Diabetes and Exercise Part III: After the Workout

Oops, I lied.

In my last article on Diabetes and Exercise, I promised that this article, Part III, would contain some tips on insulin dosing in light of special considerations for diabetics. However, when I sat down to write about those special considerations, I realized that I had left out an important aspect of exercise physiology: what happens after you exercise?

Understanding this question is vital to understanding how the diabetic's body reacts to exercise. The more intense the exercise, the more disruptive this reaction can be. So today, I'd like to provide some (very) basic information about the post-exercise phase of physiology. Just as in Part II, I'm going to keep this as simplified as possible, so that we can focus on the important information and not get caught up in a description of cellular respiration and biochemistry.

After The Workout: Anaerobic Exercise
Recall that in Part II, we learned that anaerobic energy is "ready-to-use" energy stored within the cells, waiting for the moment you move a muscle. It requires no insulin for immediate use, it simply fuels cell work and expires.

Think carefully about what this might imply about the body's next course of action. The stored energy that was once contained in the cells is now gone. The body will naturally act to replenish this energy. This act of replenishment does, in fact require insulin (and other hormones).

When you digest a meal, insulin helps carry glucose into the cells so that it can be converted into this stored energy. When you exercise, this stored energy is depleted and your body becomes "hungry" again. Whenever your body is hungry, it "feeds its cells" with whatever glucose is on-hand.

Therefore, immediately following a big burst of anaerobic exercise, the body starts drawing on its various sources of glucose (either the blood stream, fat deposits, as-yet undigested food, a post-workout Gatorade, whatever) and acts quickly to put that glucose back inside the body's cells.

It happens rapidly. Your body needs that energy immediately, not merely for the sake of exercise, but for the sake of getting around. What I mean is, let's assume you sprint as fast as you can for 200 meters. If you have given it a good effort, the muscles in your legs have expended so much of their stored energy that if that energy isn't replaced, you won't be able to walk. Indeed, track and field spectators have seen  many a 200-meter athlete collapse at the finish line, unable to continue to walk, much less run.

This is due to the fact that the body doesn't distinguish between "anaerobic energy used for sprinting" and "anaerobic energy used for walking." It's all the same stuff, and once it's gone, it's gone.

Now, here's what you need to know as a diabetic: When you engage in anaerobic exercise, your body will immediately act to replenish the energy you've used up. If the body does this too quickly or if you have used up too much of your stored energy, this will induce hypoglycemia.

After the Workout: Aerobic Exercise
When we engage in aerobic exercise, things follow a different path.

Recall that we learned in Part II that during cardiovascular exercise, we use up a little anaerobic energy to get started, and then the body phases-in aerobically generated energy to keep you going throughout your workout. This is what causes the heavy breathing, the elevated heartrate, and so forth. Your body is rapidly taking in oxygen to mix with sugar and insulin, and delivering it to your cells.

Once the workout is over, our bodies continue to have an elevated heartrate, we continue to breathe heavily, and our respiratory system continues to deliver aerobic energy into our cells. The process doesn't immediately end, it takes a little time to wind down, gradually.

Not only that, but aerobic respiration itself isn't a perfectly efficient process. You may have heard that your body "doesn't start to burn fat until twenty minutes into your workout." Twenty minutes is a ballpark figure, and in reality, the process is gradual rather than binary. But the bottom line is more or less true: It takes time for the body to be able to use the energy produced during aerobic respiration; it also takes time for the process to taper off.

This, too, functions as much logically as it does physiologically. What you might expect to occur within the body really does occur: Namely, our blood sugar remains elevated for some time after the workout, thanks to the gradual and inefficient nature of aerobic respiration. Eventually, though, it does taper off, and the energy must be replaced. The body once again gets "hungry" for more energy, and starts to transport any and all sugar from available sources into the cells so that it can be stored for future use.

Exactly how long this aerobic cycle lasts depends not only on your own unique body, but also on how fit you are, how hard you pushed yourself, and for how long you were exercising aerobically. It will not occur exactly the same way twice. In some cases, it will persist for twelve hours. Some endocrinologists have suggested to me that periods of longer than twenty-four hours are not uncommon.

Regardless, what's important for the diabetic to understand is this: Aerobic exercise will initially raise your blood sugar, and that rise in blood glucose will persist for quite some time after exercise. Eventually, however, the elevated blood sugar will subside as your body acts to replenish its stored energy - and this may induce hypoglycemia.

Some Closing Remarks/Discussion
I suppose the most vitally important thing to remember in all of this is that both anaerobic and aerobic exercise can induce hypoglycemia in a diabetic, for reasons I will (hopefully) elucidate in my next article. Therefore, always remain vigilant. Monitor yourself very carefully during and after exercise to ensure you are safe. It takes some experimentation to find out what your limits are and when you hit them.

I have to reiterate that because at every point in time, it is a diabetic's first priority to avoid life-threatening hypoglycemia. It is not the keystone of exercising as a diabetic, but it never goes away. We diabetics must simply and at all times think about hypoglycemia and how to avoid it. It is a fact of life for us.

So, the best recommendation I can give here is to always carry a little sugar with you when exercising, and always have a snack after the workout. No more than 15g of carbohydrates, and if I were you, I would not take it in the form of sugar. 

Having looked after that top priority, we can then dive into the details and nuances of the remaining information. We can then start analyzing how our bodies will react to various workouts to which we might subject it.

For example, an interval workout at the track will result in a particular "blood sugar reaction" afterward; a fifteen-mile long run will result in a different, no less unique reaction. And not only is the workout important, the sequence is, too. Lifting weights and then doing some cardio will do something different to your body than doing cardio and then lifting some weights.

In subsequent articles in this series, I will explore some of the considerations involved in the types of workouts you might choose, and the types of reactions we can expect from them.


This Week In Exercise

I could have titled this post "Week 7," but I chose not to for two reasons. First, I am not really covering any particular workout regimen at this point. Rather, I am chronicling my weekly workout experience and providing a look ahead at what sorts of exercizes I'll be doing in the coming week. That brings me to the other reason, which is that it doesn't make any sense to keep iterative track of the index of weeks involved, since the starting point was more or less arbitrary, and there is not endpoint in sight.

So, in the interest of clarity and sensibility, future posts of this kind will simply be entitled "This Week In Exercise."

Now For This Week In Particular
I was out visiting a client on Thursday and Friday, so I did not have access to my regular gym. Originally, the plan was to return to my physical trainer on Friday, but it would have been a long and pointless drive, not worth it in the long run. To make matters even more final, I had a rehearsal with a new band on Friday. I was under too much of a time-crunch to get my session in.

What I opted for instead, was to take Thursday as a rest day, get a light cardio workout in on Friday, go running on Saturday, and then on Sunday I returned to my trainer-recommended strength workout, which I detailed last week.

The amazing thing here is that the first time I did this workout, it nearly killed me. No, not really, obviously I am exaggerating. But the fact remains, it took everything I had to finish that workout, and I even had to take an unplanned break.

