where the water washed me off his foot and into the tub's drain strainer. The conditions here are unspeakable. How I wish I had entered the waste stream with my fellows, bound for the serenity of the landfill or perhaps even the blessed oblivion the incinerator offers.

May 25th: How long will it take this man to notice me here in the drain? I have come to hate him.

May 26th: At last, the tyrant notices me here in the drain. He plucks me off, and tosses me toward another wastebasket - and again he misses. (I hope his pancreas explodes.) So I lie here, right next to the toilet. I will say no more of my situation here. Oh, that this consciousness with which I was cursed might have an end.

June 3rd: Finally, finally, my blessed end is nigh. Again, I was thrown away, but this time actually made it into the basket. The last few days in the waste stream have been disgusting, but here I am on a moving belt, and I see the incinerator ahead. Oh lovely nothingness, I come!

Personal Blog Posting Month

2011-02-01T06:30:00.002-06:00

Many bloggers make a commitment during the month of November (originally) to do "National Blog Posting Month", which is a commitment to do a post each day for that entire month. Last November, I had no interest. Now, however, I feel the need to do it for February. (I'm not the only one - I know of at least two other diabetes bloggers that have independently made the same commitment.)

I've gotten myself into a little trap of wanting each blog post, particularly for my Diabetes Daily blog, to be a little gem: a complete, if short, essay wrapped around one (or more) idea that is (usually) of some importance, at least to me. That kind of blog post is HARD, so I'm not posting as much as I'd like. So, I'm going to use this month to try to get out of my rut a little bit by doing a lot of different posts of differing lengths and formats. I also hope it will be fun...and not TOO time intensive.

Some of My Favorite Books

2011-01-12T21:46:00.000-06:00

My friend Megan on Twitter asked me today to name my favorite book, a book I could reread over and over without it getting old. Because I never could follow instructions, my response is below. Many of these meet Megan's rereading test: others I simply found to be amazing. I've been worrying lately because I seem to have fallen out of the habit of reading books -- maybe compiling this list will help get me restarted. I want to reread a lot of them!

You'll note that the list is heavy on essays and other nonfiction. I've read a lot of fiction, but almost all of it has been detective fiction (mysteries). To some extent, the diversity of subjects in the nonfiction reflects my varying interests, but mostly reflects that I'm more concerned with how well a book is written than what the subject is.

Nonfiction and Essays
From Bauhaus to Our House - Tom Wolfe. A book about the surrender of 20th century American architecture to politically-driven European architects arriving in the US before World War II. It's an astonishing polemic: despite a subject that sounds like a total yawner, it's an astonishing exercise in the use of language as a blunt instrument. Pointed and sarcastic. Completely changed my view of what good writing can be. By the same auther: The Painted Word.
Lives of a Cell - Lewis Thomas. A series of lively essays about biology, life, and language by a physician and research scientist. Wonderful. By the same author: The Youngest Science, a personal history of modern medicine.
White Album - Joan Didion. Didion is one of the best-regarded prose writers of our time. This collection of essays focuses on the turbulent years in the late 1960s.
A Year in Provence - Peter Mayle. Very funny first person account of an English family that buys a house in the South of France. Wonderful stories, wonderful characters, wonderful food. Contains some of my favoite lines ever.
Dave Barry is Not Taking This Sitting Down - Dave Barry. A collection of very good short pieces by a very humorist at his best.
Life Work - Donald Hall. Hall is primarily known as a poet, and this book-length essay, about the role of work in our lives, shows it in the elegance of language. Hall's signature in my copy of this book is the only author's autograph I've ever sought: I did it partly just to say 'thank you'.
Simple Cooking - John Thorn. My all-time favorite book about cooking. I haven't reread it in a while, but it's at my elbow right now.
Sayonara, Michaelangelo: The Sistine Chapel Restored and Repackaged - Waldemar Januszczak. This short book blew me away. It's about the restoration Michaelangelo's paintings on the ceiling of the Sistine Chapel in Rome and the financing of that restoration by a Japenese television network, but it's also about Japanese society, the history of Christianity in Japan, the nature of artistic genius, and a lot of other things. Very influential in my opinions about the arts.
Playing for Keeps: Michael Jordan and the World He Made -- David Halberstam. Yes, it's about basketball, but it's about so much more. You'll learn a lot, whether you care about sports or not.
A Roomful of Hovings -- John McPhee. My goodness, McPhee's a great writer. This collection of profiles from the New Yorker features an essay (the title piece) about a man who was director of the Metropolitan Museum of Art in New York City which you should read if you're interested in art -at all-.
Tummy Trilogy - Calvin Trillin. This collection of very funny pieces originally published as three books chronicle Trillin's efforts to find something decent to eat as a traveling man.
Soul of a New Machine - Tracy Kidder. A fascinating look at a small company in the early years of the computer industry as they develop a new model of computer. The subject gives no clue as to how interesting it is.

Detective Fiction
Busman's Honeymoon - Dorothy Sayers. Subtitled "A Love Story with Detective Interruptions", this is sort of a romance and sort of a mystery. Features the character Lord Peter Wimsey. Often funny, often moving.
Aunt Dimity's Death - Nancy Atherton. It's a detective story without bodies and a ghost story that isn't spooky. Warm and fun.
Anulet of Gilt - Phoebe Atwood Taylor. Taylor's not widely read anymore, but this is one of her books set in Cape Cod and featuring 'hayseed sleuth' Asey Mayo. The first few books are rather dark, but most of them (including this one) are quite funny. Taylor's books have a wonderful sense of time and place. This one features the line "I'm just the man people give elephants to." I actually contributed to the Wikipedia article on Taylor.
Light Thickens - Ngaio Marsh. Perhaps my favorite detective is Marsh's Roderick Alleyn. This book, Marsh's last, takes place against the backdrop of a production of Shakespeare's Macbeth. Entertaining and atmospheric.
The Luck Runs Out - Charlotte Macleod. I like a lot of this woman's books. Many, including this one, are quite funny.
Glimpses of the Moon - Edmund Crispin (pen name for Robert Bruce Montgomery). Very funny and yet very evocative. Excellent.

Other Fiction
Phantom Tollbooth - Norton Juster. This is allegedly a children's book. Great. Easy to read, funny, thoughtful. Will change how you look at life.
Crime Wave at Blandings - P. G. Wodehouse. Actually a long short story by the author best known for the character of Jeeves the butler, although this is not a Jeeves story. I cannot begin to tell you how funny this is. It can be found a lot of places, but was originally published in the collection "Blandings Castle and Elsewhere."

If Scrooge Tweeted...

2010-12-24T10:49:00.000-06:00

Most people are familiar with the character Ebeneezer Scrooge from Charles Dickens' classic tale "A Christmas Carol". Here's my take on what Scrooge might have written during those fateful hours had he been using Twitter:

December 24th, 4 PM Caught Cratchit sneaking coal into the fire again. He's trying to heat me out of house and home! ha ha!

4:30 PM Another bunch of do-gooders trying to separate me from my money. What are poor houses for, then?

5:30 PM Find myself thinking of my old partner Marley, now dead as a door nail. Now there was a man who knew how to foreclose a widow's loan!

7:30 PM Off to a hopefully quiet dinner. I swear, if I hear "Little Drummer Boy" ONE MORE TIME...

9:30 PM Nasty shock: thought I saw the face on my door knocker turn Marley's! The old buzzard was ugly enough alive! Gotta lay off the mustard at dinner.

10:30 PM I've been visited by Marley's ghost! And he said more ghosts were coming! Long night ahead: may be too tired tomorrow to go steal candy from babies.

December 25th, 12:17 AM Just left by the "Ghost of Christmas Past". Ah, sweet Belle was so lovely. But have you seen her lately? What a hag! LOL

3:23 AM Boy, the "Ghost of Christmas Present" sure could stand to mix a salad in between all those goodies. What a tub!

5:15 AM The "Ghost of Christmases Yet to Come" could SERIOUSLY use some social skills. What a drag THAT guy is!

5:35 AM Exhausted, but having trouble sleeping. Thinking things over: maybe I COULD stand to make some changes...

9:30 AM Could it really still be Christmas morning? Man, I thought I'd spent a MONTH with those ghosts. Where's Scooby-Doo when you need him?

9:40 AM Just sent some little scamp off with money to buy a big goose for the Cratchits. Might as well: been giving those poor folks the bird for years now. That's gonna change now, though.

11:00 AM Off to my nephew's for dinner. I hope I'll be welcome: got a sneaking feeling I don't deserve to be. Gosh, though, I feel good!

4 PM Lovely dinner, lovely people. Feel happier than I have in many years! Merry Christmas to everybody!

Cooking Goals for 2011

2010-12-22T18:58:00.000-06:00

One of the reasons I don't think of myself as a good cook is that there's so much basic stuff I don't know how to do. Here are a few things I'd like to accomplish by the end of 2011:

1. Understand my options for thickening a liquid and be able to use at least some of them without resort to a recipe. In particular, I'd like to be able to make/use a roux on the fly and be able to do a white sauce without doing more than referring to a note card for a ratio. I have Christmas Day planned for Project White Sauce.

2. Prepare more of my own food during the summer months. Kansas City isn't exactly the Amazon, but it does get hot here, and the hot weather sucks me dry of any culinary ambition. So things go generally to heck. I need to develop a plan.

3. Learn to clarify a bouillon by using a "raft" of vegetables, meat, and egg. OK, I'm lying: I have no need for beautifully clear bouillon. But I saw this done on TV the other day and it's a cute trick. :)

4. Learn the uses for more of the seasonings in my spice drawer. A lot of that stuff I can't even mentally 'taste'.

This seems doable to me!

D-Feast Friday: The Soul of a Recipe

2010-12-17T09:03:00.002-06:00

I have a love-hate relationship with recipes. I love them when they teach me what I want to do, but I hate referring to instructions as I cook. Alas, unless I'm just making something up as I go, I do need the recipe.

Here's my main quarrel with most recipes: they tell me too much and too little at the very same time. The lists of ingredients and detailed procedures usually fail to convey what the recipe is really about. What ingredients and steps are necessary to for the dish work from a chemical standpoint, which are necessary for a pleasing flavor, and which just give the dish that extra something?

What is the soul of a recipe, its essence? If the recipe went to Nepal to find itself, what would it learn? When I experimented with breadmaking a decade ago, I learned from my reading that all you need for yeast bread to work are yeast, some kind of sugar for the yeast to much on, flour, and water. I haven't made bread in ages, but I'm reasonably sure I could bake acceptable bread just from those ingredients, using no recipe. All the other ingredients you find in bread recipes are there to enhance flavor, texture, shelf life, nutritional value, etc. I'm not saying those thing are unnecessary, because they are necessary if you're after the characteristics bring. But the SOUL of yeast bread is flour, water, yeast, sugar or something, and the steps needed for the yeast to make the dough rise.

I once tried to make a curry sauce by stirring curry powder into unflavored yogurt. The result was incredibly bitter, one of the worst things I've put into my mouth: I can almost taste it now. Today, I used the Internet to track down a number of yogurt based curry sauce recipes. The first few I looked at didn't seem to be quite when I wanted. When I pulled up the fourth one, I almost fainted from the length of the ingredient list. Once I resumed breathing normally, I deduced from the list that the author was basically asking you to build your own curry powder from whole spices - a fine idea, but not a process I would find necessary. When I had mentally crossed off the curry-powder ingredients, what was left was pretty much this: yogurt, curry powder, and sugar. I had been on the right track, all those years ago: I just needed some sweetener.

These days, I'm working on growing as a cook. As I do so, I find that I'm getting better at reading recipes and finding the soul that I seek. And that, in turn, makes the recipe easier to cook from. Because I'm not doing anything very elaborate, I start cooking knowing what I need to do: I just need the recipe as a memory jog. Why? Because I know that recipe's soul.

Thinking About Blogging: A Pop Quiz

2010-12-16T18:36:00.000-06:00

OK, class, now I'm going to give you a pop quiz about blogging. This is an open-book test, so I encourage you to consult your own hearts and minds.

Please note that all answers are correct.

Posts to a blog that's mostly about a particular subject should be:

Informational - readers should go away from the post more fully informed about the subject at hand.
Experiential - readers should go away from the post better understanding the blogger's life and heart, and perhaps relating part of their own experience to the blogger's.

2. Ideally, a blog's post should feel like:

An entry in a journal or diary.
A letter to a trusted friend.
A very small work of literature.

3. True or false: No matter what the normal subject of the blog is, it's a good idea to occasionally include pictures of and stories about cats:

True: Yes, absolutely.
True: Of course this is true! How could this possibly be false?

4. In most kinds of writing, the writer should have the needs of the reader foremost in his or her mind. In blogging, the writer should:

Put the topic and the blogger's relation to it first. The blog is a journey of sorts, and readers are welcome to come along or not as they choose.
Seek first to serve and nourish the readers. If the blogger is not serving readers, the risks of putting one's words online outweigh any advantage in having the blog at all.

Please pass your exam books to the center aisle for collection. And congratulations: no matter your answers, you get an "A".

D-Feast Friday: In a Pickle

2010-12-10T08:17:00.000-06:00

As is typical with my cooking posts, this is the report of an amateur playing around than a dissertation by an expert.

I've been pickling some veggies lately. There are various advantages to this, such as getting some additional life out of a cooked veggie that needs to have something happen to it, as with the beets I put in a brine the other night. But the main reason I'm doing it is that the little flavor bombs are delicious, and eating them feels like I'm treating myself luxuriously. Fairly often, when I want a bedtime snack, a few bites of a good pickle does as a fine substitute for alternatives that would be much higher in calories.

The pickle world sort of divides into two main approaches: processed pickles add a brine to a veggie in a jar that is sealed under sterile conditions: this is often called canning. If it's done right, the results are stable at room temperature almost indefinitely.

My experiments, though, have been with what are called quick or refrigerator pickles. The veggie is placed in a brine and then in the refrigerator. It's ready to eat in a few days and typically lasts for a few weeks. (If you resist eating them for that long.)

The brine is typically a combination of water, salt, vinegar, often some spices, and some sugar. (I haven't tried this yet, but I was reading yesterday that Splenda or the like can be used in quick pickles though not for processed pickles.) Brines differ in the proportions and in the type of vinegar years, because different veggies vary in the level of acidity that work best, and different tastes may be sought.

Basically, following the recipe, you build the brine in a saucepan, chop your veggies and place them in the jar. Pour the brine over the veggies, put on the lid, and refrigerate. It really is easy-peasy.

I've done a mild version of kimchee, beets, bread-and-butter pickles, and pearl onions. My very favorite, though, is pickling roasted red peppers - I've used the Food Network recipe here. This recipe also teaches you how to roast peppers, which is pretty easy and (if you like roasted peppers) is a HUGE savings over buying them at a deli.

If you're interested in playing with this, check your favorite markets for a spice blend called "pickling spice". When I got in a toot to use it, the store I used most didn't have it, and made my own blend out of a bunch of stuff. This may be fresher, but the packaged blend would be easier!

Go on. Get in a pickle.

