If Scrooge Tweeted...

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

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

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

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:

1. Informational - readers should go away from the post more fully informed about the subject at hand.
2. 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:

1. An entry in a journal or diary.
2. A letter to a trusted friend.
3. 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:

1. True: Yes, absolutely.
2. 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:

1. 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.
2. 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

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

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

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

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?"

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

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

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

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

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

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

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

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

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

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

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!

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

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

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

(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

(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

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

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

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

"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

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?

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?

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...

(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?

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

"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

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

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

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

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

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?