But by Sunday, the workout was almost easy. It was still a decent workout, but my body has already adapted to it. I can burn through the workout in about a half an hour, leaving plenty of additional time for cardio. It leaves me out-of-breath, but it doesn't leave me exhausted.

If this is what I have to look forward to during the time I have invested in physical training, then I am going to be in very good shape, indeed.

This week, I will get a new set of workouts, hopefully on Tuesday. In the meantime, my intention is to focus a bit more on running. The heat has been a real challenge, and I am having a difficult time getting any really good mileage in. It may also be true that the strength training is impeding the running a little bit - which happens every time I focus more on muscles and less on running. But it's far from impossible to maintain both a robust running regimen and a robust physical training regimen.  This week, I'd like to keep myself focused on getting some good mileage in, whatever "good" passes for in the burning heat out there.

I apologize for being a bit sparse with the posting over the last week or so. I had a busy week on the job, and multiple converging extracurricular commitments to look after. Things should improve henceforth.

A Must Read

I will not even sully it with my own take. Just read it. Now.


The World In Which We Live

This can be considered "part three in a thee (so far) part series" on discussion. You can find part one here and part two here. In those previous write-ups, I elaborated on some challenges involved in maintaining a good dialogue. Today, rather than comment on the quality of discussion out there, I'd like to provide some remarks about the consistency of the dialogue.

Namely, commentary on the various current events affecting our lives seems stagnant.

Reasons For Stagnant Commentary
One reason for this is that there is simply too much of this commentary to go around. We're saturated by perspectives. Everyone who puts their commentary to words (on a blog, in the papers, on TV, etc.) is naturally compelled to provide their own, unique take on the issue. A significant problem with this is that, after a few dozen perspectives, no one "take" is sufficiently unique to offer a valuable contribution to the public dialogue.

For example, the recent movie theater shooting in Aurora, Colorado offers us a few points of discussion: mental illness, violence in the media, gun control, the moral state of society, and the heartbreak of random acts of violence. It is possible to provide a unique perspective on one or more of those points, but after a dozen or so, the readership has already formulated their own thoughts on those matters. Additional commentary doesn't even become a feedback loop. It's just noise. Readers start to cluster the "unique takes" by general category and nothing new gets learned.

Another reason for the stagnation is that intellectuals who write about current events are engaged in the process of cultivating their own pet theories, and hashing them out with other intellectuals' pet theories. It is more of a pedantic, academic dialogue that does not offer the general public much meat.

An example of this would be the average economics blog post. If I may pick on Scott Sumner, every new economic data point enters his mind and receives "the NGDP treatment." He then writes a blog post aiming to reinforce his own personal NGDP theory - the specific current event is beside the point, it merely serves as a basis for Sumner's elaborating on his NGDP theory. The same might be said of Paul Krugman, only, instead of a real economic theory, he's just expounding on the idea that the conservatives whom he opposes require a capable opposing voice. The specific current event - and the specific economic concept involved - merely serves as a starting point for his anyone-who-isn't-me-is-not-as-good-as-me screed.

Each theory is relatively unique, well-reasoned, and well-researched, but the specific applications of such theories are so narrow that the public soon realizes that it is merely a dialogue being held among a half-dozen university professors.

A final reason why commentary is stagnating is because only certain kinds of commentary "sell." The mainstream media knows this best of all, and they offer us plenty of the specific kinds of commentary that sells. There is not much space left in the program schedule for less-bombastic commentary.

An example of this would be the classic daytime talkshow. Think about those old Geraldo episodes featuring members of the KKK and the Black Panthers discussing race relations on stage. Plenty of fighting, plenty of broken chairs.

In this case, no one would ever suggest that the public dialogue consists of "the KKK on the one hand, and the Black Panthers on the other." That would be preposterous. Everyone knows that normal people don't think like either side of that Geraldo debate. Normal people aren't even "somewhere in the middle." It really is just bombastic television programming aimed at giving viewers something to gawk at.

And yet, when it comes to politics, people really do believe that it's "the liberal Democrats on the one hand, and the conservative Republicans on the other." Funny, isn't it?

What To Do About Stagnant Commentary
It seems to me that there are only a few options available here.

First, one can ignore the stagnation and continue supplying a barely unique take on the issues. (Might this be the Stationary Waves strategy?) The views will be filtered into a general category and not given much consideration.

Second, one can recede into pedantic academic debates with a half-dozen of one's colleagues and ignore the general readership and their comments.

Third, one can become the next Geraldo.

Finally, one can attempt to elevate the conversation a little, and hope for the best. This is what I actually hope the Stationary Waves strategy is. My "take" might not be all that unique, but it does come with an official lexicon and I have tried to flesh-out the general principles involved. So if it is not a truly original set of ideas, it is at least a comprehensive set of ideas. Comprehensiveness is not merely an end in itself. When we provide complete ideas, we provide something that can actually be discussed. We're not merely just debating categorical talking points.


In A Word, Faith

From the very beginning, faith has been mankind's way of grappling with any of life's particularly unsettling unknowns. The harmless stuff has always been the domain of science.

For example, there are creatures everywhere around us. Only very primitive humans saw animals and developed theories about monsters. Thinking man saw animals and developed taxonomies, biological theories, and ultimately the theory of evolution. We humans observed the phases of the moon and were prompted to ask why. We trained our eyes on the stars and developed astronomy, navigation, and theories of the universe.

And yet, when it came to aspects of life that posed difficult or uncomfortable questions, we turned to superstition. Dark, creepy staircases leading to potentially spider-infested corridors inspired ghost stories out of us. Even walking down such a staircase inspires us to believe something is creeping down our necks, or that the shadow in the corner just moved in a threatening way...

Death scared us so much that we developed ideas about the afterlife. These ideas came from nothing in our physical universe. They came to us, passed down from generation to generation, via oral history and the vague wording in dusty old tomes. The evils we witnessed ourselves capable of committing in cold blood were so frightening to us that we developed ideas of demonic possession, Satanic offiliation, temptation, sin.

I have blogged about these sentiments before. I called them The Spider Effect. Creepy things will creep us out. It's only natural.

What I have not blogged about, though, is how this ties into faith.

A Stationary Waves Definition Of Faith
I submit the following as a definition for faith: Faith is the act of favoring what one wishes to be true over what one knows to be true.

While the definition is admittedly loaded, I feel it is fully consistent with believers' own views. In other words, a believer will say that faith is a requirement of religion, and that at some point one needs to accept that many religious beliefs will never and can never have scientific explanations. At some point, if one wants to accept a religion, one must stop demanding knowledge and scientific answers, and must replace those demands with faith. As all believers accept this fact as a natural aspect of their own beliefs, I feel my definition need not offend.

Moreover, it is also consistent with secular use of the term faith. When I put my faith in another individual, I know there is a possibility that he/she need not demonstrate the behavior I expect. It may be that my lawyer sells me out, or that my doctor will engage in malpractice, or that my good friend will betray me. It's possible. But, I wish it will not be so. Without a need for concrete evidence - indeed, in the complete absence of concrete evidence, other than a good prior track record - I put my faith in an individual, wishing that I am correct. I will not know it to be true until the situation is passed and I can assess what actually happened.