Aging Mind, Young Memory

2010-12-02T19:44:00.001-06:00

Today, picking up my prescriptions at the pharmacy, I saw a young woman who looked so much like someone I knew that I almost spoke to her...could it be her? Then I realized that the young woman I'd known would now be in her 40's.

I tweeted the experience, as part of my "This is what aging is" series. My friend Jess, who blogs awesometastically, responded (translating from Twitter), "So your brain is aging but your memory isn't? :)"

I thought that was beautiful. I haven't seen the woman the girl in the pharmacy reminded me of in many years. I don't know what her life has been like, though I hope she's happy, or if she ever wishes to again be the age at which I knew her. In a sense, though, she'll live as a young woman, preserved in the amber of my memory, for as long as I live. So, too, will all the people that inhabit my memories, wherever life (or perhaps death) has taken them since we last met.

Something to be Grateful For

2010-11-22T20:07:00.000-06:00

The fabulous Mike Durbin has challenged his fellow diabetes bloggers to post each day of Thanksgiving Week to acknowledge blessings we've received as a result of diabetes.

I don't know that I'm going to make it to seven: I don't know that I'm going to make it to two. (I've written several posts in the last couple of days, and I feel the hot breath of laziness close upon the back of my neck.)

But, this one is a big one.

See, one of the things I think a person needs for a full life is something to be involved in, a way of doing good that absolutely nobody in authority expects you to do. To qualify in my mind, the "cause" would be something that no employer, family member, or even church leader that would attempt to make me do. Purely voluntary, done solely from belief and passion. Political or social movements, charities, community organizations, teaching kids to read - there are thousands of things a person could do along these lines.

Now, I've got diabetes. Diabetes provides a focus for my efforts. I tell my story as part of my efforts, and I try to provide a little support. Some of what I do is intended to help the larger Diabetes Online Community better understand Type 2, but mostly I just seek through blogs and tweets to lighten peoples' loads just a little bit. While I may someday do more to represent diabetes to society as a whole, what I'm doing now feels productive and worthwhile.

I'm grateful for something to do.

I went a long time without finding something that fit for me. Sure, I've done a whole bunch of little things, but I've not have a specifiec

Fake Diabetes Statistics

2010-11-11T20:59:00.000-06:00

We read many statistics that are faked or exaggerated. Here, there's no mystery: I'm telling you I made them up.

73.6 -- The number of hours of sleep I lose in a year while putting off loading my pill sorter.
2 -- The number of test strips per container that, once used, escape and try to make it to the border.
0 -- The number of members of the "diabetes police" sent to the hospital each year by enraged diabetics.
12,873 -- The number of members of the "diabetes police" sent to the hospital each year in the imaginations of enraged diabetics.
6.2 -- the percentage of health information sites on the Internet that are actually run by people genuinely interested in the health of others.
95 -- the percentage of 'finger wipers' who think that 'finger lickers' are a little bit disgusting.
98 -- the percentage of 'finger lickers' who think that 'finger wipers' are a little overly fussy.
1 -- the number of blood tests per lancet encouraged by lancet manufacturers.
17.6 -- the average number of blood tests per lancet by anybody that's been testing for more than a week.
99 -- the percentage of diabetics who've secretly wished a high blood sugar episode on some officious carb pusher.
15,872 -- the number of new diet books published each year.
3 -- the number of new diet books published each year that actually help a significant number of people achieve meaningful and lasting weight loss.
9.8 -- on a scale of 1 to 10, the amount of fun I've had making up these statistics.

Bob Pedersen

"Do you go to a lot of PLAYS?"

2010-10-19T20:05:00.001-05:00

Quite a number of years ago, I attended a professional conference. In a rare attempt to behave like a social person, I signed up for an optional activity to be go with a group to a museum and then out to dinner. At dinner, I mentioned in the course of conversation that I didn't own a television. One of me dinner companions was surprised, and said that I must go to movies then. I said no, that I hadn't been to a movie in several years. With growing astonishment, she looked at me and asked, "Do you go to a lot of PLAYS?" She seemed unable to conceive of entertainment in a form other than one playing out in front of her.

Still, I have to admit, I'm pretty unusual in our culture. I've seen three movies since moving here 15 years ago, and one of those was a documentary. I do own a television now, but not only do I rarely watch movies on it, there are weeks when I don't turn it on. (I do watch some television, mostly Food Network, with a friend.) And, no, I don't go to a lot of plays.

Part of my lack of TV/movie watching is a matter of habit. I watched my share of TV as a kid, but limited myself as a teen so that my parents didn't do the limiting for me. I didn't own a TV for several years after leaving home, and just got out of the habit. I've never gone to a LOT of news, but if you don't watch TV you don't really get much movie info without seeking it out.

Another big reason I don't go to a lot of movies or watch typical television shows is that I tend to get bored pretty easily. When I get bored in a movie theater, I often feel almost physically trapped - this is not a pleasant feeling. Plus, I have a strong aversion to almost any display of violence.

But here's the big thing: I have a pronounced dislike for becoming emotionally involved in a movie or program. And I do become involved, quite easily. Even when I was a kid, watching shows like "Leave it to Beaver", I would become quite uncomfortable when Beaver got in trouble or when his parents had there "talks" with him. Sure, I've seen movies where I came out feeling exhilarated after all the discomfort (the 'Breakfast Club' is an example), but the ride is just so unpleasant I prefer not to take it at all.

Strange but true.

Nocturne

2010-10-02T19:16:00.000-05:00

A nocturne ... is usually a musical composition that is inspired by, or evocative of, the night. (Wikipedia)

It is late evening. I'm lying in bed, on my stomach, perhaps with a pillow under my chest. I may be on my laptop, in order to read, to tweet, to blog, or to play a silly game. Or I may be reading a book, though not as often anymore, or I may be working on a crossword puzzle.

I may have a radio on or - rarely - the television is providing background noise. Usually, though, the only sounds are the hum of the laptop, what few neighbor noises come through the concrete apartment walls, and the noise from the highway and the rail yard nearby. Because I live atop a bluff and have a west-facing exposure, there is usually wind. All this is not silence, but it's close, and my brain easily filters it out and passes on a sense of silence.

Being here in this place, enjoying the quiet and the soft lighting, is often the most enjoyable time of the day. No one expects much from me. The phone's unlikely to ring. E-mails that contain obligations do not come at this time of night. I am at peace, more or less, and I feel a sense of security that often eludes me at other times.

It's a struggle for me to turn out the lights, to willingly bring a close to this time of peace. If I've got work the next day, I am usually able to choose sleep at a reasonable time. If not, or if my heart or mind are burdened, I may extend my evening activities much longer than I healthily should. If I become drowsy, I keep going until I am simply longer able to do so.

For as far back as I can remember, such have been my nights. It's not a problem with sleeping, although I sometimes have that as well: it's a problem with choosing to sleep.

I see headlines from diabetes news sources suggesting that insufficient sleep may play an important role in the development of Type 2 diabetes. I know that frequent fatigue eats away at the energy available for exercise and other healthy activities.

But, late at night, none of that seems to matter very much. And so, as it always has, my nocturne plays on.

I'll Tell You a Story

2010-09-29T19:33:00.000-05:00

There was an incident on Twitter the today that got me thinking about words (again). Specifically, I was thinking about what word I'd choose to describe my role in the Diabetes Online Community, at least as I perceive it.

What happened with this: a Twitter user who's been aggressively trying to make connections within the community was asked by the diabetesalicious Kelly Kunik to explain her repeated statement that she's working to "cure diabetes". (Kelly's account of the story, as part of a moving post, is here.) The resulting exchange - in which other DOC members participated as well - revealed that this person means "manage" rather than "cure", arguing that doctors see "effectively managed" as the same as "cured", and that the low-carb/high protein meal plan she's pushing will produce fabulous management. Part of me wanted to participate, with my opinion that "effective management" and "cure" are miles apart, and that any doctor that really used the terms as synonymous was dangerously out of touch with the patients. But, I didn't participate - partly due to a failure of nerve.

Later in the day, I sent Kelly a tweet of thanks. In that tweet I described myself as a "lousy advocate" for not taking up the cudgels. I regret saying that, though I got a couple of heartening responses. But, my discomfort with describing myself as an "advocate" or an "activist" remains. I don't disparage the role I see developing for me, but I don't think either of those words quite describes it.

I thought for a while, as I did my data entry, about the word I would choose to describe my role, particularly in reference to my blogs. After a while, the word that fits came to me.

I'm a storyteller. I'm proud to be a storyteller: a storyteller can make a tremendous difference.

I'm telling the story of a disease that I didn't ask for any more than anybody else did, and the impact it has on me, and my struggle to respond to it more effectively. I'm not really comfortable providing much information ABOUT diabetes, though I've felt I needed to do so more often than I'd like. I'm a long way from an expert, and health information shouldn't be guesswork.

So, I tell my story. Sure, I describe my thoughts and feelings more often than I do incidents from my life, but my thoughts and feelings are a big part of my story, too.

I hope you find, from time to time, that in telling my story I'm telling part of yours, too. And I hope that just a little more understanding, a little more sense of connection and of community, a little dispersal of isolation, will result.

D-Feast Friday: Curry Cauliflower Soup

2010-09-24T07:03:00.000-05:00

This soup grew out of what I had on hand one evening.

Cooking oil of your choice
1 head cauliflower, cut into smallish florets
1 quart low-sodium chicken broth
A few stalks green onion, shopped or shredded
1 tomato, chopped
Curry powder
Cinnamon powder
Salt
2-3 cups cooked short- or medium-grain brown rice

1. This is probably optional, but this was going to be a stir-fry when I started, so I sauteed the cauliflower and green onions for a few minutes.
2 Add chicken stock.
3 Add curry powder to taste, then add some more. I think I used like 2 tsps. This much was an accident, but it worked. Trust me on this.
4. Add some cinnamon powder, maybe 1/2 to 1 tsp. It may just be me, but I find that cinnamon takes some of the heat out of curry while not taking away from what I call it's 'warmth'. I'm not Emeril and don't know how to describe this stuff.
5. Add tomato and salt to taste.
6. When the cauliflower is about tender, add the rice and cook for a few more minutes. Serve hot.

Diabetes Limericks

2010-09-22T23:24:00.000-05:00

I wrote the below as relief from having written several rather earnest posts. I hope none of the below crosses the line from funny to offensive for you, and hope that you'll forgive me if they do.

My doctor had offered me kudos
On maintaining an excellent glucose
But I blew it away
On the way home that day
That sweet shop was entirely too close!

A 'betic in old Narragansett
Who hated to swap out her lancet,
Said, "I know that it's strange,
But it's annoying to change,
So I guess that I'll just have to chance it!"

My pharmacist showed an example
Of a test strip that took a small sample
"You don't need a quart,
I'm pleased to report,
A teensy bit ought to be ample!"

Breakfast With My Meter

2010-09-13T21:11:00.001-05:00

This an experiment. Please let me know what you think.

In a dream....

I was sitting in a molded plastic booth at a fast food restaurant, finishing my breakfast, when a woman slipped into the seat across the table from me. "We have to talk", she said.

I was startled - by the interruption, by the woman's loveliness, and most especially by such words coming from someone I didn't think I knew at all. A case of mistaken identity? I wondered in a moment of anxiety. Was I about to be drawn into some drama I had no part in?

"Um, okay, but who are you?" I asked, trying to recover my sense of calm.

"I'm your blood glucose meter."

In the logic of dreams, this simple statement seemed quite sensible, and I felt reassured. "I don't remember my meter looking like you!" The woman was sleek, handsome rather than beautiful, and dressed stylishly in silver and black.

She grinned at me. "I can take human form once in a while. It's a new feature."

I grinned back. "I don't remember seeing THAT in the manual!"

"Yeah. Like you actually read the manual."

I was stung by the shot - and its absolute truth - and made an ungentlemanly response. "Oh? And is the manual more accurate than YOU are?"

Her eyes narrowed, and she seemed about to answer my insult with one of her own. But she bit off her words, took a breath, and relaxed. "Bob, I know the accuracy issue is a real problem for diabetics that use insulin. But, honestly, is it really that big an issue for you?"

"Not that big an issue, no," I admitted. "The numbers are good enough to show a trend in the fasting levels, and that's probably the most important for me. But when I do pre/post testing on a particular food, I really can't learn much unless I do the testing the same way a number of times. And, since I don't really do that, it's not much more use than not testing at all."

"I understand that," she said, "I wish I could do a better job. But do YOU understand that you could be helping more?"

"What do you mean?" Suddenly, I knew perfectly well what she meant.

"Several things. First, while you do your fasting test fairly often, and that's good, it's nothing like every day. Daily would give you much more meaningful numbers. And you know how you could round out the daily variations to show trends a little better - you've just never done it."

"Guilty as charged", I said.

"Next, this pre- and post-meal testing you mentioned. You need to do more of it, both to learn about specific foods and also to compare the pre-meal number. Sure, you'd probably have to buy some strips beyond what the insurance will be happy about. But you spend money on less important things than that."

"True."

"Finally, you're pretty casual about how you test. Often, you don't wash your hands, you just suck on the finger you're going to use and dry it on whatever's handy. That introduces a lot more room for variation than you'd have with better practices."

She fell silent. I was silent, too: she was right, but I didn't want to admit it.

In the silence, she looked at the tray with my interrupted breakfast. "You're not gonna eat those hash browns, are you? Since you're also having an English muffin?"

"What are you, the diabetes police?"

She laughed out loud. "Yes! Isn't that my job?" She grinned at me, then grew very serious. "Look. You do a good job with a lot of diabetes stuff. But I want you to be healthy for a very long time. And you could be doing more to help yourself."

She stood. "Give me a quick hug, and I'll let you finish your breakfast." As I rose, I thought I saw that her eyes were a little misty. "Take care of yourself", I heard her whisper, "and let me help."

Barely had my mind begun to register the hug when it was suddenly gone, completely. As I tried to puzzle this out, I noticed something in my hand. My meter.

And then I awoke.

Games Pedersens Play

2010-09-03T17:25:00.001-05:00

I spend a fair amount of time playing computer games. Whether you would consider me a "gamer" or not depends on your definition of that term. If you're passionate about that definition, I probably don't fit.

The games I choose are based on the following things I've learned about myself:
* I play for entertainment. I enjoy a challenge, but too much challenge means frustration. When I want a huge challenge, I do one of my cranium-crushing crosswords.
* I have very little manual dexterity and a lousy reaction time. So I have no realistic chance of being successful enough at an action game to enjoy it. So, while I've never TRIED "Modern Warfare", I just can't imagine having the fun others do.

(This would be me playing a combat game: *start* *SPLAT* *restart* *SPLAT* *restart* *SPLAT!* "Gee, I wonder what I've got on my DVR?")

Taken together, these factors put me at home with what are called "casual" games. These games are designed to be easy to learn, so that you don't need an hour with an instruction manual to get started. They're typically limited in length as well - I can finish most of the games I play in an evening.

The games I enjoy most are "hidden object" and casual adventure games. In a hidden object game, the player is presented with a cluttered scene and given a list of objects to be found in that scene. In the older games of this genre, that's pretty much the whole gameplay, and the stuff you looked for was often silly, like hotdogs. In the last few years, however, this genre has been sort of morphing into adventure games of sorts: some of the objects you find are used to solve problems that move you towards some objective. If the plot isn't TOO absurd, that's enough for me.

So, I'm not up to taking on dragons or virtually defending our nation from zombies, or terrorists, or even zombie terrorists. But I have a great time with what I do play!

D-Feast Friday: Garlic-Feta-Olive pasta topping

2010-09-03T12:36:00.000-05:00

I was taught this bit of yumminess as a pasta topping, but I imagine there's all sorts of things you can do with it. Green beans come to mind, though I've never tried it.

* olive oil (a couple of tbsps per serving)
* fresh garlic, diced or sliced (a clove or two per serving)
* black olives, sliced or diced (I think other olives would also be tasty; use a tbsp or so per serving, or to taste)
* feta cheese (use a tbsp or so per serving, or to taste)

1. Put the garlic into the olive oil over very low heat. You're not sauteeing the garlic, you're creating an infusion. If the garlic starts to fry, move it off the heat for a bit while you turn down the heat. I'm guessing step takes three to four minutes.
2. Once the oil tastes nice and garlicky, strain the oil and dispose of the garlic.
3. Resist the urge to call off dinner and disappear into the basement with the garlicky oil and a loaf of crusty bread.
4. Toss the oil, the feta, and the olives into whatever you're serving it with.

A Very Bloggy Announcement

2010-09-02T18:39:00.000-05:00

I've been honored with an invitation to become a "featured blogger" over at Diabetes Daily, which was my first diabetes "home" on the Internet. You can find my entries there at http://www.diabetesdaily.com/pedersen. I hope you stop by!

But those of you who've read me here won't get rid of me that easily. I'm still going to post here as I write stuff that may not quite fit the decor in my new digs. While I'm not clear on just how I'll draw the line, I do address some topics that clearly aren't related to diabetes. My eyebrows, for example. (If you do visit the new site, you may notice that my picture there clearly shows the expansionist tendencies of my eyebrows.)

I want to express thanks to the folks who encouraged me to start blogging and the folks who've supported me as I've worked at finding my "voice". It's only quite recently that I've felt confident thinking of myself as a "real" blogger, rather than just someone getting a few things off his chest. Thank you for reading.

The Gumption Meter

2010-08-30T21:27:00.001-05:00

I want a meter, just like my glucose meter, only one that checks for gumption. Yes, gumption: if you don't know or don't like the word, you can use "pluck" or even "courage". But "pluck" in this sense is pretty passe, maybe even archaic. "Courage" is accurate, but seems to fit more in the context of military personnel, police, fire fighters, and junior high school teachers.

"Gumption" is simply the ability to face up to what one has to do in everyday life. And tonight, my levels are pretty low.

My gumption meter would look a lot like my glucose meter, and would work pretty much the same way. If the target range was the same for my blood glucose, a check tonight might read "43 mg/ml. Check for depression." Then, I might go to my bathroom to take a second test to get a reading as to where a more fundamental reading of my current mood stood.

Tonight, I think I'm basically okay. I'm in a situation that has me outside of my comfort zone, trying to fix a situation that I brought on myself, and needing to call on good friends (bless 'em!) to help me out of it. I've been unable to sleep on a regular schedule for a few weeks: that doesn't help. Anxiety, stress, guilt, fatigue: a perfect scenario for low gumption.

For tonight, I'm going to go care for my neighbor's pooch, and try to go to bed. Tomorrow, the plan to get me out of my situation moves into action: mostly what I need is a little luck, and I'll be past it by the end of the week. My friends are gracious and genuinely willing to help.

A little sleep, a little friendship, a little resolution. I think my gumption meter will be showing target readings really soon.

D-Feast Friday: Getting Started with Fresh Chiles

2010-08-27T19:17:00.000-05:00

Cooking with fresh chile peppers is an easy way to add heat - but not necessarily too much heat - to your food. I'm a long, LONG way from an expert on this, but maybe what I do know can help you get started.

I was scared off of using chiles for a long time, because chiles to me meant jalapenos, and I don't like jalapenos. I eventually learned that different chiles carry different flavors as well as different heat levels, and that I just don't happen to care for jalapenos.

One other note: I am not a fan of really spicy foods. I do not use hot sauces with names like "Instant Death". I use chiles in moderation. In short: respect the chile, but do not fear the chile.

Here are some tips from what I've learned:

* I AM NOT KIDDING: when using anything stronger than a bell pepper, WEAR GLOVES. If you don't, you will eventually get a little of the oil that makes a chile hot into your eye, and you will be VERY UNHAPPY. I have done this twice, because I am a moron.
* Generally speaking, the smaller the chile is, the hotter it is. The varieties usually available here, from mildest to hottest (and from largest to smallest) are poblanos, Anaheims (also, I think, called New Mexico), jalapenos, serranos, and habaneros. Habaneros dang well mean business. (You may find "Scotch bonnets" in your stores: I've seen different stories on whether or not these are the same as habaneros.) The stores here also often carry the skinny little dried peppers you may have seen in Chinese food: these also mean business.
* Speaking of dried peppers, although I'm mostly talking here about fresh varieties, it's useful to know that the dried form of a chile often has a different name. Thus, a chipotle is a dried, smoked jalapeno.
* Most of the heat in a chile is in the seeds and the light-colored membranes inside the pepper. Removing some or all of these gives you a lot of control over the heat of a final product.
* I've seen soups prepared on TV that included making a slit in a really hot variety, such as a habanero, and cooking it with the other ingredients, then removing it before serving. I've done this once, and it was good.

A couple of suggestions:
* Find a recipe on the Internet (or in a cookbook, if one of yours has it) for "New Mexican Green Chili". Cook and eat. You're welcome. You owe me one.
* If you ever do a small roast in a slow cooker as I do, chop up some poblano, Anaheim, or jalapeno into the cooking liquid. It will add a lovely (but controlled) spiciness to the meat, and you'll be able to do something interesting with the cooking liquid afterward.
* Try substituting some seeded, demembraned, and finely diced Anaheim into a tuna or chicken salad. A few experiments with this will start to teach you about the spice tolerance of you and the folks you cook for.

It's official!

2010-08-21T21:06:00.000-05:00

It's hardly a unique experience, and others have written about it. But it's the first time it's happened to me, so I'm gonna write about it.

When I cleared out my mailbox tonight, I saw the envelope and knew immediately what it was and what it meant.

The letter was from the AARP, formerly known as the American Association of Retired Persons.

It was an invitation to join.

I'm officially old.

This does not traumatize me: the evidence has been mounting for some time. But I turned fifty a few weeks ago, and so my name popped up on some AARP computer, and the letter got sent.

I may well join. I think it's a good organization, and the magazine is pretty good.

Get off my lawn.

A Toast to Fleeting Friendships

2010-08-17T19:27:00.000-05:00

I'd like to raise a toast (Coke Zero, if you'd like to join me) to those people who have touched my life for just a little while, be it a few months or even just a few minutes. I'm not talking about romantic relationships, but they've been no less special for that.

Here's to seatmates on airplanes or buses with whom I've had conversations that I think about to this day. It won't surprise my friends to learn that I usually keep to myself, but have still had some splendid opportunities.

Please join me in thanking the people in the short-lived depression support group I attended, who showed me so much about life I'd never suspected.

I drink the health of the retired government official from Syria I found sitting on the front lawn of my apartment complex in my home town. My conversation with him, using scraps of three languages and some rough drawings, gave me hope for international understanding. I hope he, as he taught me to say, went in peace.

Further, I pay tribute to the two friends from a silly newsgroup who reached out to me in friendship after a family tragedy.

A further raise of my glass to the girl who played me a song on her guitar during a free period in high school. A precious gift from someone I hadn't otherwise really talked to, either before or since.

Here's to the Internet friends with whom a single conversation has created a precious sense of connection. There have been so many in the diabetes online community. I appreciate you, individually and as a group.

Yes, friendship can be eternal. But fleeting can be pretty good, too.

The Investment Paradox

2010-08-15T14:18:00.000-05:00

I find life to be full of paradoxes, big and small. One of the paradoxes I find in the search for personal change is that to get more of something you want, you often have to give up some of what you have of that thing.

I find it useful to think of financial investments as an analogy. For most of us, part of increasing our financial stability is finding ways to build some savings, even if just a little bit, to get us through a rough patch or to secure a more comfortable retirement. But, few of us make the kind of income that allows us to save money without any pain. So, if we can't increase our income, we have to make the choices that allow us to cut our spending.

Exercise is a lot like that. Most of us know that exercise is good for everybody, and it's especially good for diabetics. It's most especially good for those of us with Type 2 (and many type 1 folks as well) because it reduces insulin resistance, sometimes dramatically. When I'm exercising regularly, my fasting numbers improve, I don't seem to spike as high after a meal, AND I seem to recover from the spike more rapidly.

I've been off the regular exercise pattern for a few months now. I'd recently been making some headway, but was derailed by the heat wave we've had here: the highs have been above 95 just about every day for a couple of weeks, and more exercise has just been out of the question for me. Perhaps as a result of the non-exercise, I'm just not feeling as well as I could be.

So, here's the paradox: in order to feel better, I have to "invest" some of my dwindling energy store into some aerobic movement. I can't buy exercise in a store, and I can't borrow some from a friend - I have to make that investment myself. Bummer, huh?

I suspect that sleep works the same way. I often have trouble sleeping, especially on Friday and Saturday nights. So, I sleep late on Saturdays and Sundays. But, I've often read that one of the best ways to improve one's sleep is to have a regular sleep schedule - that DOESN'T include sleeping until 10 on weekends. To improve, I'm probably going to have to give up sleeping in, even though it feels desperately needed, as an investment in better sleep.

What investments do you need to make?

'Chops', the Arts, and Diabetes

2010-08-14T17:40:00.000-05:00

(I promise this will get to diabetes. I don't promise a short trip.)

I believe that ability in the arts - in most things, actually, but that's a broader subject - is composed of two major elements. The first is what is either inborn or perhaps gifted by the universe: talent, genius, soul, inspiration, whatever makes sense to you. The other is what I like to call "chops", borrowing a term some musicians use: the accumulated skills, experience, practice, and know-how that goes into producing the artistic work, whether that work is a dance, a sonnet, a song, a painting, or any other creative work.

The full role of talent, etc., is perhaps disputable. (I recently heard an interview with a psychologist who argues that talent plays little or no role in ability, which is really obtained through education and practice.) But the role of "chops" is not disputable: the cellist is the high school orchestra may have loads and loads of soulfulness to express, but that doesn't make him Yo-Yo Ma. No amount of talent will make a toddler with her fingerpaints into an instant Georgia O'Keefe. The five-year old in ballet class may have been gifted with a body perfectly suited to dance, but he's not (yet) Rudolf Nureyev.

It's my belief that we pay too much attention to the "talent" side of the equation. Many years ago, I read a weird and wonderful book called "Sayonara, Michelangelo", which was about many things, but mostly about Michelangelo's paintings on the ceiling of the Sistine Chapel and the restoration thereof late in the last century. At one point in the book, the author argues that in praising Michelangelo's genius, we wind up giving him insufficient credit for his ability, his experience, and his hard work.

I once read a memoir by the actor Alan Alda, most famous for his role in "M.A.S.H.". The real revelation for me from that book is the amount of the actor's craft that must be learned, from the ways to express certain emotions to successfully mimicking an accent. George Clooney's a great actor, I'm told, but he wouldn't be without his chops.

Earlier week, with considerable reluctance, I blogged a poem I'd written. I got some very nice comments on it, and I'm pleased it connected for some people. But, other than the schoolwork everyone's done, I've written maybe three dozen poems in my life. But I haven't written hundreds of poems, I haven't sat through critiques by fellow students knowledgeable and passionate about the craft, and I know very little about form and meter. While I did write a poem that expressed my idea, I'm not a poet - I just don't have the chops.

Chops plays a huge role in diabetes management, too, and we acquire them only with time and effort. Although our bodies continue to spring surprises on us, we do learn how to anticipate and deal with many of the individualities of our own diabetes. (Shredded Wheat is poison, diabetes? Really, diabetes?) We learn tips and techniques for a thousand things, from how to test our blood to the way we want to handle doing so in public. A person dependent on insulin are engaged in a lifelong process of learning how to be his or her own pancreas. (My hat is off to those who have mastered the "double wave bolus".) From time to time, we need to learn (or relearn) that the things we know HOW to do are important enough to actually do them.

Then, there are the lessons that can be harder to learn because we don't entirely want to learn them, from maintaining our weight (for those with that issue) to avoiding those favorite foods that, although we CAN eat them, just aren't worth what they do to us. (I'm looking at you, white rice.)

I'm learning, and you're learning. We need to be gentle with ourselves about what we haven't yet learned, acknowledge and feel good about the things we have learned, and be open to the things we don't yet know that we need to learn.

Above all, there are no good or bad diabetics. It's all chops.

First Time Frightened

2010-08-12T23:50:00.000-05:00

(Please note: I am aware that some of my readers have dealt for many years with diabetes being fare more intrusive than mine is at this stage. I am guessing that my reaction to what happened may seem silly, but I want to document this as I experienced it.)

Wednesday morning, my fasting test was in the 140s, higher than is optimal for me. So, though I don't to this often, I decided to test before leaving for my lunch hour and choose lunch based on the result. 132, so I decided to just have a salad for lunch.

I usually like to relax in the staff lounge over lunch hour and pick my meal up on my way back to my desk. I'm trying to do some pre- and post-testing to learn better meals, so I tested again. 82. I'd dropped 50 points in an hour of doing essentially nothing. That felt new, and as close as I was to the bottom of my good range, I was afraid that I was still dropping. And the meal I had chosen was pretty close to carb-free.

I admit it: I panicked a little. Was I going to go low, maybe seriously so? And what could I do to stop it? If something really bad was happening, a quarter cup of tomatoes wasn't going to slow it down. (Did I remember that I had glucose tabs for backup, sitting right in my desk? Noooooooooo.)

For the first time since diagnosis, I was scared about what was happening to me then. Sure, I've worried plenty about complications down the road, and about the significance of the occasional tingling in my feet, but that's a different thing. Even the time I was in the 400s, I knew what had caused it and I thought I knew the best thing to do about it (though I was wrong).

Even though the adult part of my brain kept trying to assure me that a problem was unlikely, I still felt frightened. And, I felt alone.

I calmed down some, and ate my salad. Half an hour later, I was at 87, so I was no longer dropping. At my 2-hour post test, I was nearly 100. The crisis, if there ever was a crisis, was over.

What's significant about that event to me is not what happened with the blood sugar, but how I felt about it. I'm not surprised that I was frightened, but I wouldn't have anticipated the sense of isolation. That sense of isolation might be telling me that I need a stronger emergency backup system. Maybe I need to remind my colleagues about my supply of glucose tabs and what to do if I need them. Maybe I need to decide how I would handle a real semi-emergency, one that didn't seem at a 911 level.

I'm not alone. I just need a plan.

English: a Love Affair

2010-08-08T14:32:00.000-05:00

I am in love with the English Language, and have been as long as I can remember.