Therefore, in all contexts, faith represents the replacement of what I know to be true with what I wish to be true.

Scrutinizing Faith
By far, the most commonly discussed form of faith is that which pertains to religion. Millions of people worldwide place their faith in one of the various religions out there.

Religion offers people a rich oral history to which they can engage in cultural attachment, foster a sense of belonging - both to a "higher cause" and to a community of like-minded people - and provide themselves with a set of moral guidelines by which they can govern their ethical behavior.

On the other hand, the deontological nature of religion provides a powerful disincentive to believe. That is, because the rules and guidelines involved in religion are so strict, many of us find ourselves at odds with other people when it comes to situations that matter to us. For example, we may find that religion advises against associating with certain kinds of people. We may find that religion counsels us to keep a "safe" distance away from certain kinds of art. Religion prevents us from eating certain kinds of food and wearing certain kinds of clothing.

While the underlying reasoning behind these seemingly arbitrary rules is often well-intentioned (e.g. it is in the name of preserving a sense of "modesty" that we must wear certain clothing, or a preserving a sense of "cleanliness" that we must avoid certain foods), many of these rules start to become confusing when examined under more scientific scrutiny.

Puritans, for example, thought it sinful for a woman to expose her ankles. That seems clear enough, until we're asked where the ankle begins. At this point, we must engage in the Paradox of the Heap. Point A is not the ankle, Point B is. Between the two points lies ambiguity.

If the ankle itself cannot be defined, then neither can any point "above the ankle," at least when it comes to creating a rule about what can be exposed "modestly," and what cannot. This must surely be how miniskirts and bikinis came into existence in the first place. Everyone agreed on the line at which "modesty" ended until someone pushed the line infinitessimally. Since the movement was infinitessimal, no objection could be raised. Today, we wear a variety of clothing that is perfectly modest, but not by Puritanical standards.

More to the point, when exposed to real scrutiny - when we seek to define exactly where "good" ends and "bad" begins, we find that the decision can only be one of two things:
  1. Arbitrary
  2. Well-Reasoned
If we accept my definition of faith, then we must confront the fact that a person's wishes are fundamentally arbitrary. I wish to be rich and eat hamburgers because that is my subjective value-preference. It's arbitrary. I wish angels to greet me upon my death because that is my subjective value-preference. Other people wish to be greeted by kittens. The death-lore of angels is no less arbitrary than the death-lore of kittens.

This means that faith is deontological, arbitrary, and weak when scrutinized. If a position or preference is well-reasoned and clearly stated, then it must not be faith. It must be reason or knowledge.

Scrutinizing Knowledge
Knowledge can always be assessed and scrutinized. A major advantage to knowledge, reason, and truth is that knowing you are wrong puts you in a better position than believing incorrectly that you are right. The primary argument for science over religion has always been that when scientific "knowledge" is proven wrong, science adjusts. When one theory is disproven, a more correct theory takes its place.

Knowledge, then, changes with time. The more we know, the better we understand. We never reach a static point at which we say, "Here is the place where life makes the most sense to me. I no longer wish to know anything further, for it will only be a detriment to my understanding of the universe." Such a statement seems laughable, because it is. Knowledge yearns to be improved through the refutation of prior mistaken beliefs.

When exposed to scrutiny, what we think to be knowledge becomes one of two things:
  1. True
  2. False
This means that truth is determinable, objective, and stronger when scrutinized. If a position does not change and improve when it is found to be incorrect or arbitrary, then it must not be knowledge or reason. It must be faith.

Adherents of faith can always rationalize a wish by saying, "It may be that the universe behaves according to X, and if so, then my faith is correct and well-founded." In this way, many practitioners of faith reconcile what they wish to be true with whatever the most recent trends of knowledge happen to be. And yet, their faith never evolves to a greater understanding of anything.

Indeed, the mark of a faith-based belief is that, no matter what new information presents itself, the core position held by people of faith never changes. They may develop a new rationalization for holding the same position, but the core position never changes.

It must be, therefore, that faith is the act of favoring what one wishes to be true over what one knows to be true.

Please note, the above discussion applies equally to religious faith as it does to other beliefs like socialism or anthropogenic global warming. The key point is simply this: You know you are looking at a faith-based belief (rather than reason or knowledge) when, no matter the evidence, the position does not change. That's because faith is a wish held over knowledge. What is important is the wish; even knowledge itself cannot compete.

Week 6: Plenty Of "Help" From My New Friend

As I discussed last week, I joined a local gym, scheduled a fitness assessment, and was promptly suckered into buying a few months' worth of one-on-one physical training sessions. I had my first session last Friday. It hurt.

I'll give you a run down of what the trainer asked me to do:

Superset #1: (Do all of this three times)
  • 20 Deadlift-to-cleans
  • 20 push-ups on bar bell w/ half burpee w/ bar bent row
  • 20 hammer-curls-to-shoulder-press
  • Max sitting leg extensions (i.e. "V-sits")
Superset #2: (Do all of this three times)
  • 3 reps of: (5 frog jumps, 10 push-ups)
  • Approx. 50m low crawl
  • 20 hinge crunches
The workout takes about 45 minutes if you go straight through without much rest. It is a killer workout. By the end of it, I find myself panting and gasping for air. I also find the hinge crunches very hard on my back muscles - which can only be true if my abs are too weak to handle them.

This means that my whole body is getting a truly challenging workout the likes of which it hasn't really experienced since my Hyperfitness days.

I did a supervised session on Friday, went for a run on Saturday, and then got back at it again on Sunday. I expect my 3rd and final session of the above workout will be this Tuesday, and I'll aim to schedule my next session with the trainer on Thursday.

Right now, I can already tell that the real challenge will not be the workouts themselves. This was extremely difficult, don't get me wrong. But the real challenge is not finishing the workout, but rather keeping up with my daily run on strength training days. The sessions are so intense that I find myself too drained to get a good run in. Either that, or they last so long that I no longer have time for a run.

But I can feel the results in earnest, so I'll keep it up. I wanted to build some upper body strength, anyway.


In Praise of Protein Shakes

In a past life, I did not have type 1 diabetes. Those days were full of exciting, carefree excursions into the mountains (or the desert) with nothing but my running shoes and a snack. Sometimes, there wasn't even a snack. At a gruelling pace, I'd push myself to lengths of which I hardly thought myself capable. As my body would start to succumb to the punishment, I would silently admonish myself, scolding myself for feeling pain where other runners felt nothing. No adventure was too intense, or too stupid, to subject myself to.

When the workout was finished, I'd hurry home to drink an isotonic beverage. Truthfully, I'd buy the powder and mix it myself. It was delicious - salty enough to replenish my electrolytes, sweet enough to go down easy, and always so refreshing!

Of course, all of that changed when I was diagnosed with diabetes. With a little extra attention, the exercise has proved to be no problem. The isotonic beverages, though, are a thing of the past.