I love words. I like their sound, and I like their rhythm. Most of all, though, I love their meanings, the often subtle shades of connotation that make apparently interchangeable words just a little bit different.

I like the history of English. I love that English is a Germanic language that took a French lover. I love that this couple adopted Greek and Latin and loved them as their own children, and I love that this raucous, tumultuous family parties with every language on the planet. (Did you know that "ketchup" is Indonesian and "boondocks" is taken from the Tagalog? How can you not love that?)

I don't read much poetry, and I haven't read much literary fiction. Most of my reading is nonfiction and essays. But that doesn't mean the quality of prose doesn't matter to me. I love reading writers that love language as much as I do. Some of my favorite essayists are primarily poets: Donald Hall is the only person for who's autograph I've stood in line. I love the twinkle-in-the-eye elegance of E. B. White, the brittle beauty of Joan Didion, and the riotous combativeness of Tom Wolfe.

My interests are many, and I'm always open to a new one. So, I'm less concerned with a writer's subject than with his craft. I've loved Roger Angell on baseball, Lewis Thomas and Richard Selzer on medicine, Witold Rybczynski on architecture, and John McPhee on many different things. Years ago, the library where I work created a bookmark with titles I'd chosen from each of the ten classes of the Dewey Decimal System.

I love puns, the more groan-inducing the better, and I love them best of all when they contain a play on meanings as well as sounds. I love word histories, although most of the ones you see outside of reference works are bogus. I love how etymology can suggest connections between ideas and concepts that I'd never considered.

English makes me happy.

Discouragement: a Poem

2010-08-07T17:39:00.000-05:00

Discouragement
can come upon me in a rush,
grasping at the throat of my peace --
choking off ambition
choking off change
choking off hope.

Discouragement,
more usually, however,
creeps in around the corners of my mind.
Knowing the way well, he requires no light,
Has no need to alert me to his presence
Before his bags are fully unpacked.

Discouragement
likes to wear disguises
to defer the moment of recognition.
Most often he borrows the solemn raiment of Realism,
but sometimes disgraces the sacred robes of Humility,
defiling the cloth with his lies.

Discouragement
is not invincible.
He can often be defeated
by laughter, by love, or by prayer.
But seldom can you dislodge him
Before you know who he is.

A Quick Tip on Brown Rice

2010-08-06T06:30:00.002-05:00

If you like rice and recognize that brown rice might be better for you, but find that you don't like the texture, check to see if the market where you shop has medium-grain or short-grain brown rice available. The different "lengths" of rice are actually quite different, and cook up differently. I find that the short and medium grain brown rices much have a softer texture than the long-grain when cooked. It's still not as soft as white rice, but nearly so. And, in my experience, short and medium grains don't get hard in the refrigerator. (I can even enjoy it cold, but I'm a little weird that way.)

As with beans, you can create some great-tasting dishes by adding spices or other flavorings to the cooking liquid. I love using reduced-sodium chicken stock for this.

Intermission

2010-08-05T21:22:00.000-05:00

"Gee, Dad, this blogger has sure been serious lately"
"Yes, son, he has."
"He's not usually this stuffy for this long!"
"Well, you see, son, his friends in the Diabetes Online Community have given him some great post, and they've all been things he feels strongly about. He's writing deliberately because he really wants readers to understand, whether they agree or not."
"I guess. But the posts have been so LONG!"
"Well, he's got a short one in mind for tomorrow, a D-Feast Friday post. And he's hoping to inject some humor over the weekend."
"He's going to do a dfeast post? Last week he wrote about cooking beans, and he ruined a whole batch the other day!"
"Well, son, he just didn't know that the citrus just in the cooking liquid would keep the beans from softening."
"I think he's softening in the head, Dad!"
"Shh, son, that's just not nice."

"Pre" but not Easy

2010-08-05T19:24:00.001-05:00

I've seen several discussions recently in the Diabetes Online Community recently about the notion of "pre diabetes", a situation where a patient has blood glucose levels that are abnormally elevated without meeting the diagnostic criteria for Type 2 diabetes. Mike Hoskins wrote a thoughtful post about it not long ago, and it was discussed in the second Diabetes Social Media Activism session. It's come up one or two other times, as well.

By and large, the people I've seen weigh in don't care for it, either as a term or as a concept. And I have to say that I disagree, at least in regards to the concept. This post relates pretty heavily to yesterday's post about "reversing" Type 2.

The Analogy

I've seen a number of folks who argue against the notion of pre-diabetes by drawing an analogy to pregnancy. You can't be pre-diabetic, and you can't be a little bit pregnant. Once you're pregnant, you stay pregnant until the pregnancy is interrupted in some way or the baby is born. According to the analogy, either you're diabetic or you're not, and once you're diabetic you're always diabetic until death or such time as there's a cure.

In pregnancy, there is a pretty well-defined beginning, to the best of my layman's understanding: an ovum is fertilized by a sperm cell. It may be that the onset of Type 1 diabetes is comparable, if onset is considered to occur when the immune system starts trying to kill off the pancreatic beta cells. So, it may be that the pregnancy analogy would work for Type 1. (It's also a distasteful analogy, in my mind. Comparing the prospective birth of a child to a disease state? Really?)

But what's the analogous is/isn't point in Type 2 diabetes? Is it when insulin resistance rises above a certain point, and how wold this be measured? Is it when the observable measure of fasting blood sugar rises above a certain level, or a certain A1c, or a certain result from a glucose tolerance test? Is it when the ability of the pancreas to supply insulin begins to be impaired, through a mechanism that I don't believe is yet understood?

And, do we really know that no one who meets whatever criteria you choose ever stops meeting that criteria?

Ironically enough, I think the case against the pregnancy analogy ultimately falls when we consider gestational diabetes. Some significant percentage of women develop insulin resistance during pregnancy and need to be treated with oral medications or insulin. When the pregnancy ends, so does the diabetes. A woman who's had gestational diabetes is at significant risk of later developing Type 2, but for many the diabetes goes away and stays away.

The pregnancy analogy just doesn't work for Type 2.

The Concept

The next point I want to consider is whether the concept of pre-diabetes is meaningful or not, temporarily laying aside the choice of term. It may be that further research will allow us to dump it entirely, if the diagnostic criteria for T2 can be refined such that a patient is considered diabetic at one level (of whatever we're measuring), and those folks below that don't need to worry. But, given what we think we know now, this seems counter-intuitive.

As I discussed at length yesterday, there does seem to be a stage early in the development of T2 when lifestyle interventions may arrest the progression of the disease and development of symptoms. It makes sense to me that there would be a stage where there's sufficient insulin resistance to cause blood glucose levels to climb but precede (it is to be hoped) much in the way of damage to the pancreas' ability to produce sufficient insulin.

(Mike, in his post linked above, describes an experience his wife had being "diagnosed" with pre-diabetes in a health fair. It would be my hope that, if such a fair showed elevated blood glucose levels, the patient would not be "diagnosed" but rather encouraged to visit their physician for possible further testing and perhaps intervention.)

If there IS such a state, if significant lifestyle change can stop disease development (possibly for a lifetime), it seems to me that physicians have a strong obligation to watch for it. And there's another thing: we're used to Type 2 progressing pretty slowly, but that's not the case for everybody. A patient who doesn't quite meet diagnostic criteria at one checkup may, I'm guessing, come to the next checkup complaining of foot pain and blurred vision.

The Term

So I'm a fan of the concept of pre-diabetes, at least until it's shown not to be useful in helping people be as healthy as possible. However, I don't much care about the term itself. I don't doubt that there would be good candidates, and I'd be happy with any of them if the support for it is broad enough to minimize confusion.

So, if you hate the term, I'm not going to argue with you. If you hate the concept, though, I'd ask that you give the idea another look.

Reversal of (Mis)Fortune?

2010-08-04T22:28:00.001-05:00

The following is a response to a topic suggested by my friend Mike Hoskins. Thanks, Mike!

Point one: Type Two diabetes is a very serious illness.

I don't see this to compare it to Type 1, or to Type 1.5, or to any other condition. I don't say this as an editorial about research priorities or an argument for or against any particular public health policy. I just state it as an unassailable fact.

Let me say it again, and expand a bit:

Type Two diabetes is a very serious illness, and it becomes more serious over time. If uncontrolled, and sometimes even in spite of control, it can steal sight, destroy organs, calcify the heart, and rot extremities. Extreme hypoglycemia and hyperglycemia pose the same dangers to a Type 2 that experiences them as they do to any other diabetic.

Point two: Because Type Two diabetes is a serious illness that grows more serious over time, the possibility that patients may be able to delay either its onset or its more serious serious stages MUST be taken seriously by those patients and their physicians.

The development of Type 2 diabetes appears, as I understand it, to depend on:
1) genetics;
2) risks such as age and obesity that are usually present (but aren't always); and
3) other factors not yet understood which may include environmental exposures or something(s) else.

We can't do much about 1) or 3) at present, either as individuals or as a society. So that leaves 2).

Point three: With all this horse manure, there's got to be a pony in here somewhere!

There's an awful lot of nonsense being spouted about "reversing" Type 2 diabetes. A great plenty of this nonsense is coming from snake oil salesmen who want to go on talk shows and sell books. Some of it is coming from people who honestly (I think) hope to address T2 as a public health problem by trumpeting warnings about the diabetes risks of obesity, overestimating (I think) the power of fear to promote lasting healthy lifestyle changes. Both groups slide over points 1) and 3), and omit distinctions between types of diabetes almost entirely, in an effort to present the simplest possible message: obesity causes diabetes. Reduction to absurdity.

The damage from this approach is felt by diabetics of all types who wind up being blamed for their illness by those around them. This is probably most unfair, and screamingly frustrating, to PWDs of Type 1 and Type 1.5, and some of Type 2, who had NO role in the development of their illness. But it just might be most damaging to we Type 2s who DO (or did) have the lifestyle risk factors and therefore must carry the burden of the misconception, all too often in our own hearts.

But all the nonsense, all the lies, all the misunderstandings, all the snake oil should not be allowed to wash away a truth that's becoming pretty evident:

Point four: Many newly diagnosed Type 2s, and many of those with elevated blood glucose numbers that do not yet meet the current diagnostic criteria, can delay the onset or progression of their disease via good diet, exercise, and weight loss where appropriate.

I have no idea what percentage "many" represents in the previous sentence, but whatever that percentage is represents a lot of people. And that's why we can't dismiss this point, however corrupted and misused in the media and however often its used to bash us over our heads.

If your life is touched by diabetes of any type, wouldn't you have wanted to delay the onset of the disease, were it possible?

Point five: Just because many can, that doesn't mean everyone can.

Using diet and exercise to delay the onset or development of Type 2 diabetes doesn't work for everyone. Unfortunately, the ability of many Type 2 PWDs to produce insulin is already pretty damaged by the time of diagnosis. For those of us with serious lifestyle-related risk factors, even when diagnosis comes early, that diagnosis does not necessarily remove whatever barriers to healthy living existed before diagnosis. I am one that was unable to make serious change. I don't know what part of that failure is rooted in laziness or warped psychology, or to what extent the metabolic deck is stacked against me, but there you go.

Point six: "Reversal" is just a word.

In preparation for writing this post, I spent a few minutes trying to find responsible medical opinion on the subject of reversing Type 2 diabetes. I did find a WebMD article that made a pronounced distinction between "reversing" T2, which the author believed in, and "curing" T2, which is clearly not yet possible. I don't know, but I'm guessing that to a physician, "reversing" a disease may be something equivalent to my layman's understanding of putting a condition into remission.

I'm interested in linguistics, and you're never going to hear me say that words don't matter. But sometimes, particular words do more to disrupt understanding than they do to promote it. I think "reversing" diabetes has become an example.

So, in review, let's review what seems to be true and not true:
-- Nobody can currently say with any truth that any type of diabetes can be "reversed" if "reversed" means "cured".
-- Nobody can say with any truth that diabetes of types 1 or 1.5 can be "reversed" in any meaningful sense through ANY amount of diet or exercise.
-- However, it CAN be truly said that SOME type 2 diabetics or "pre-diabetics" can delay the onset or profession of their illness though good diet, good exercise, and weight loss where appropriate.

I don't like the term "reversing diabetes" because it sounds too much like "curing" to my ears.

But I LOVE the concept. Even though I couldn't make it work for me.

Is Insulin a "Failure" for Type 2 Diabetics?

2010-08-02T07:49:00.000-05:00

My friend Jess asked a very interesting question on Twitter the other day. (I had requested suggestions for topics Type 1 diabetics might like to see a Type 2 address.) Why, I was asked, do many Type 2 diabetics feel that going on insulin therapy means that they've failed?

(It may be a good idea here to remind everyone that I'm not a doctor or a scientist and that the following is only my best understanding.)

It's an excellent question. First, from what I've read, it's certainly true that many Type 2's struggle when that transition becomes appropriate. It's so true, in fact, that many physicians delay making the recommendation because it's so likely to be poorly received. That's a shame, because when other therapies no longer work well, going on insulin will bring a dramatic improvement in blood glucose control and result in the patient feeling much better, immediately. I've read a couple of articles talking about how PWDs that have begun taken insulin often wish that they'd done so years before.

My speculation is that the problem is rooted in two ideas. They're both false, but they're both so seductive as to be nearly irresistible. The first of these false ideas is that insulin-dependent diabetes is "worse" than that treated in other ways. It's really hard to dismiss the notion that Type 2 "worsens" as it progresses - especially, I imagine, when it's happening to you.

The second of these false ideas is that Type 2 diabetes, its progression, and the complications we're all trying to avoid are the "fault" of the diabetic because of the lifestyle component in the development of insulin resistance. Science now knows that there's a genetic component as well - no T2 genes, no T2, no matter how many Twinkies you scarf. And, it's thought that there are other factors as well, perhaps in the environment.

But, that's not the message in the media. The bookstores are crowded with books on using a combination of diet (their special diet, of course) and a serious exercise regime will "reverse" Type 2 diabetes. As with all the best lies, there's some truth here. Many new T2s, or those with numbers that suggest a problem in the future, ARE able to use strict diet, weight loss and vigorous exercise to cause blood levels to go down and symptoms to disappear. I think (not sure here) that it's expected that this only delays full onset, but that delay may be a number of years.

Because of this partial truth, even many doctors with the best of intentions try to hammer home the notion that exercise and weight loss can "prevent" or "reverse" diabetes. But where does that leave those of us who are unable to make those changes, or whose pancreases are already too badly damaged for this approach to be effective? It leaves us feeling guilty and at fault for our diabetes. Society believes that we're diabetic because we're fat (even though many of us AREN'T fat) - our families believe that, our friends believe that, our insurance companies love to believe that, our employers believe it, and all too often WE believe it. It may even be that our doctors believe it.

So, if we accept into our hearts the lie that our diabetes is our own fault, even subconsciously or partially, then the progression of our disease also becomes our fault. Seen through that lens, the need for insulin becomes the scarlet letter "I" we wear on our inner selves that we have failed to prevent the progression of the disease.