What to do? How can I recapture the experience of having a nice, cold, delicious, flavored beverage after a difficult workout?

My first stop was Diabetic Boost. This is reasonably tasty stuff that contains limited carbohydrates, but it comes in small bottles and is pretty expensive.

Next, I tried Glucerna. As it turns out, I love this stuff. It is nutritionally balanced, and more importantly, it has a slow-release technology that prevents the sugar from hitting the diabetic bloodstream all in one go. It is a wonderful snack. As a post-workout drink, though, it falls a little flat. For one thing, it comes in small bottles and is pretty expensive. For another thing, I usually eat shortly after working out, and so it actually ends up being too many carbohydrates for me to take so close to a meal. For a third thing, I like it so much as a snack that I would rather just save it for snacking, rather than for after a workout.

In the interest of telling a complete story, I can admit to having tried vitamin water. No thanks.

But what was I experimenting for? The post-workout beverage I had been seeking all this time was right under my nose, developed decades ago by body-builders. I'm talking about protein shakes.

Now, body-builders drink protein shakes for weight gain. They're trying to build muscle, so they increase their protein intake and, as they engage in a variety of strength training, their muscles grow and grow. It really works, too. We distance runners don't want to build muscle, though. We want to stay lean. Have no fear, though. Eating more protein won't make you bulk up - you have to lift a lot of weights to do that.

What this means is that protein shakes offer diabetic runners like myself a nutrionally balanced, low-carbohydrate post-workout beverage that is healthy and delicious. Why didn't I think of this before?

So far, my protein shake of choice has been Costco's Kirkland brand chocolate protein shake. It hits the spot after a tough workout, and with only two net grams of carbohydrate and 25% or more of a dozen or more micronutrients, I get a good dose of nutrition without an adverse impact on my blood sugar.

The packaging indicates that this stuff can be used as a milk replacement. While I don't really want to replace milk in my diet, I am glad that I can incorporate a new source of vital-to-life calcium into my diet plan. This stuff is also lower in fat than cheese, which means it's a better source of calcium than my previous "second-best" choice.

What's your favorite protein shake?


Carbohydrates Not Necessary For Human Existence?

Here's an astounding claim by a commenter on Mark Sisson's blog: "Actually, no form of carbohydrate is required for life or function."

Cult much?

For the record, I thought Sisson's treatment of the issue was fair and balanced, even if I do disagree with his dumb fad diet.

"You Didn't Build That"

I have been going back-and-forth about whether I should comment on this galactically stupid Obama gaffe. It is such an easy target, that I am reluctant to say much about it, for risk of turning myself into a pundit.

Unlike pundits, I will take Obama at what he meant, rather than what he actually said. This is fairly important, because I believe the real problem with what Obama said really is what he meant.

The notion indicates a belief held among the likes of Obama and Elizabeth Warren that the state can perform actions which - regardless of whether I endorse them - leave me permanently indebted to the state in a way that I cannot back out of.

For example, if I were given the choice between socialized health care and private health care, I would choose private health care. If, on the other hand, I lived in Canada, where private health care is against the law, then I am prevented from choosing. Is it then fair to suggest that I owe my health to the government?

Take a less esoteric example. Consuming heroin is against the law. Is the fact that I have not died of a heroin overdose due to the law against its consumption? Or, has my decision to avoid all drugs played a role here? If the latter, was my having not overdosed a combined effort of both good laws and good decisions?

When the law prevents me from making one choice or forces me to make another, that is not really something I "owe" the government.

Finally, even assuming the government played some role in my success... for example, I couldn't have driven to work today except on government-built roads... Does that really mean that the government has a claim of ownership on the work I perform when I'm at the office?

The state is inescapable and all-encompassing. We are all forced to interact with it. Some of us are not grateful for the "opportunity." We would have been better off without it. But to the socialists, everything you have was the product of the state. The state is bigger than you and me. The state is the fountainhead of human produce.

Forget what Obama said, and focus on what he meant. That is the real problem. It's scary to think that the political class believe that they own you simply because you drive on "their" roads.

Once Again, No Amount Of Socialism Is Ever "Enough"

I was working out at the gym yesterday, on one of those exercise bikes that have a television attached to the front of them. The screens on these things are positioned such that a person on the bike has one of two options: stare at a blank screen, or turn the TV and stare at it. No matter what, the screen dominates the rider's field of vision, so it's TV or what amounts to being blindfolded. I begrudgingly chose TV.

While I was working out, I saw a television advertisement that made the following claim: "Medicare only covers 80% of Part B. The rest is up to YOU."

I make no claims about the authenticity of this statement. Let's assume it's true. What really fascinates me is the concept of "only" 80% coverage.

I know health care costs are rising and they can be very expensive. (Believe me, I really know how expensive medicine and health care is.) But the idea that we live in a world where four fifths of a person's health care expenditures under a particular plan are covered by somebody other than "YOU" serves to perfectly demonstrate the point I made a short time ago.

Simply stated, there is no "end game" to socialism, other than the complete provision of all goods and services free of charge by a large totalitarian regime that controls how high society's incomes are allowed to be. If you doubt me, think to yourself what someone 100 years ago might have thought about getting 80% of his/her health care expenses paid for, and whether they would say to you, "What, only 80%? What a lousy deal..."

This is my fundamental criticism of all things pertaining to socialism.

Suppose the various politicians sat down and agreed, once and for all, on a plan to placate the socialists. (And note, I am including people like Barack Obama when I use the term "socialist;" if you disagree with this identifier, hash it out with me in the comments.) Suppose we all sat down and agreed that "certain things" were human rights and ought to be provided free of charge by the government. Suppose we offered the socialists everything they want. Suppose we wrote it into law...

But suppose that we could only accomplish this if the socialists agreed that, once our job was done, they could not ask for any further socialism, period.

What do you think would happen? I think we would end up with one of two situations:
  1. Totalitarianism
  2. A failed negotiation
This is because what socialists really want is more socialism now and more socialism later. The only way to accomplish this is either through totalitarianism or by asking for a little bit now, and then a little bit more later, and then a little bit more later, etc.

Please note, I am not engaging in a slippery slope fallacy. I am not suggesting that if we make any concessions to leftists, we will automatically have to make additional concessions later.

Instead, I am accusing leftists of moving the goal posts, no matter how much we give them.

Under that kind of negotiation, what do we hope to gain by making any concessions, whatsoever? Furthermore, I believe that leftists figured this out decades ago. Politics in the United States has demonstrated this perfectly. Leftists stand against free markets - everyone else favors free markets. But everyone else makes concessions on economic policy in a good-faith effort to negotiate with their political opponents. The concession is 100% of what the leftists want, because they know they will get another concession the next time.

That is the path they have taken toward total socialism, and they are succeeding. When was the last time a leftist "conceded" a free market point on any policy?


Diabetes and Exercise Part II: Exercise "Physiology"

Last week, I introduced this series of posts on diabetes and exercise by taking a look at the things you'll need as a diabetic aiming to start an exercise regimen.