If and when my current medications no longer work for me and I need to start climbing up the list of other available therapies, I hope very much I'm able to establish a relationship with a CDE or other medical professional that I can trust to recommend insulin therapy when it has become appropriate. I hope that I'll recognize that point myself and initiate the discussion, but the blizzard of medication options may make that tough.

I'm not afraid of insulin. I'm afraid of not knowing I need it.

Dear CDE...

2010-08-01T11:32:00.000-05:00

(Saturday afternoon, I put out on Twitter a request for Type 1s to make suggestions about anything they might like to see a Type 2 address. Sarah, who is working towards becoming a Certified Diabetes Educator (CDE), responded "Everything!" I've chosen to write this post to the CDE I might work with someday.)

Dear CDE --

I don't know you yet, nor what circumstances caused me to need your services. But I'd like to tell you some things about me and my diabetes to give you the best shot of helping me. Because Type 2s rarely have Certified Diabetes Educators, your availability to me suggests that I'm having real problems.

First, I am a man in full. I am more than my metabolism, more than my BG log, more than what they scale says, even (despite the saying) more than what I eat. I have a sense of humor and am an incorrigible punster. I've read an awful lot of books. I have some hopes and a lot of fears. I am cranky and often inwardly judgmental, but my compassion and overriding desire to treat all people well are easily aroused and overcome the crankiness and judgment. I'm happy to live alone, but I am sometimes lonely. These details are not important for you to know. What IS important for you to know is that I, like all your patients, am a complete person.

Second, I need you to start with questions about who I am and what I already know about diabetes. If you start with a standard informational spiel, you're going to be wasting time for both of us. I don't doubt that there are many things you can teach me, but none of them would come up in your first session with a newly-diagnosed patient.

Third, you're not going to make me skinny. I've been seriously obese for four decades. In all likelihood, I've worried about my weight since before you were born. It's no longer a healthy goal for me. I need to you to assist me in my efforts to live a healthier life. If substantial weight loss happens as a result of that healthier life, that will be wonderful. But that isn't, and can't be, my goal.

Fourth, if I need changes in my treatment and your role includes making suggestions to my physician, I suspect that my needs as a Type 2 may be a little different than for your Type 1 patients. An experienced Type 1 may be able to be at least your equal in deciding changes in basal rates and so forth. However, it's not possible for me to really understand all the types of medication therapies that are available. However, I do expect you to solicit my strong participation in decisions about tradeoffs among alternatives.

Fifth, it's often said that insanity is doing the same thing over and over and expecting different results. Given the miniscule percentage of people who are able to make sudden dietary change, and the even smaller percentage of those who are able to stick it for the long haul, just what would be sane about your reaching into your desk and handing me a one-page meal plan? If I could make a "meal plan" work for me, it's overwhelmingly likely that I wouldn't be meeting with you. What I do need is information about smaller changes I can make or suggestions as to how I can circumvent the barriers I face. I also need help in sorting out which pieces of medical research I should be paying attention to.

Finally, don't try to "scare me straight" or scold me. Fear does enable to make some people to make changes. But my diagnosis was a long time ago, and I wasn't ignorant for long about what it meant. Frightening me won't make me skinny, it will just make me fat and scared. I don't consider that progress. As for scolding, I assure you that all the scolding that might be helpful, and more, has already happened within my heart. From you, I need respect and a little kindness.

Thank you for meeting with me. I respect you and your very significant attainment of education and training. I'm likely to be a little reserved when we first meet, but I do hope you can help me. I hope that very, very much.

Your patient,

Bob

Easier or harder?

2010-07-31T19:22:00.000-05:00

This afternoon I put out on Twitter a request for Type 1s to make suggestions about anything they might like to see a Type 2 address. My friend Scott Johnson responded, "I often think you guys have it harder - depending more on willpower & dietary choices for BG control. Do you feel that way?"

It's a complicated question, or a simple question with a complicated answer. I've often thought about it, and I've been hesitant to address it. My basic reaction is "absolutely not!" However, I've rarely been angrier than the time I was listening to a podcast panel of Type 1 PWDs, and someone said that "Type 2 is easy!"

The first thing to remember, and I'll mention it again, is that Type 2 is a progressive disease. Type 2 covers people in many different situations: diet and exercise alone; a dizzying array of oral and injectable medication options, each with its own set of consequences; a combination of oral medication and basal insulin injections; and full insulin dependency. A Type 2 may be as healthy as a horse or a very sick individual indeed. A Type 2 may be dealing with the effects not only of diabetes itself but any or all the other conditions that tend to cluster with it: hypertension, elevated cholesterol, heart disease, apnea, and others.

I have to say that in my mind, it's the manner of treatment and how well it's working that affects what life is like far more than the disease mechanism. For the purpose of this discussion, by "Type 2" I'll be referring to someone on the diet/exercise regimen or oral medications.

I also want to note that my knowledge of what Type 1 is like to deal with is all second hand. I think I know more about it than most people, but I'm sure there are important things I don't understand. So, I hope my friends will forgive me if I'm missing something important.

I have some academic background in political philosophy, and it often helps me to go Aristotelian on the bit and break things down into parts. I see four areas to compare lifestyles for the two types: immediate health impact, daily management, complication avoidance, and the complications themselves.

Immediate health impact -- As I noted above, a Type 2 diabetic may be at many different places on the scale between healthy and sick on a day to day basis. In my own case, because I'm so fortunate in how well my medications work at present, I don't experience anything like the rollercoasters I see many of my T1 friends experiencing. I've never had a low, as I've noted elsewhere, and anything like reasonable choices in what I eat keeps me from getting too high to feel poorly in that respect. I do have days in which I feel ill because my metabolism hates me in general.

Daily management -- There are sort of two sides to this coin. There's absolutely nothing I currently have to do that's as intrusive as the daily routine of shots/pump management, diabetes arithmetic, many daily blood tests, etc. On the other hand, many of the folks that manage Type 2 without medication work vary hard, with very significant dietary restrictions and exercise routines that would make Richard Simmons blush. On the third hand (can you believe I'm not a lawyer?), Type 1's are not necessarily immune to the same genetic, lifestyle, and environmental factors that produce insulin resistance in Type 2 folks, and thus diet and exercise become critical for some of them, too. So, this one is kind of a toss-up to me, and depends on the individual's situation.

Some Type 2s feel a bit of envy for folks on basal/bolus regimens who "can just push a button" or "just take a shot" to prepare for a special meal or to treat a high. I'm not one who feels that way - I think it's way more complicated than that, and I don't want to minimize the difficulty and discomfort of managing boluses. Yes, it would be nice to have a tool (other than patience) to deal with a high that's beyond exercise being a safe option. But that might yet be down the road for me.

Complication avoidance

For people with all types of diabetes, the best chance of fending off the complications we can all list consists in good long-term control of blood sugar levels. (And, of course, complications may show up even when control has been good.) But, in order to achieve that control over the long term, many Type 2s must do their best to make very significant changes in their dietary and exercise choices. Most often, Type 2 is diagnosed in middle age or later, and habits have been built up over decades, and making those changes is very difficult. Plus, for those of us who are truly obese, there are often psychological issues that must be either addressed or somehow sidestepped for meaningful changes to occur. So, the challenges are considerable, and I for one am not even out of the foothills at the basis of this particular mountain. For most (I think) Type 1 PWDs, this is a set of issues that's not part of the equation. Again, however, Type 1 PWDs are not immune to this set of issues and may deal with them as much as anybody else.

(Mini-rant: I just about lost my temper during last week's #dsma session. A number of folks talked offhandedly about lifestyle choices, as if it was a simple thing, like upgrading your wardrobe and grooming yourself a little more carefully to get a better job. If losing weight is so freaking easy to do, how come millions of Americans (and countless others) are unable to do it? Do you really believe all of those people are stupid, or have deeply flawed personalities? Or, just based on your own experience with blood sugar management, don't you think that human metabolism is way more complicated than we currently comprehend, and that we simply don't yet know how to actually help people rather than just lecture them? *ahem* Sorry.)

The Complications Themselves -- I think it's important to note that the long term effects of diabetes do not much vary between the two major types. The organs of our bodies that rely on intricate networks of tiny blood vessels don't care why they've been assaulted by excess blood sugar for many years. They're not concerned about antibodies, or insulin resistance, or beta cells, or artificial ingredients, or even cheeseburger consumption.

So, in summary, my answer to Scott is no, I don't think that Type 2 is harder, although distinctions between the two types fade as Type 2 advances. On the other hand, that's not to say that Type 2 is "easy", and involves issues and complications not common to most of my Type 1 friends. All diabetes is hard, all diabetes sucks, all diabetes needs to be cured.

D-Feast Friday: Getting Started with Dried Beans

2010-07-29T22:05:00.000-05:00

"Beans, beans, the wonderful fruit..." - every 8-year old in the US

Canned beans are very useful. They can turn some veg and/or a little meat into a fast, satisfying meal. I keep some on hand pretty much continually.

Cooking dried beans is a little more (though not a lot more) trouble. But they have four huge advantages over the canned:
1) They're really cheap, probably the cheapest available protein source.
2) Dried beans do not have the tons of sodium usually poured into canned beans.
3) By starting from dried, you've got the opportunity to build flavor INTO the beans, not just in whatever you add them to.
4) They're really, really cheap. (Yes, it's worth two reasons: do you consider two hands redundant????)

Cooking Beans

If you've never cooked with dried beans, here's enough to get you started.

The basic method I use is sort, soak, add liquid and flavor, cook.

Sort - It's a good idea (even though I usually skip it) to examine your beans for loose rocks and such not removed in processing. This almost never happens anymore, but think how you'll get to laugh when I break a tooth someday.

Soak - almost all beans, except tiny ones like lentils and split peas, benefit from soaking in water somewhere between four hours and overnight. I use a 2 quart pitcher for this (because the lid, designed to keep ice cubes from being poured out, make draining easy) for a 1 lb bag of beans. Give it plenty of water and room in whatever container you use, because the beans will get a lot bigger.

At the end of the soaking, drain off the water and give a quick rinse.

Cooking liquid and flavoring

It works just fine to cook your beans in plain water with no flavoring at all, but you may find the results a bit bland if you're not going to do a lot to the beans after cooking. I've gotten fond of using low-sodium cooking stock for my cooking liquid. I like to add some roughly chopped garlic and onions or some spices. maybe some fresh or dried chiles. (You're going for a fairly strongly flavored broth - the beans will soak in some of the flavor, but won't get nearly as strong as the cooking liquid.) I really think that the possibilities here are endless. I find that a quart of chicken stock (in the containers like large juice boxes) needs to have some water added to be enough to cook the beans.

Cooking the beans

Cooking is usually done on the stovetop or in a pressure cooker.
* The pressure cooker is FAST - if you've got one, you've probably got a little book with cooking times for beans.
* If you cook on the stovetop, put the beans a-simmering in plenty of water/cooking liquid (a good couple of inches above the beans) and keep an eye on it to make sure there's plenty of liquid. Cooking times depend on the variety and age of the beans and the humidity at which they've been stored, but most varieties of beans will average cooking times of 45-90 minutes. They're done when they mash fairly easily with fingers or a fork.
* My favorite method, actually, has become my slow cooker on "high". I'm not actually sure how long to tell you, since I just sorta let it go and check occasionally, but I'm guessing 2-3 hours.

Using the beans

There are zillions of recipes for beans. Cooked beans can be used in soups, in one-dish meals or countless other ways. Don't be in a big hurry to throw out the cooking liquid, which can be a nice base for a soup or something.

Lately, I've been taking advantage of the fact that cooking beans in bulk is just as easy as cooking less. After I've portioned out the beans I need for whatever I was planning, I let the remainder cool and then put them in freezer bags. I put in about a cup and carefully make the package as flat as I can - they store efficiently and thaw more quickly. Several times I've broken a bag's worth of frozen beans straight into a hot pan with a little oil to thaw and heat.

A note in closing: The Great Soaking Controversy!
Soaking has traditionally been done to speed cooking time and to reduce the gassiness some folks experience with beans. (I don't, but maybe I'm used to a higher-fiber diet.) Among the science set, there's a lot of skepticism that soaking helps the gasiness. And others say that the beans are better and more nutritious without the soak. I'm not an expert, and there's no reason to believe me if you don't want to. I just report that when I don't soak, they never seem to get tender. If you want to try it without soaking, though, figure on increasing the cooking time by quite a bit.

Culinary Therapy for Diabetes

2010-07-27T20:23:00.000-05:00

In a couple of recent posts, I've let my interest in cooking show. Since I think I'll continue to do that from time to time, I feel the need to justify the presence of those posts in a blog dedicated to Type 2 diabetes. While I'll never promise not to write about irrelevancies from time to time, I should explain a new recurring theme.

A huge, huge part of coming to terms with my diabetes is learning to eat a more healthy diet. For the past decade or so, I've prepared some of my meals at home (bland stuff, mostly) and eaten the rest out (fast food, mostly, or inexpensive sit-down places), or had pizza/Chinese delivered (maybe once a week). Given the realities of my cooking skills as they have been, there are really only a few possible approaches to improving my diet:

1) I could learn to not much care about the yumminess of what I eat. Plenty of wonderful people really enjoy delicious food when they get it, but eat the bulk of their meals only as fuel, to get their bodies through to the next meal. It's a sound approach, I think, if you can do it -- and I can't.

2) I could continue to eat out, but do so more healthily. The options for doing this are sadly limited -- I can only eat so much salad. This doesn't work for me either.

3) I can learn to cook well enough so that the food coming out of my own kitchen is usually the most attractive option. This is the path I'm trying to follow.

So, over time, I'm working hard on learning to work with unfamiliar ingredients (especially vegetables) and flavor enhancers like herbs and spices. My growth is limited by the fact that I hate to cook from recipes. But I watch a lot of cooking shows, and I'm finding that I can sometimes read several different recipes for the same item to get the essence of the thing and cook it off the top of my head.

I'm making good progress. OK, it has to be admitted -- some of my experiments are acceptable only because I live alone and don't have to talk anybody else in to eating what I've prepared. But most of what I turn out is acceptable, and occasionally I turn out something that's fabulous. I'd have been proud to serve one batch of chipotle chili to anybody. And, more to the point, I'm eating out in the evenings much less often and even taking my lunch less infrequently. Plus, when I want to indulge, I can make treats of types and in amounts far more modest than the pizza place would bring me.

Chipotle chili, anyone?

Thoughts on healthy cooking

2010-07-22T19:35:00.001-05:00

In commemoration of D-Feast Friday, I thought I'd offer some thoughts on healthy cooking. On the face of it, it would seem absurd to listen to me on this subject, but I've been working on it, and have some things I think are worth sharing.

1) If you're interested in making the food you prepare be more healthy, I suggest you expand your ability to use spices and herbs. Most people find that fat, sugar, and simple carbohydrates taste really good. If we're to reduce the role of those things in our food, we need to find other ways to make our food delicious. Spices and herbs can be a pretty easy (and usually cheap) way to make things tasty.

2) One of the current trends among the foodies is an insistence on fresh, high-quality ingredients. I have some quarrel with that. I believe that approach will improve the tastiness of our cooking, but I also believe that budget and circumstances necessitate compromise. I read a recipe the other day that called for "farmer's market turnips". I call "nonsense!" on that. Are they really saying that supermarket produce would not be acceptable? I know a lot of words for that, but I'm not putting any of them in a blog posting.