To take the next step, you should be aware of some of the things that occur in the human body - diabetic or otherwise - when we exercise. While having some knowledge of the science behind fitness is highly beneficial for everyone, it is particularly valuable for us diabetics. The reason for this pertains to something I mentioned last week:
When it comes to exercise, you will have to start assessing the impact of different kinds of exercise, and different levels of exertion, on your body and blood sugar. As we will see in subsequent posts in this series, the impact of exercise may be immediate, or it may be delayed up to twenty-four hours in the future! As you start out, these impacts seem erratic and unpredictable. So the better-informed you are and the better-aware you are of short- and long-run trends, the better you will be able to control your blood sugar with exercise.
Let's try to take some of the guess-work out of it, shall we?

A Two-Penny Science Lesson
I've read a few physiology books, had all the important biology classes, and applied the principles to my own life through personal experimentation. What I've learned, is that the average person doesn't need to take a deep dive into biochemistry in order to understand what's going on when they exercise. So, I'm about to give you the simplest lesson in exercise physiology you've ever had...

If we ignore the various chemical transformations that occur during human respiration, we can focus on what's really important to the task at hand. To wit, all human energy is made up of the following components:
  1. Sugar
  2. Water
  3. Air
  4. (Insulin)

When you begin to exercise, your body draws on the energy that has been previously converted from sugar, water, and air, and then stored in your cells. The fuel used to create this energy comes from the food you've been eating lately, the water you've been drinking, and whatever oxygen has been culled from your casual breathing. (Insulin is the hormone mechanism that is responsible for delivering the sugar from the bloodstream into the cells.)

This is obviously a limited energy source that can only get you so far. In order to exercise for a prolonged period of time, the body must reach a point where it is converting fuel (sugar, water, and air [and insulin]) into energy on-the-fly and utilizing it to the extent that it can be generated.

This second type of energy is built from the water that happens to be in your body right now, the air that you're breathing right now, and whatever sugar can be had on a moment's notice. Now, everyone has a given quantity of sugar in their bloodstream at all times, so this is the body's "first stop" for aerobic fuel. The next stop is whatever sugar exists in as ready a state as the body can find, starting with the easiest-to-access and progressing steadily toward the most remote sources of sugar. (Insulin is utilized at all stages, because it is required to deliver the sugar into the cells.)

The "stored energy" in this case is anaerobic energy. We use it for short bursts, i.e. lifting weights, sprinting, kicking at the end of the race, and so on. The "directly converted energy" in this case is aerobic energy. The important takeaway here is this: anaerobic energy utilizes energy that is stored readily inside your cells; aerobic energy must be generated and transported into the cells from outside sources first.

It is tempting to say that we use aerobic energy for aerobic, i.e. cardiovascular, exercise and anaerobic energy for everything else, but this is not exactly how it works. Technically speaking, everything the body does involves a blend of the two. There is a sequence that is as much logical as it is physical.

The body can't start doing something unless it employs anaerobic energy. Were this not the case, you would have to engage in heavy breathing for several minutes before you did anything simple, like type an email or lift a fork to your mouth to eat. Anaerobic energy, then, is a ready-source of energy that is employed whenever your muscles first act to do something.

Note carefully: A technical feature of anaerobic energy is that it does not require insulin for immediate use. While your body had to utilize insulin in order to store the energy, simply using it once stored requires no insulin at all.

If you have experience lifting weights, you know that the body can often reach a point where further action becomes impossible. You can no longer lift your arms, your legs stop moving, your muscles burn. Even if it doesn't hurt, there is no point to further physical expenditure - it will not occur. This physical barrier is your body running out of anaerobic energy; there is no more left to be had.

If you are engaged in a lighter, more repetitive movement (like running, for example), then your body has an opportunity to generate some aerobic energy before it completely runs out of anaerobic energy. Your heart starts beating rapidly and you start to breath heavily. After some time, the cardiovascular process has generated enough energy to feed the cells during the exericse. Aerobic energy, then, is the energy generated by an individual's ability to create movement from fuel on-the-go.

Note again: As implied from the above, aerobic energy requires a ready source of insulin. Without it, aerobic respiration cannot produce any energy at all. That is why you as a diabetic may have felt your body start to burn and reach a point of exhaustion in a matter of minutes.

Of course, aerobic respiration is not a perfectly efficient process, so eventually this energy source also declines and the body experiences exhaustion. Extending the length of time required to fully exhaust the body is what endurance training is all about. As you engage in endurance training, your body learns to become more efficient at processing aerobic energy. It does this by growing tailor-made muscle tissue that is particularly adept at this, and also by increasing the amount of oxygen that can be stored in the blood at any given moment. (For water, you pretty much just have to stay hydrated.)

In contrast, strength training does not improve the body's efficiency for utilizing anaerobic energy because the process is already highly efficient. Instead, the body grows additional muscle cells so that there is more anaerobic energy "on hand" for the next time you sprint or lift something heavy. In essence, the body builds more storage for immediate energy, but continues consuming it at about the same rate.

Now that you have a general idea of how the body is making use of its energy, you are ready to apply these principles to your own diabetic body. Because diabetics are less-able to engage in the energy conversion process (either from lack of insulin or the incidence of insulin resistence), some extra consideration is required to understand how we can best exercise, what we can expect as we start to undertake a new exercise regimen, etc.

So, in my next article in this series, I will discuss some special considerations for diabetics, including some words on insulin dosing, planning, etc.

What, Me Worry?

I once knew a man - let's call him Dennis - who had heavily invested himself in a particular company's stocks. Unfortunately, that company experienced a major decrease in value, and its stock price plummeted. Question: What did Dennis do next?

Answer: He invested even more heavily in the same stock.

Now, Dennis was not in love with the company in question nor its stock. He was not chasing fools' gold. There was an underlying purpose here. As many stock traders know, when a stock loses value, it often "rebounds" at a slightly higher price shortly thereafter. Dennis understood this. He bought more of the losing stock so that he could sell it quickly and lock in a small amount of profit.

In fact, Dennis did this several times with the same stock over the next two years, and ended up making a substantial amount of money when it was all said and done.

What You Should Learn From Dennis
When the going gets tough, pessimists lament their bad luck, sell their stocks, lock in a huge loss, and go cry about how nothing ever works out for them.

When the going gets tough, optimists think to themselves, "How can I use this to my advantage?"

This is big. This is much more than merely seeking a silver lining on a cloud. This is reinventing a bad situation, transforming it into a good one. This is not just "making the best" of things, it is "making something good." This new, good thing would never have existed had it not been for the bad thing.

So, I rather than looking for the silver lining on a cloud, make lemonade out of lemons. If something is sour and unpleasant, sweeten it and turn it into a delicacy.

I Know - Easier Said Than Done, Right?
A practiced pessimist will quickly retort that this is easier said than done; but at what point did anyone claim this was easy? The question is not whether or not it is "easy" to profit from a bad situation. The question is simply, what other choice do you have?

Think about that. You can roll over and die, or you can come out on top. If you've already lost, what difference does it make if you lose again? The one great advantage bestowed upon a loser is that he or she no longer has anything left to lose. The marginal cost of additional failure is zero. The marginal benefit of trying again is very high.

So, to sum up, here are a few important attributes that optimists have, which serve them well in times of trouble:
  • An unwillingness to simply lose
  • A belief that success actually is possible
  • An attendant narrative associated with that potential success
  • A desire to use the conditions of a particular failure as the springboard for subsequent success
These things don't happen naturally. They are skills honed with practice. Are you practicing your optimism?


Week 5: A Little Help From My Friends

Last week did not exactly go according to plan. While I had every intention to perform a week of body-building exercises, life caught up with me a little bit, and it came to pass that I did not quite have the time.

The problem here was not that I didn't work out at all - I did. The problem was that my workouts have gradually reconfigured themselves to being once a day, rather than twice a day. The reasons for this are relatively organic. I joined a gym, which means I reacquired access to a wide array of high-quality strength training devices. This is good. The gym, however, is conveniently located next to my office, which means I am very inclined to hit the gym immediately after work.

These combined facts have provided me great incentive to do my strength training in the afternoons. This would suggest that I wake up early for cardio, but as we have seen recently, that doesn't ever quite pan out for me. The solution that developed was thus: both strength and cardio training in the afternoon and a half-hour extra sleep in the morning.

Having said all that, I successfully completed my cardio training from last week, and replaced the rigorous and comprehensive strength training with a sort of hybrid of last week's arms exercises and my "matrix" workout.

This afternoon, I have an appointment for a fitness assessment. I am going to postpone developing this week's workout plan until I have a better idea of what the assessor will say. But, still, I shouldn't leave you hanging. Here is my anticipated week 5 of training:

  • Strength assessment (max all muscle groups?)
  • Cardio assessment (work out to VO2-max?)
Tues, Thurs:
  • No strength training (rest)
  • Long and easy cardio: 45min run
Wed, Fri:
  • Arm weight circuit (triceps, biceps, back, shoulders)
  • Ab circuit (4x50 mixed crunches)
  • 30-40 minute cardio: fartlek, if possible.
Saturday, Sunday:
  • No strength training (rest)
  • No cardio (rest)
As you can see, it's a bit of an easier week. I feel that I need one more week to suss-out how my body is feeling and to figure out the right balance of strength-versus-cardio. Once it's over, I will have a better idea of how to structure my long-term plan.

The specifics of that plan will unfortunately have to wait for one more week. I want to figure out the feasibility of training for the kinds of things I'd like to accomplish in the near future. How exactly I go about that will depend on all the things I plan to figure out this week. More on that, I suppose, next week.


Mises Versus Rothbard On Mathematics and Economics

Within the community of adherent to the "Austrian school" of economic thought, there exists certain members of the community who are willing to accept only the Rothbardian conception of things. Unfortunately for all of us, these folks believe that Rothbard is the only post-Mises economist whose theories accurately capture, modernize, and improve upon the Misesian praxeological tradition. They will not tolerate any other point of view. They adhere to this point of view with a rabid dogmatism better befitting a religious fervor than an intellectual pursuit.

They also happen to be among the most vocal members of the Austrian school community. Consequently, there is a widespread idea that Rothbard's views are the same as or are improvements upon Mises' views, and that all other notions within the school are either wrong, "confused" (to use a term common among a particularly noteworthy Austrian school adherent), or bad in some way.

Now, it's one thing to believe the above, state the position, and defend it intellectually and civilly. It's quite another thing to shout down all opposition, to publicly berate those holding opposing viewpoints, and to be so intolerant to questioning that the rest of us get turned off to the conversation long before any truth presents itself.

In the following blog post, I will highlight one example of Rothbard's views being a rather paler send-up of Misesian praxeology, to the point of being - in my opinion - extremely mistaken, wrong, confused, and bad. In doing so, my hope is to break down some of the religious reverence some hold over Rothbard's views.

Why? Because no intellectual pursuit can ever hope to be advanced if the assumption is that it was fully and perfectly developed in 1959. If Rothbard was correct about everything and it's unacceptable to question him, then we are no longer talking about a study or a discipline, we're talking about a religion or a cult. (Yep, I said it. A cult. Pretty rich, if you ask me.)

Rothbard On Mathematics In Economics
Murray Rothbard, supposedly the great palladin of Austrian school economics and its last great innovator, rejected all forms of mathematics in economics. However, in saying so, I'm not really doing justice to complete and utter disdain Rothbard held for not just mathematical economic models, but even using mathematical notation to express logical ideas.

In Man, Economy, and State, Rothbard writes (footnotes eliminated for brevity):
The suggestion has been made that, since praxeology and economics are logical chains of reasoning based on a few universally known prem­ises, to be really scientific it should be elaborated according to the symbolic notations of mathematical logic. This represents a curious misconception of the role of mathematical logic, or “logistics.” In the first place, it is the great quality of verbal propositions that each one is meaningful. On the other hand, algebraic and logical symbols, as used in logistics, are not in themselves meaningful. Praxeology asserts the action axiom as true, and from this (together with a few empirical axioms—such as the existence of a variety of resources and individuals) are deduced, by the rules of logical inference, all the propositions of economics, each one of which is verbal and meaningful. If the logistic array of symbols were used, each proposition would not be meaningful. Logistics, therefore, is far more suited to the physical sciences, where, in contrast to the science of human action, the con­clusions rather than the axioms are known. In the physical sciences, the premises are only hypothetical, and logical deductions are made from them. In these cases, there is no purpose in having meaningful propositions at each step of the way, and therefore symbolic and mathematical language is more useful.
It is difficult to see where in this paragraph Rothbard made any correct statement about mathematical logic.

First, there is Rothbard's claim that the notation of formalized, mathematical logic is not in itself meaningful, whereas verbal statements are inherently (i.e. "in themselves") meaningful. For Rothbard to simply leave these claims standing without proving them is to have failed at the requirements of a praxeologist. One cannot simply state that one's own method is inherently meaningful while the method of one's contemporaries is not. One must prove it, or at least provide a compelling argument why this is so.

So, I will counter with the following argument:
  • Rothbard claims that all verbal propositions are inherently meaningful.
  • If I can establish one verbal proposition that is not inherently meaninful, I will have demonstrated that Rothbard was wrong.
  • The following proposition is not inherently meaningful: If this sentence is true, Rothbard was an Objectivist.[Note: This is an example of Curry's Paradox. For further discussion regarding the meaninglessness of paradoxes, see this Stationary Waves post.]
  • Therefore, Rothbard was wrong.
The reader may find it particularly pedantic to disprove Rothbard in this way, but I find it important to use this particular line of reasoning, since it is the only one Rothbard himself thought valid.