3) A small amount of something really tasty can bring life to a pedestrian meal. I've been experimenting with quick pickles, a term used to refer to pickles that don't have to be "canned" and are ready to eat in a few hours or days. I have done kimchee, pickled roasted red peppers, pickled onions, and marinated cucumber. They're really easy to do, and a bite or two can liven up a plate, make a sandwich special...or even substitute for a late night snack.

4) Learn to roast vegetables. If you haven't had roasted cauliflower, you haven't had cauliflower. Don't quibble with me on this - Uncle Bob understands these things.

5) Speaking of veggies, there's a lot of very valid concern about how expensive healthy cooking can be. There are ways to alleviate this, though: cabbage is cheap, as are carrots and usually celery. Lots of other stuff is inexpensive in season. If you do well on beans (pintos and such), dried beans are really cheap and aren't hard to prepare.

6) Also on veggies, don't listen to people putting down the nutritional value of frozen veggies. According to the best info I can find, what kills the nutrients in produce is time off the vine. While the fresh produce in your marked may have been in transit or storage for many days, frozen veggies are flash-frozen within hours of picking.

7) Finishing up the veggie section, steaming produces a better-tasting result than boiling for many vegetables and does a better job of preserving nutrients.

8) Substitutions. The basic trinity of stuff most Americans could stand to eat less of is sugar, fat, and salt. The food industry has responded to interest in healthier eating by offering lots of products that has reduced amounts of one of these things or that are intended to substitute for other foods. From my standpoint, there are three things to be aware of here:
a) Most of the time, it seems, the manufacturer compensates for reducing one of the three "bad" ingredients by boosting one or both of the others. So, a low fat product, for example, might have increased amounts of sodium - maybe MASSIVELY increased amounts. Whether the approach they've taken is appropriate for you depends on just what you want in your diet. For example, I need to watch both carbs and fat. But, my blood pressure is well-controlled, so I'm willing to (selectively) accept increased amounts of sodium, even in careful choices.
b) The acceptability of substitutes as far as flavor is individual. I happen to like fat-free mayo, which many find to be horrible. On the other hand, I can't handle most fat-free cheeses. When I was a vegetarian for a while, I enjoyed some "veggie burgers", but the tofu "hot dog" I tried was one of the vilest things I ever put in my mouth. My point here is that if you choose to experiment in this area, don't be discouraged if the first product you try won't pass muster for you.
c) I don't know enough about this to speak knowledgeably. I do know, though, that some sugar-free foods (such as hard candies or gum) contain "sugar alcohols" that may raise blood glucose just as "real" sugar does. So be aware that "sugar free" doesn't always mean "good for diabetics". See this article from the Joslin Diabetes Center for a little more information.

That's probably enough ranting for now, don't you think?

A (Non) Rolling Stone: An Allegory

2010-07-18T03:46:00.000-05:00

Once upon a time, there was a man who, while on a certain part of his journey, found his path blocked by a large stone.

The man first tried around the stone, but the stone lay against a high cliff on one side and a steep cliff on the other. He also found that climbing over the stone was impossible.

So, the man dedicated himself to pushing the stone off his path. But, try as he might, he wasn't strong enough. Day after day, he pushed against the stone with no movement. Every few days, he was able to summon a little extra strength and move the stone a fraction of an inch, but when he exhausted himself and had to let go, the stone rolled back to its original position.

The man became deeply discouraged. He had known others who had been strong enough to push similar stones out of their way. He had known those who, though no stronger than he, had been able to push more consistently and been successful. He had also known people who never seemed to run into stones or who just didn't seem to mind when they did. He was sad that he couldn't be like these other persons.

But this man cared. As he either pushed or dropped in fatigue, there was rain, and snow, and (worst of all) presidential elections. His friends and family told him that he should push harder or that he must not really want to move the stone badly enough. (In truth, they rarely told him these things - he just thought they did, because that's what he told himself.) Eventually, he came to feel completely trapped, and divided his time between occasional pushes and trying to change his thoughts so as to be able to push harder or longer.

After many years, our friend wearied of feeling bad all the time, and came to somewhat accept his situation. He wasn't a bad person, he reasoned, he was just a man behind a rock. He still pushed from time to time, but he also built himself a shelter from the weather, and planted some basil, and subscribed to digital cable. He was still sad about his situation, but slowly changed how he thought about it.

One day as he was writing idle thoughts in the dirt, he discovered that he had written these words:

"Personal change is more about strategy than psychology."

For several days, he often thought about those words. He thought about them while cooking ratatouille, and while washing his dish, and after "Monty Python's Flying Circus" reruns.

Finally, he got up, and went and looked at the rock and the surrounding areas, really looked at them, for the first time in many years. He noticed a few fist-sized stones around the base of the stone. After he thought about these things, he went and pushed against the stone with all has strength. As he had before, he moved the stone about half an inch. This time, however, he used his foot to move one of the smaller stones to wedge against the big one to prevent it from rolling back to its original position. A few days later, he did this again.

That's the situation now. The man is hopeful that his new strategy will enable him to move the stone out of the way. But he has glimmers of a couple of other ideas if that doesn't work.

At least the stone is moving.

Recipe - Black Beans and Rice

2010-07-18T00:02:00.001-05:00

Recipe - Black Beans and Rice

I had some black beans I wanted to cook, and read several recipes for Cuban-style black beans, so this recipe is along those lines. As I went along, I did things that made it like Louisiana Red Beans and Rice.

This is not especially diabetic-friendly, though there is a lot of fiber. I don't think I tested after eating, but I didn't have any symptoms suggesting a problem, and I do know I do well on brown rice.

I'm not a food snob. I've only ground whole spices a couple of times, and this is the first time I ever toasted a spice. The result, however, was FABULOUS. This would probably be good with powdered cumin, but starting with the whole spice gave such a fabulous aroma to both my kitchen and the food.

REQUIRED EQUIPMENT:
* spice grinder, coffee grinder (that you don't plan on grinding coffee with again), or mortar & pestle.
* slow cooker, or just a large post if you prefer cooking the beans on the stove
* stick blender, food processor, or blender.

INGREDIENTS:
A teaspoon or so of cumin seeds
One pound black beans, soaked overnight in plenty of water and rinsed
1 qt chicken stock (I used reduced sodium)
One white, yellow, or Vidalia onion, roughly chopped
3 or 4 largish garlic cloves, chopped
Salt
Cooked brown rice or another grain you do pretty well on (optional)

1. Put the cumin seeds in a small, dry frying pan or sauce pan over low-to-medium heat. Toast until the aroma is pretty strong but not burnt. It doesn't take long.(I had to do this twice.)
2. After the seeds have been toasted and cooled, grind them. Do not forget to marvel at the aroma.
3. Put the black beans in the pot or slow cooker with the chicken stock and a couple cups of water.
4. Add the ground cumin, the onion, and the garlic (but not the salt, which some say does weird things to the beans if added at the front end)
5. Cook until the beans are tender, almost mushy. No way to predict how long this will take, but my beans took about four hours in the slow cooker. Check periodically and make sure there's always enough liquid to cover the beans - add more water if needed.
6. When the beans are done, allow them to cool. Important for safety
7. Remove maybe a quarter of the beans and mash them lightly, leaving them pretty chunky. Set aside.
8. Puree the rest until smooth. If you use a food processor or regular blender, step 6 is especially important.
9. Add the lightly mashed beans back into the puree. Add the amount of salt that makes it taste good.

To serve, reheat and put in bowls. Add the rice or other grain in a scoop-like shape in the middle of the bowl.

The Pursuit of Dailiness

2010-07-14T19:57:00.000-05:00

Some of life's victories can be gained by one big effort. An all-nighter to do a big school project, two or three days of focused effort on a report for work, or an afternoon in a kitchen to prepare a wonderful meal are often the best ways to approach those types of tasks.

However, most things worth doing are best accomplished by a modest effort applied consistently over time. No all-nighter will overcome a semester's undone mathematics assignments. There's nothing a gardener can do in August to rescue a crop neglected all summer.

I use the word "dailiness" to describe the quality of achieving results through effort applied regularly and consistently over time. (It's a real word, actually, but I use it with a bit of a spin.) There's just so much stuff that benefits from a little effort daily - not EVERY day, necessarily, but consistently. (I'm much better at being aware of the principle than I am putting it into practice. But, baby steps, baby steps.)

There's a great deal of dailiness in diabetes management. There are the daily routines of testing, taking medications, and seeing to the insulin supply. Good eating habits and exercise both have the best outcomes when applied with consistency. (I think I've read that the regularity of exercise may be more important than its intensity or duration.)

I often tinker with the tools I use to improve my daily practice of important habits. My morning pill sorter is on my living room table, where I'll be sure to see it, my evening pill sorter is in the bathroom (where I end each day), and I have a computer reminder to remind me of afternoon pills, since I'm almost always at one PC or another at that time of day. I've read of people who keep exercise clothes right by the door, serving both as reminder and shortcut. I'm beginning to experiment with checklists, to try to harden some of the things I should be doing into routines that I don't need to think about.

Have you found any tools that help reinforce your daily routines?

Those Blasted Pills!

2010-07-04T00:50:00.002-05:00

"I can't complain but sometimes I still do." - Joe Walsh *

This post is clearly in the category of complaining about something trivial. I think it says something important about my life with a chronic disease, but the highly kvetching-sensitive might want to skip this one.

I had a Twitter exchange with my friend Mike this evening which started when he mentioned having finished his pill sorting for the week. I replied that the weekly pill session is what I might find most irritating about diabetes and its cronies -- not the worst or most worrisome by any stretch, but the most irritating. (OK, office goodie pushers are worse. But still.) Mike responded with the perfectly sensible attitude that he finds it annoying, but that taking all the meds beats the alternative. My feelings about the pill session are stronger than that.

It's long been apparent to me that my mind often settles on something insignificant as a sort of psychological focus for something I feel uncomfortable about. On the rare occasions that I hold a grudge against someone, I'll find myself deeply annoyed by their voice, say, or a hairstyle. My pills are a Good Thing, since I believe I benefit from them, and the sorters are also a Good Thing. (Since I only have to think about my meds once a week, my regularity in taking them is VASTLY improved.) But I think that few minutes once a week carries part of the emotional weight of diabetes. I don't just sit down to sort pills, I sit down to my resentment over needing the pills, annoyance at the cost of the pills, anger that there isn't a cure, and fears about the future.

("Look, Mommy, this blogger is being a weenie again!" "Yes, sweetie, he is, but at least he's almost done for today.")

Man, since they bear all that weight, it's good that the sorters are built of such sturdy plastic!

* Walsh, Joe. "Life's Been Good To Me So Far" But Seriously, Folks... New York: Asylum Records, 1978.

The Type Two Word

2010-06-27T23:47:00.000-05:00

Do you like word games? Here's one: I'm thinking of a word, a word that may be the most important word about Type 2 diabetes, and yet I suspect that it's a word that most people, including too many T2 diabetics themselves, don't really understand.

Give up?

The word is "progressive". And I'm not trying to sell you car insurance.

See, type 2 diabetes changes, or at least always has the potential to change. It doesn't suddenly appear: most T2s, whether they've known it or not, go though a condition now being called "prediabetes", in which insulin resistance has begun but has not yet seriously outpaced the pancreas's ability to regulate blood glucose. Eventually, for those diagnosed with type 2, the pancreas can no longer keep up - the insulin needs are too great, and at the same type the pancreas has become damaged. (The traditional view has been that the pancreas has been "worn out" trying to overcome the body's increasing insulin resistance. As I understand it, there's now doubt about that.)

The diabetes has progressed, has moved from a normal metabolic state through prediabetes to diabetes.

And, for many people, the disease continues to progress from there, requiring more aggressive treatments and posing greater danger to the body. The danger lies in pretty much the same set up complications as exist for Type 1 PWDs, because the feet, kidneys, eyes, and arteries don't care about the clinical reason for the blood glucose being too high.

For some people, good control and a healthy lifestyle slow, stop, or even (for a time, anyway) reverse the progression of the disease. My own father has had T2 for around 25 years and is still (I believe) being adequately controlled by the same medication I take. To the best of my knowledge, he has experienced almost none of the commonly-known complications. (He does have another rather nasty condition that MAY be a complication.)

Will I be so blessed as to be like my dad and prosper so long without major progression in the disease? I don't know, and I can't know. Even if the genes are the same, some of the other factors are different. It may be that I will go down a road requiring additional oral medications, then injected medications, then basal insulin, then full insulin therapy. If I'm to travel that road, I have no way of knowing how long it may take.

If anyone ever wonders why I hold so tightly to the online community when diabetes as I currently experience it is so much less of a problem than it is for many others, the answer is simple:

Type two diabetes is a progressive disease.

(And also, of course, that I love y'all dearly.)

The things I learn from my friends on insulin about insulin and insulin dependency are things I may need someday.

For all of the people who teach me, I thank you.

I Will Lay Me Down

2010-06-26T16:28:00.000-05:00

"When you're weary, feeling small..."

I don't listen to music very often, actually. When I do, my tastes are somewhat eclectic - cool jazz, some "early" music, symphonies. And, though I quit listening to current pop a long time ago, I continue to love some of the music that was important to me when I was younger.

Yesterday was a terrible day. I'd slept very poorly, and I began the day with a flurry of stupidities on my part that resulted in missing an all-day seminar. (This may wind up costing me $180.) I then had to go back to my job and explain to my less-than-pleased boss what had happened. And, some folks from the DOC that I value seemed to be having tough days as well.

"When tears are in your eyes, I will dry them all..."

All of this had me pretty down, depressed almost to the point of being incapacitated. As I sat at my desk, the podcast I was listening to made a reference to the song "Bridge Over Troubled Water" by Simon and Garfunkel. I happen to love that song. It's my opinion that Garfunkel's singing on that is the greatest performance in pop music history: no other nominations will be accepted. (Do I have anywhere near the expertise I need to make such a statement? Absolutely not.)

So, I interrupted the podcast to give "Bridge Over Troubled Waters" a listen. "A listen" is a bit of an understatement - I listened to the song time six or seven times, one after the other. In the song, the singer is offering unconditional support to the person he's singing to: the lyrics feature the line "Like a bridge over troubled water, I will lay me down."

In that moment, I found the song incredibly moving, and struggled to keep from crying. As I listened, I alternated between feeling myself in the role of the singer and feeling myself in the role of the person being sung to. After a time, I could no longer stay seated. I went downstairs and chatted with a coworker for a moment, than I went and got a soda.

"Sail on silver girl, Sail on by.
Your time has come to shine. All your dreams are on their way."

By the time I got back to my desk, I was starting to feel better. I listened to the song one more time, then resumed my work. A little later, I had a nice chat with my boss, and even got a small project done. I was still very glad when the work day ended, but my mood had improved considerably.

(Lyrics taken from Simon and Garfunkel, "Bridge Over Troubled Water." Bridge Over Troubled Water. New York: Columbia Records, 1970.)

Motivational, My Left Kneecap

2010-06-18T19:17:00.000-05:00

Motivational quotes are often genuinely motivational. Sometimes they're silly, however, and sometimes I just find them depressing when they seek to inspire me to an attitude I can't seem to muster.

One time, a number of years ago, I was making my first visit to the office of a mental health professional. The receptionists desk had a page-a-day calendar from the manufacturer of a psychiatric medication. I don't remember the quote on the page, but I've always remembered it as "Stride Confidently Into Your Glorious Future!"

I chuckled to myself with an ironic, mirthless chuckle. I called the quote to the receptionist's attention and said, "If I could do that, I wouldn't be here!"

Hunger

2010-06-17T20:53:00.001-05:00

As a person who's been overweight since childhood, I've eaten a lot of meals for reasons other than hunger, the real, physical hunger by which the body signals that there aren't enough calories on board. Studies have shown that many obese people have lost understanding of what actual hunger even feels like: this is true of me, mostly. I was on a program once that asked participants to rate hunger on a one-to-five scale before and after each meal. I found this a real struggle.

When I was diagnosed with Type 2 diabetes, I was put on Metformin. From the day after the first dose, my fasting numbers dropped to within or near the target range. For the first time in who knows how many months, my blood glucose level was normal.

But nobody had told my metabolism that.

This is my understanding of what happened next: after many months of continually elevated blood sugars, my body had grown to consider those elevated levels to be normal, what it expected, where it would work to keep me. And, when my BG dropped, my metabolism sent out the signals that the level needed to be raised.

I got hungry.

This was real hunger, physical hunger, body-in-need of nourishment hunger. Not boredom hunger, not emotional-emptiness hunger, not boy-that-looks-good hunger. Hunger that I had only occasionally experienced.

I may appear to exaggerate. Obviously, this was not the hunger of starvation. But it was brain-says-FEED-ME hunger, and I didn't handle it very well. I ate, and ate, and the Metformin and whatever's left of my pancreas diligently worked to keep me from getting too high, and, well, let's just say I ate a lot.

As it happens, I was a Weight Watchers member at that time, and I'd been losing significant weight. (Ironically, having changed my diet and lost some weight, I was symptom free at diagnosis. Heaven knows what my A1c would have been if taken a month earlier.) But within two weeks of beginning treatment, I had regained almost all the weight I had lost. And, even though the feeling that I could clean out a buffet subsided after a few days, it was quite a while before I again felt in reasonable control of what I ate.

The reason I share this is because I know I'm not the only T2 that's experienced this when beginning treatment: perhaps some Type 1 folks experience it as well.

So, although I often forget: yes, ma'am, I do know what physical hunger feels like.

(Next-to-last paragraph edited for clarity.)

Brief Review - OneTouch Delica lancing device

2010-06-16T18:29:00.001-05:00

(2/3/11 - I'm editing this to remove a word that draws a lot of folks to this post, many of whom are probably disappointed. -BP)

So the pharmacy chain I use gave me a good coup** for the new Delica lancing device and lancets, which is supposed to be a less painful way to do blood tests. I don't actually have a lot of problems with testing being too painful, except for the apparently random occasion when it hurts like a mother. But, I thought I'd give it a try.

The device achieves (or not) its goal of reduced pain in three ways. The lancing device features "glide control". (If you know what that means, that makes one of us. Maybe the flight path, if you will, is straighter?) The device is designed to for less vibration, presumably meaning it's doing less damage inside the finger. And the needle is the smallest (33g) OneTouch offers.

(The lancets are not compatible with the device I got with my OneTouch meter. I tried.)

I did about five or six pricks. And, I gotta say, the thing does seem more comfortable than either my other OneTouch device or my MultiClix. The vibration thing may account for my needing to squeeze a bit to produce a sample. On the other hand, I was able to get a sample at setting four out of seven, and my other devices need me to be at about the highest setting. So, it could be that the Delica would be an improvement for folks needing a deeper jab to get a sample.

My plan is to pass the Delica along to a T2 friend who's complained about her lancing device being painful.

Bad to the Bone

2010-06-15T20:11:00.000-05:00

This post has grown out of a number of things I've seen in the last couple of days, particularly a discussion about diabetes and depression on Twitter, a cool post by Allison Blass, and also a posting on a forum from a self-described "bad diabetic". I've posted along these lines before, but it's an important set of ideas.

One of the reasons that depression so often follows diabetes, I believe, is that diabetes constantly invites us to see ourselves as having made a mistake. PWDs can be caused problems by factors entirely beyond our control or which couldn't have been anticipated. Highs or lows can also result from simple mistakes, the kinds of mistakes everyone makes. Even if we're secure enough to not judge ourselves for those times, and not all of us always are, the people around us and even our physicians may not be so wise. And, sometimes, we make choices that might have been wiser.

A few weeks ago, I had lab results that were MUCH better than what I had expected. I've thought a lot about what could have created such a huge gap between my perception of how I'd been doing and the reality. Clearly, much of the answer relates to how well my medicines work for me. But I think I also constantly measure myself against a vision of PERFECT diabetes management, thus only allowing myself to see "mistakes" without taking credit for the better choices.

Consider the following sequence of statements:

A healthy diet has room for an occasional treat.
A healthy diet has room for ONLY an occasional treat.
A healthy diet is better off without any treats at all.
I shouldn't have the candy bar I want, because it's not part of a healthy diet.
I shouldn't have eaten that candy bar: that was a bad choice.
I had a candy bar yesterday, too. I frequently make bad diet choices.
I take poor care of my health and my diabetes.
I am a bad diebetic.

Any logician would laugh at this list - most of the statements simply don't logically arise from the one before. Statement #1 is true, but each of the succeeding statements is a little bit farther down a road toward harsh self-judgment. But my mind takes off down the list so fast that I don't even notice #1 as I fly by. I live by #7 way too much of the time, and a bad day has me sitting at #8.

Take another look at #5. In my mind, anyway, that's where a key change occurs. My choice to eat the candy bar has changed from a choice about nutritional balance to a moral choice. In other words, I'm not a person who made a non-optimal choice, I'm (in my mind) a bad person.

This is obviously not the way for a diabetic to maintain a healthy attitude. But it's what I do, all too often, and from what I see in the forums and on Twitter, I bet I'm not the only one.

A healthy lifestyle is about balance, and a healthy lifestyle with diabetes that much more so. I need to learn to more consistently SEE it as a balance rather than as an unending series of challenges to my adequacy as a person.

Many of us seem to see our encounters with our care team along these lines. We don't just go to get information and guidance: we go to get approval. And, all to often, members of our care team encourage this attitude by granting or withholding approval. No wonder we hate our appointments -- we're not going to the doctor, we're going on trial! I confess: part of what I was so thrilled about at my appointment was that I felt my doctor's approval. That's fine, as far as it goes, but what if the approval had not come? It would be healthier not to grant my doctor that much power over my attitude.

Like everything else, it's a progress. But I'm gonna work on living higher up on my list.

How about you? Are you able to separate your sense of worth from the ups and downs of life with diabetes?

Lessons Learned

2010-06-10T19:25:00.000-05:00

For me, the biggest enemy of good diabetes management is denial. In my current situation, it's awfully easy to pretend my diabetes doesn't exist. I suspect I could go weeks at a time pretending that no action, no change, was required of me. Active participation in the online community of diabetics helps prevent that.

One day last week I had a meal that, while not ideal, I've had before without particular problems. (Can you say "five dollar footlong"? Can you avoid singing it?) Later in the evening, I found that I was thirsty. No surprise, everybody gets thirsty now and then. So I had a glass of water and went back to following the DOC on Twitter.

An hour or so later, I felt thirsty again. I think that it's only because I was thinking about diabetes that I got the suspicion that perhaps I should should test. I was 176 -- FIVE HOURS after eating, with nothing since. Heaven know what it had been earlier. After I tested, I tweeted what had happened, indicating my frustration. I was instantly reassured (thanks, Doug!) that bad BGs happen.

So, that night I learned that the five dollar footlongs need to be a part of my past -- unless maybe eaten at TWO meals. I also (re)learned that the support of the online community has become important to me.

We all gotta keep learning, right?

Type Two Mythconceptions Affect PWDs of All Types

2010-06-03T19:38:00.000-05:00

At Fault?

Many people in our society, if they know anything about type two diabetes at all, are under the impression that it is the direct result of obesity, poor diet, and a sedentary lifestyle. This view is promulgated by people who want to sell books about "reversing" diabetes and those concerned with public health who hope to scare those most at risk into changing their ways.

I'm not a doctor or a scientist, but my understanding is that type two is believed to result from a combination of lifestyle, genetics, and other factors not yet understood. Obesity is certainly a major risk factor, but it's neither a necessary precondition nor a guarantee: many type twos are not obese and never have been, and many many obese people do not have type two.

While type twos feel the effects of the misunderstandings, type ones are also affected. Many people know little or nothing about type one and mistakenly carry over their (mis)understanding of type two, when in fact lifestyle bears NO role in the development of type one. This can result in type one PWDs being harshly and unfairly judged.

Diabetics in Society

People with diabetes, like essentially everybody else, participate in society. We have friends, family, coworkers, waiters, fellow bus-riders, neighbors, and garbagemen. And very few of us are above being affected what these people think of us. For people living with a dangerous and frustrating condition like insulin-dependent diabetes, I can understand it being frustrating (okay, enraging) to have the people around us express the notion that not only is the disease our fault but that we could cure ourselves by getting off our lazy butts.

A Credibility Problem

I admire the many different ways in which PWDs I know advocate. I've sort of struggled to find my role in this: I'm not a fundraiser, and the notion of calling on congressmen makes me feel faint. For right now, my small efforts involve trying to offer a bit of support for others and to maintain this type two blog in the hopes that I'm reaching at least a few who are helped.

In many ways, I would really like to be a voice in helping diabetics of all types, as well as people in the society as a whole, understand the roots of type two diabetes. But I can't keep but feeling that I'm a very poor person to be front-and-center on this issue. As many members of the online community know, at the time of my diagnosis I was an overweight, non-exercising, poorly-eating, sedentary-job-holding, sleep-apnea'ed embodiment of the stereotype we all struggle with. (Alas, this is still too close to the truth, though I have made changes.) Thus, it seems to me that I have a real credibility problem: I'm sort of in the position of the little boy with the slingshot yelling that he didn't break the window -- it may be entirely true, but who's he going to convince?. If someone who didn't like what I had to say on this issue accused me of just making excuses for myself, how could I respond? That's not what the science indicates right now, but maybe it's the truth.

My own experience

I myself haven't had to deal much with the misconceptions about type two. The people in my non-virtual life either know better, don't know I'm diabetic, don't much care, or are too polite to point fingers. I have had a few (a VERY few, I'd like to stress) painful experiences online. I read a comment on somebody else's blog from a type one who expressed very bitter resentment against type twos. Another comment on another blog was from a type two who'd been able to diet-and-exercise himself off of medication and was quite confident that any type two who "took their lifestyle responsibilities seriously" could do the same. Another time a community member tweeted resentment towards "fat diabetics" in quite graphic terms. This comment left me feeling hurt and angry, but also feeling hamstrung - I understand (in part, anyway) where the comment was coming from, and anything I could think of to say might be seen as whining self-justification.

I, too, wish the public understood the differences between the types of diabetes. I, too, wish that Oprah and Dr. Oz hadn't muddied the waters. But I hold out little hope: we live in a complicated society, people lead busy lives, and not everybody gets good exposure to correct information about diabetes. In the meantime, the best most of us can do is to try to be reasonably well-informed ourselves and to take advantage of the opportunities we have to educate.

Second D-versary

2010-05-31T16:28:00.001-05:00

Today is (I think) the second anniversary of learning of my diagnosis as a Type Two diabetics. (I told that story here.)

I can't say that I'm grateful to be diabetic, but I am grateful to have been diagnosed. Many Type Two folks are only diagnosed only when they develop complications. So, it's definitely a blessing to have the opportunity to minimize the likelihood of those complications.

Is my life different since diagnosis? Well, I certainly eat better. And I think I feel better physically than I did before, even if that's not true every day. I think my health future may be brighter, too: I was on a pretty bad path before I started making changes, so it's likely something would have come up even if diabetes didn't.

Two years is just a beginning, I know: there's a lot of life to life yet. I look forward to learning to live it ever more fully.

The Jelly Jar

2010-05-28T11:14:00.000-05:00

I don't know if other people do this. But for me, the strangest things can take on symbolic importance.

I have a cheap little plastic three-drawer storage unit in my bathroom. One of the things that lives in the top drawer thereof is a glass pint jar. I don't know what it originally held, but it LOOKS like a jelly jar, so I'll call it the jelly jar. The lid's been gone for years. It's functioned as my bathroom glass for when I need to brush my teeth, take pills, or just get a drink.

The jelly jar and I have been through a lot together. The jelly jar did hard time in the months before my diagnosis, when I would drink it dry three or four times in a row, multiple times a day and sometimes multiple times a night. So, the jelly jar has been my friend.

But the jelly jar has also been my enemy. Well, not enemy, exactly, but a potential danger. My bathroom floor is hard tile. I realized very shortly after my diagnosis two years ago that keeping a readily-breakable glass object in a room where I'm often barefoot was not a good plan, and that I should replace the jelly jar with something plastic. It took me eighteen months (just how crazy does that sound?????), but I finally did get a small plastic container that works well. But the jelly jar has remained in its drawer, both an old friend and a symbol of an extremely simple thing I could do for my health but which I haven't done.

This morning, I threw away the jelly jar.

Greatest Doc Appointment EVAH

2010-05-24T18:22:00.002-05:00

Three questions, two unanswered:

Question One: Where do I go to get a lab report framed?

I met with my doctor today to get lab results from last week's blood draw. I was very anxious about this last night: I even tweeted about it. (Bless those who responded.) In conjunction with stress over some other issues, the worry was enough to keep me up most of the night. The reason for the worry was that I was absolutely convinced that my A1c was going to be way up. I even spent part of today's wait reading up on the meds used in conjunction with Metformin when the Met is no longer enough, assessed by their proclivities to produce weight gain or hypos.

Why was I so convinced of a bad result? Well, DUH - my diet is horrible, and I don't exercise enough.

The results? A1c 6.0, down .9 from a year ago. Total cholesterol, LDL, and triglycerides within desirable ranges, HDL a wee bit low. The most amazing part was my doctor telling me, "You're doing everything right. Don't change a thing."

I have NEVER had a doctor tell me anything like that. Not anything within a hundred miles of that. The last doctor I saw more than once seemed to despair of my ever being able to make good choices.

Question Two: So why did my expectations very so far from reality?

Well, certainly my inborn tendency to expect disaster is part of it. But I really, truly, believed that my choices, along with my upward-creeping fasting numbers, reasonably led me to expect a pretty big jump.

Here's what I think accounts for it: I think of "perfect" diet and exercise as my goal, with suboptimal choices (and there are plenty of these, sometimes plenty bad) being viewed as damaging, moving me towards complications and heart disease. Perhaps the reality is that good choices (and there are plenty of these as well) represent not a baseline but as actively moving me towards wellness.