As to the allegation that the symbols of mathematical logic "are not in themselves meaningful," one could make the same claim about letters of the alphabet. That is, in the philosophy of language, we generally accept that words have specific definitions. That Om means "peace" in Hindi and "mango" in Bangla is a fact that essentially boils down to the fact that one community of people agrees that the associated noise means one thing, while the other community agrees that it means another thing. That is, the sound Om is not in itself meaningful, and is in fact quite meaningless in English.

But Rothbard isn't merely suggesting that mathematical logic clouds the issue. In fact, he states in the above quote that "If the logistic array of symbols were used, each proposition would not be meaningful." In Rothbard's view, merely using mathematical logic notation to express an idea at all is "not meaningful."

We may as well argue that the English language is the only "meaningful" way to engage in dialectics. Who would ever make such a claim?

To this absurdity, Rothbard offers only one defense:
Simply to develop economics verbally, then to translate into logistic symbols, and finally to retranslate the propositions back into English, makes no sense and violates the fundamental scientific principle of Occam’s razor, which calls for the greatest possible simplicity in sci­ence and the avoidance of unnecessary multiplication of entities or processes.
Rothbard calls the expression of ideas in a language other than verbal exposition a violation of Occam's razor (which, by the way, is hardly a law). By that line of reasoning, Human Action violates Occam's razor by virtue of its being a re-worked English-language version of Mises' Nationalokonomie, especially if read by a native English speaker who must translate the German text into English-based thoughts in order to understand them. Indeed, Man, Economy, and State itself began as an update to Human Action and could likewise be dismissed as a violation of Occam's razor.

But this is ridiculous!

Mises On Mathematics in Economics
The question arises, is this really praxeology in the Misesian tradition? Did Mises feel this way about mathematical economics? Some say yes. Let's take a look at what Mises did say.

In Human Action, he writes:
The mathematical method must be rejected not only on account of its barrenness. It is an entirely vicious method, starting from false assumptions and leading to fallacious inferences. Its syllogisms are not only sterile; they divert the mind from the study of the real problems and distort the relations between the various phenomena.
This is from a section of the book entitled "Logical Catallactics Versus Mathematical Catallactics." While this is a damning passage indeed, right away we notice that Mises is not attacking the use of the mathematical expression of ideas, but rather the mathematical method as it pertains to solving economic problems.

In other words, Mises would never childishly attack mathematical expression as being "inherently meaningless." Mises had great respect for mathematics and science. He simply felt that logical catallactics were a more appropriate methodology than mathematical catallactics.

And please note: Mises makes no reference to verbal logic. This is important because the use of mathematical logic is still an example of logical catallactics. This fact must be underscored several times over. The particular language used to express logical ideas does not impact the validity or "meaningfulness" of the logic itself. Whether we notate our dialectics using the Queen's English, mathematical notation, or street Bangla, we may freely engage in logical catallactics so long as we follow a logical chain.

Mises found three methodological problems with mathematical catallactics. The first problem was the use of econometrics as a tool of economic theory. As Mises put it:
Statistics is a method for the presentation of historical facts concerning prices and other relevant data of human action. It is not economics and cannot produce economic theorems and theories.
He further states that "The arrangement of various price data in groups and the computation of averages are guided by theoretical deliberations which are logically and temporally antecedent." In other words, a theory must be developed prior to the application of a statistical model.

This, however, is a far cry from condemning the use of mathematical symbols at all, as Rothbard did.

Mises' second objection to mathematical economic theory was rather complex, but I shall try to summarize it succinctly. First, Mises remarks that supply and demand equations implicitly assume the existence of money to arrive at a particular price or cost. One objection to this is that it ignores the case of non-monetary transactions and barter. But this first objection is merely a lead-in to a greater problem with mathematical economics, which is the (mathematical) assumption of (mathematical) continuity:
On the other hand prices--if this term is applicable at all to exchange ratios determined by barter--are the enumeration of quantities of various goods against which the "seller" can exchange a definite supply. The goods which are referred to in such "prices" are not the same to which the "costs" refer. A comparison of such prices in kind and costs in kind is not feasible.
Note that again this is not a problem with the notation of mathematical logic. Continuity is an assumption of calculus functions. The problem is not the symbolism used, but rather the theoretical assumptions.

Mises' third objection to mathematical economics is unique only to those mathematical economists who prefer to explore mathematical equations outside the particular context of economic theory:
The characteristic mark of this third group is that they are openly and consciously intent upon solving catallactic problems without any reference to the market process. Their ideal is to construct an economic theory according to the pattern of mechanics. They again and again resort to analogies with classical mechanics which in their opinion is the unique and absolute model of scientific inquiry. There is no need to explain again why this analogy is superficial and misleading and in what respects purposive human action radically differs from motion, the subject matter of mechanics. It is enough to stress one point, viz., the practical significance of the differential equations in both fields.
Thus, we see a large discrepancy between the views of Rothbard and those of Mises with respect to mathematical economics. While both economists were critical of mathematical analysis in the context of economics, Mises' objections were methodological, while Rothbard felt that mathematical notation itself is inherently meaningless.

It is important to stress this difference because Mises' views were epistemological in nature. He felt that mathematical models were inappropriate for tackling the abstract problems of economics.  Rothbard did not even address this point, but rather simply dismissed mathematical logic notation because he himself felt it was meaningless.

It is possible to come to the correct conclusion for the wrong reasons. Rothbard correctly adhered to a logical catallactic methodology, as well he should have. Yet, he quite incorrectly chose this methodology only because he himself didn't understand the meaning of mathematical symbols.

It is akin to claiming that the world is round based on the notion that "flat is a meaningless concept."

There are two important takeaways from this discussion:
  1. This is one point of many on which Rothbard's views are wildly and importantly different from Mises' views. That is, Rothbard and Mises were not engaged in the same reasoning. Rothbard's work is not a "continuation" of Mises' work, nor is it in any way an "improvement" upon it.
  2. This is one point of many on which Rothbard was not just wrong, but ridiculously wrong.
This second point is especially important because if we do not note important shortcomings in the theoretical works of famous Austrian school economists, the praxeological tradition will evaporate into the haze of cultish dogma.


Booing Politicians

I'm all for booing politicians.

By now, you must have already read that Mitt Romney was booed three times during his speech at the NAACP. (I'm choosing not to provide a link to any of the stories because, frankly, they're everywhere and I have no reason to believe one report is better than any other.)

Setting his politics aside, I think there are two good things about this event.

First, it's good that people boo politicians when they disagree with them. Politicians are not particularly good people, and I don't think they deserve much respect. They lie, cheat, steal, and then vie for reelection. Booing is natural. It states, "We know what you are, and we don't like you. Go away." This needs to be stated regularly.

The other good thing about this event is something that reflects well on Mitt Romney. We could have all anticipated in advance that a Mitt Romney speech delivered to the NAACP would be unpopular among the audience members. We can expect that the NAACP will be more supportive of the Obama agenda than the Romney agenda. Even beyond racial allegiances, the NAACP is historically a democratic-leaning organization, and I don't think I'm being particularly controversial in saying so.