Question Three: Is it really possibly that I'm not slowly getting ever sicker, day by day?

Boy, do I feel good.

I Want a New Feed

2010-05-19T23:09:00.000-05:00

I've previously addressed various frustrations with health/diabetes news feeds -- you know, the ones that constantly tell me that something I've got probably caused something else I've got or puts me at dire risk for something I don't yet have. There are other traps, too -- over the last couple of days, I've seen a number of things about the Dire Awfulness of something I do that I'd regarded as pretty dang benign. Oh, joy.

I want a new feed -- a custom Bob Health News Service.

In order for this service to work, I'd daily post a few things that I did well in the health area, or at least failed to do wrong. The service would respond with a drizzle of stories about the wonderful benefits of what I'd done. For example, tonight I cooked unbreaded chicken wings, put about half of them away for tomorrow, and also had some spinach. When I went to look at my feed, there would be stories proclaiming the virtues of small changes, how much fat is saved by not breading fried food, and the wonderous benefits of green leafy vegetables. On a day when the best I can say is that I didn't eat barbecued ribs with my pizza, the stories would be along the lines of "Continued Respiration Proven to Delay Death!"

Doesn't that sound like fun?

Meet the New Doc

2010-05-17T19:03:00.000-05:00

Today, I had an appointment with a doctor that I'd not seen before. I was pretty nervous: I blogged about this last week, and last night asked on Twitter for thoughts and prayers about it. (Many thanks for those of you who did this for me.)

Since arriving in Kansas City about 15 years ago, almost all of my doctors have been interns in Family Practice clinics. I'd see the same intern as long as they were here, then they'd leave and I'd be assigned a new one. This was okay, though I had anxieties each time I had a new one, but since my diagnosis I was coming to feel that I'd like a longer term relationship. I decided to try a clinic that's so close to my work that I don't actually have to go outside to get there, although it's probably easier to do so.

I like her a lot. She's somewhere in the 35-45 range, I'd guess, so at least we're approximately the same generation. The phrase "efficient but unhurried" from my earlier post fits perfectly -- I certainly didn't feel invited to chat, but I also felt that I could ask my questions.

One, thing, though -- she wants to schedule me for The Test Which Must Not Be Named. Aaaaaauuuuugggghhhhh!!!!! I have no desire to have any tubes put there! :)

I'll be meeting with her again in a week to go over test results.

Diabetes Blog Week: Sunday - If There Was A Cure

2010-05-16T10:48:00.000-05:00

Today's topic was to discuss what I would do should there be a cure.

My first response, I confess, was silly. Find a good Italian restaurant. Order angel hair pasta with olive oil, garlic, and good parmesan. Tell 'em to keep it coming until I cried "Uncle!".

But then I thought more about it.

If I could take a pill....

If I could take a pill that would not only make my insulin resistance go away but undo any damage that has been done to my pancreas....

If, further, this wonderful little pill also magically cured the whole cluster of maladies that like to hang out with Type 2, such as high cholesterol, hypertension, sleep apnea, and depression....

If all these things were true, if all these symptoms went away....

Wow. What would it be like?

What it would be like to not worry every time I eat, every time I fail to exercise, every time I forget my meds, if I've just made the "last straw" mistake that will doom my pancreas, my feet, my kidneys, my heart, my ability to recognize my friends, or my ability to face the day?

That would be a new day, indeed. And I'm unable to imagine what it would be like.

Diabetes Blog Week: Saturday -- Picture This

2010-05-15T10:08:00.000-05:00

I've spent a fair amount of time thinking about what word I would use for the "Word in the Hand" project done over at Tudiabetes.org. About a month ago, I came up with my word, and thought I would share it with you today.

My word is "waiting", and it seems to me to be a good word for my stage of Type 2 diabetes, at least as seen through my personality. Right now, my health is okay. My fasting BGs are normally pretty good, and beyond feet that sometimes tingle, no signs of any complications. (As far as that goes, my circulation could be iffy for completely non-diabetes-related reasons. )

But, how long is that going to last? I'm waiting for something to go wrong: a significant decrease in pancreatic function requiring more aggressive treatment, the onset of complications, maybe even a cardiovascular event.

Yes, I know: I should be optimistically and with self-empowerment and faith making those changes that might well help me prevent or long delay any of those things. Yet one more healthy habit I don't seem able to pull off.

You can also see photos relevant to my diabetes life in this post and in this post.

Diabetes Blog Week: Friday - The E Word

2010-05-14T06:00:00.001-05:00

Exercise. It's important. I know it is.

When I exercise regularly, my fasting numbers are lower and my post-meal numbers don't appear to go as high and come down faster.

Exercise is good for, well, everything.

I saw a headline on a podcast the other day (I haven't listened to it, yet) about how exercise may help prevent Alzheimer's disease. My dad has Alzheimer's disease.

I walk to and from work essentially every weekday. That forms a basis of about 25 minutes a day of moderate walking.

But more than that? Well, crud.

My Eyebrows: A Chronological Outline

2010-05-13T20:11:00.000-05:00

1960 -- I, and my eyebrows, are born. Hordes of researchers have failed to produce any contemporary notice of my eyebrows whatsoever. We must then assume that they differed in no way from the eyebrows one would expect on an infant that resembled Winston Churchill.

1960-1995 -- My eyebrows show no expansionist tendencies. They lie waiting. And plotting.

1995 -- I mention to my sister that I am on my way to get my haircut. She suggests I ask to have my eyebrows trimmed. I shrug it off, deeming it ridiculous. When I arrive for my haircut, I am asked if I would like my eyebrows trimmed.

2000 -- I begin trimming my own hair, doing so roughly monthly. I trim my eyebrows first occasionally, then about every other time, then almost every time.

2010 -- Circa May 9 of this year, it becomes clear to me that my eyebrows require trimming, although my hair does not.

Where is this going? Are my eyebrows in on Siah Sausage's plot for world domination? I have fear.

What I Want From My Doctor

2010-05-13T20:01:00.000-05:00

I'm seeing a new doctor on Monday, one I've never seen before.

Throughout my time in Kansas City, I've always gotten my medical care at Family Practice clinics, where I would be seen by interns. They'd assign the same intern to see me every time, but after a year or two the intern would go on to the rest of their career. Some of these folks I've liked, some I haven't.

So, on Monday, I'm taking my care to a new clinic, one so near my workplace that I don't technically go outside if I don't want to.

And, I'm feeling some anxiety. So, I thought I'd summarize what I want from my new doctor:

I want her to have experience with Type 2, but not the sort that leads her to think that we're hopeless.
I want her to be receptive, though not necessarily agree, when I ask about Byetta sometime in the next couple of appointments.
If she needs to explain risks I face, she needn't phrase those risks as threats. ("If you don't lose weight, I'm going to raise your dosage.")
I want her to be kind.
I want her to be efficient but unrushed. I want to not have the feeling that her most important patient is the next one.
I want her to check my feet. They don't NEED checking, especially, but I need her to be attentive to the basics. In the two years since diagnosis, my feet have never been checked, despite all appointments having taken place in rooms with posters reading "Diabetics - Show Us Your Feet!"
Finally, if I like her, if she's what I need, I want her to be available to me for a long time.

Diabetes Blog Week: Thursday - The F Word

2010-05-13T06:30:00.002-05:00

The "F-word". Food.

Most folks with diabetes have complicated relationships with food. Not only am I not an exception, I might be the poster child

At some point, I should try blogging about all the various ways I manage to screw up my food life, but I'm really not up to that.

So, here's what I TRY to do about food, without answering the touchy question of how often I pull it off.

Because I'm obese in addition to being diabetic, and because my risk of heart disease is huge, I try to eat reasonably low carb and reasonably low fat. In practical terms, this means trying to focus on the veggies with enough protein and starch to make it to the next meal without discomfort.

Breakfast these days is half a cup of All-Bran with cinnamon, Splenda, skim milk, and sometimes flax meal. (The cinnamon really helps the flavor.) I eat this out of a dixie cup both so that I don't have a bowl to wash and so that half a cup of cereal doesn't seem really small. Supplemented with a string cheese, this gets me through to lunch.

On a good day, I take my lunch. This will be some kind of vegetable entree (like the ratatouille stew I invented) with some chicken breast or something to fill it out. The carb will be a sandwich thin, some brown rice, or a "variety grain" like quinoa or barley. Sometimes I have a salad bar instead of the above, but I can't eat lettuce salad too often without risk of crankiness.

Supper (as I was raised to call the evening meal unless it's an event) is similar in concept to lunch except that the portions are larger.

That's the goal, anyway.

Diabetes Blog Week: Wednesday -- Sources of Support

2010-05-12T06:30:00.001-05:00

My biggest source of support in my diabetes life is the Diabetes Online Community. I do have one close T2 "in person" friend, but diabetes is not a big subject of conversation between us. I rely on the DOC for friendship, information, and (above all) constant reminder that I have to take this diabetes thing seriously. My approach to the Big D is certainly questionable, but I'm confident it's much, much, better than it would be without my daily DOC involvement.

Beyond the DOC, it's a touch iffy. Neither my family nor other close friends are really in a position to offer much diabetes-related support. I do have a nurse and a life coach through my insurance company, each of whom I talk to by phone approximately monthly -- they have been significant help. I'm starting with a new doctor later in the month, but none of my recent physicians have been much help beyond writing prescriptions. (In nearly two years, nobody has yet looked at my feet.)

So, I'm very grateful to my friends at Diabetes Daily, my Twitter buds, and the authors of the blogs I read.

Diabetes Blog Week: Tuesday - Hypoglycemia

2010-05-11T06:56:00.000-05:00

As a Type 2 diabetic treated only with oral medication, there are some experiences common to other diabetics that I've not yet had. Since my only diabetes medication is Metformin, there's one such experience that's huge:

To the best of my knowledge, I've never been hypoglycemic.

I hasten to add that I'm in no way deluded that this is evidence of sound diabetes management. It's a function of my current disease state, my current therapy, and a certain amount of luck.

Older medications used with T2 were more likely to produce lows: my dad used to have them regularly. And a combination of metformin and the older meds can produce them: my neighbor lady goes low on occasion. But for those of us on metformin only, I understand that my experience is common.

Because T2 is a progressive disease, I expect that my share of lows is coming. At some point, as my pancreatic function diminishes, hypoglycemia awaits.

I have discovered two things that have taken me to the bottom of the normal range, and therefore deserve some caution: heavy exercise and Kansas City summers. So, I need to control the intensity of my exercise (not a huge problem anyway) and be careful about the heat of the day in July through September.

I do have glucose tabs at work, just in case, and my coworkers have been told where they are. I also have some at home. I'm familiar with the basic hypo treatment formula of test, eat 15 carbs, wait 15 minutes, retest. For when my time arrives.

Diabetes Blog Week: Monday - My Type Two Day

2010-05-10T06:29:00.000-05:00

(This is a lightly edited version of a post that first appeared 1/10/10.)

Here is what I do (or should do) about my T-2 diabetes on a daily basis. I'll try to be pretty honest about what I actually manage to accomplish and what I don't.

Note: take NONE of this as advice. My sole goal here is to give a picture of what I do (or try to do). Go forth, and discover what works for you.

1. Medication
It took me a long time to figure out how to be regular with my meds. I now have one large 7-day pill sorter for morning pills and another for evening pills. (I'd be a little better off by doing one for dinner time as well, since a couple of my bedtime pills would be better at that time, but I haven't implemented this yet.) Using the pill sorters means I only have to think about the pills once a week. This is a Good Thing.

I currently take prescription meds for diabetes, for blood pressure, for cholesterol, for glaucoma (not diabetes related), and for one or two other things. I also take a number of over-the counter supplements which have been credibly (to my satisfaction, anyway) recommended at one time or another.

2. Testing
Most Type 2s seem to be told to test once a day in the morning before eating. That number is used as sort of the baseline for how your diabetes life is going. I work at not letting myself be too up or down about a given day's number (unless it's way out of whack) but to watch the trend, expressed as "about how I've been running." I think it's safe to say that I do this more often than not, but I go in spells of not testing several days in a row.

When I'm being conscientious, I test once or twice more during the day. I don't have a set pattern for this: sometimes I'm checking on the effects of a particular food, if I've come down satisfactorily after a meal, etc. If I feel weird physically or emotionally, I sometimes test to see if there's a blood sugar relationship. (Usually, for me, there isn't.)

I'm not very good at all about testing my blood pressure, which I should also be doing on occasion.

3. Food
Oh, boy, is there conflicting advice about optimal eating plans. I try, when I'm doing well, to eat reasonably low carb AND reasonably low fat. Eating this way, with exercise, helps me to lose weight. But I'm not very good at it. It's easy for me to feel discouraged about this area, but I have made progress in terms of laying off many of my worst choices or indulging only occasionally.

One thing that works very well when I do it is to plan a few days at a time, then hit the grocery store. My basic approach for each meal is to plan for some veggies and/or fruit, a modest amount of carbs, and a lean protein source. I try to lean in the direction of whole grain stuff for the carbs. (In particular, I find that I do well on brown rice, while white rice is a spike food for me.)

4. Exercise
I'm off-and-on here. The exercise I most enjoy doing is walking, but iffy weather and tiny injuries don't always allow for this. I'm experimenting with other things. I recently got a Wii Fit, but am inconsistent. Exercise videos tend to leave me feeling fat and clumsy.

I will tell you this: when I am exercising regularly, the effect on insulin resistance is very marked. I not only see it in my morning numbers but think I have a much faster return to "normal" BG after eating.

That's my Type 2 Diabetes day. (Sometimes.)

Depression and Lifestyle Change

2010-05-07T18:23:00.000-05:00

In a recent post, I discussed my experience with depression. Here I want to think about how depression may impact attempts to make the lifestyle changes appropriate to dealing with diabetes.

When I'm depressed, I tend to feel a serious lack of energy. Exercise seems like it requires an investment of "oomph" that I don't have, like asking a family in poverty to contribute to a savings account. An excellent idea, but it just feels impossible. (Ironically, research has shown - and my experience confirms - that exercise is a powerful treatment for depression.)
When I'm depressed, the way I normally do things feels like survival strategy. I suppose that most people have habits they fall back on during tough times. For me, that involves climbing in bed and grabbing a crossword, a computer game, a favorite book -- anything that allows me to turn off my stupid brain. (I'm fortunate - no, make that blessed - that I never got into drugs or alcohol: I don't think it would be pretty.) I'll hide away like that for the whole evening, or even the whole weekend. This strategy does nothing to help me feel better, or to take care of my diabetes -- but the pull of this practice when things are crazy is very, very strong. And the strong pull of the old tricks makes it that much harder to try out "new tricks" such as exercise, meditation, reading positive literature, and finding new activities.
When I'm depressed, medical appointments and even testing feel like judgments on my character, on my value as a person, that I just can't face. (Yes, I know this is absurd. That doesn't help.) Not getting regular medical appointments means that I'm not getting the information I need, and maybe not even the tools I need, to better control my diabetes.

So, for me, part of lifestyle change includes learning some New Tricks when it comes to dealing with depression. Not an easy thing.