I think it is absolutely commendable that Mitt Romney gave a "please-elect-me" speech to a largely hostile audience. Really, this is the way elections should work in a democracy. Candidates should not simply stage big events among their existing supporters, trying to create the illusion of a bandwagon in hopes that undecided voters will join to be part of the crowd.

Instead, candidates should regularly deliver speeches to audiences of people who hold differing views. You know, the point is to persuade other people to change their minds. I'd like to see Barack Obama deliver a speech to the Tea Party or something. You know, conduct some outreach, communicate, change some minds.

Too little of this sort of thing happens these days.


Frequent Testing Is Key To Blood Glucose Control

Under the headline "Patients Prefer New Diabetes Technology," Susan D. Hall of FierceHealthIT covers new research on the impact of insulin pumps and continuous glucose monitoring (CGM) technology on type 1 diabetes patients.

Ms. Hall reports that "patients say they're happier" with pump + CGM technology, as compared to multiple daily injection (MDI) therapy.

Considering my own experience with insulin pumps, faithful Stationary Waves readers would expect me to read this kind of article with a critical eye. I readily concede that many patients prefer pumps over MDI therapy, and that it is the right decision for patients who have this preference. But, I must reiterate, that at this point I do not prefer pump therapy. MDIs work for me, at least at this point in my life.

It is therefore interesting to note the following excerpt of the story:
The study found little difference in blood sugar control between those who give themselves multiple insulin shots a day and those who used insulin pumps. However, those who used the pumps along with continuous glucose monitoring devices, were able to better control their blood sugar.
Pumps were found to offer no significant improvement in BG control. This is consistent with my experience.

More importantly, CGM technology actually had a good impact on blood glucose control. This is consistent with my largely anecdotal experience, too. It seems to me that my BG is better controlled when I test more often.

But why just leave it at a gut feeling? In the below graph, I have actually graphed my average daily BG (blue) alongside the total number of tests taken (red), by day:

As you can see, there is a visual indication that when my number of daily BG tests decreases, my blood glucose itself seems to increase.

Not satisfied, I did a simple linear regression of one variable against the other. This confirmed the observation: I found that (setting aside all other factors), the number of times per day I tested my blood sugar was inversely related to my average BG by about 0.105 mmol/L (at the two-sigma confidence level).

That is, each test decreased my blood sugar on average by about 0.1 mmol/L. Not bad, considering I ignored all other factors.

Now, there are some problems with this. For example, I am more likely to test more often when I am experiencing hypoglycemia, as per maintenance recommendations. So that may explain a significant part of the impact.

Still, the results, combined with the graph and the findings of this new study seem to indicate that the better we diabetics can monitor our blood glucose, the more control we have.

Who Pays For A Botched Job?

Yesterday, The New York Times reported on the FDA's recent decision on pain medications. Summarizing the FDA's conclusion, the Times writes as follows:
The Food and Drug Administration, overriding the advice of an expert panel, said Monday that it would not require doctors to have special training before they could prescribe long-acting narcotic painkillers that can lead to addiction.

But the agency said companies that make the drugs, like OxyContin, fentanyl and methadone, would be required to underwrite the cost of voluntary programs aimed at teaching doctors how to best use them.
Emphasis mine.

Let's Add Some Context Here
When pharmaceutical companies engage in programs designed to teach doctors how best to use their own products, they are engaging in a practice called Detailing. Detailing is an industry term. Typically, the pharmaceutical sales rep - perhaps accompanied by a small team of subject matter experts - schedules a ten-minute appointment with the doctor, summarizing the product's best practices, mechanism of action, and prescribing recommendations.

It has long been the opinion of critics of "Big Pharma" that detailing is one of the ways Big Pharma distorts the scientific information and misleads doctors into believing something that is not supported by the evidence.

Is this true? That is tough to say. There are inherent conflicts of interest here. The pharmaceutical companies have every reason to make their products look as good as possible when they're visiting prescribers. On the other hand, doctors have every reason to more favorably weigh information coming from a sales rep with whom he/she has a good working relationship than when that information comes from outside sources. In general, I think it's safe to assume that the reps - whose job it is to make drugs look good - present only a good case for their drugs. I think it's also safe to say that doctors have more incentives to listen to Detailing than to spend all their free time scouring the clinical literature for all new drug information.

The Plot Thickens
In other countries - Canada, for example - government agencies, and quasi-government agencies (such as CADTH) engage in counter-detailing practices. They call this Academic Detailing, and during these sessions, government bureaucrats schedule appointments with doctors to provide similar detailing.

However, rather than pushing specific products, these detailers push cost-effectiveness research and so-called "evidence-based medicine."

Proponents of this kind of detailing suggest that it offers a more objective voice than doctors might get from Big Pharma. However, we must not pretend that it is objective information.

Suppose a very expensive - but very effective - new drug hits the market. Big Pharma's detailing projects will naturally promote the drug's efficacy among doctors. Government detailers, on the other hand, will present the opinion that, while the drug is very effective, a patient still gets "acceptable" therapeutic benefits from the next-cheapest medication.

Now the doctor must choose between the most effective medication and the one that makes economic sense to the government. The cost evaluation is no longer being done by the patient. The doctor makes the ultimate cost decision.

Is this fair? Shouldn't patients have a say in the matter?

Looking Forward
As you can see, just because the government provides the information doesn't mean it hasn't distorted the healthcare landscape. But that is Canada. What about the United States?

This recent FDA decision indicates that the government does not want doctors to have to educate themselves about pain medication prior to prescribing them. This seems ludicrous, doesn't it? I would speculate that the FDA's rationale has taken into account the fact that doctors would pass this cost on to consumers, the largest of which is the Federal Government. The government doesn't want to pay more money, so they are insulating themselves from the cost.

There is also a long-term game at play here. Pharmaceutical companies are already engaged in Detailing, therefore the FDA's decision doesn't actually cost Big Pharma any additional money.

Instead, the FDA has set a precedent for Detailing. While the government may not be able to afford additional training for all doctors in the country, it can certainly earmark funds for grant recipients who are willing to conduct "Academic Detailing" on behalf of the government.

We know this will happen because it already happens in every other rich country in the world. To use more inflammatory language, the "Death Panels" will be going door-to-door, visiting every doctor in the country, "teaching" them the government's message about which drugs to prescribe and which not to.

I reiterate: This already occurs in other countries. This is not pure spook stuff. It happens all over, and it will happen here. What we're seeing with this latest development is merely the early roots of CER and "evidence-based medicine."


Arthur Brooks Says We Are Already Europe

In this Wall Street Journal op-ed, Arthur Brooks makes his claim that America is not "becoming Europe," but rather that it already is.
In 1938—the year my organization, the American Enterprise Institute, was founded—total government spending at all levels was about 15% of GDP. By 2010 it was 36%. The political right can crow all it wants about how America is a "conservative country," unlike, say, Spain—a country governed by the Spanish Socialist Workers Party for most of the past 30 years. But at 36%, U.S. government spending relative to GDP is very close to Spain's. And our debt-to-GDP ratio is 103%; Spain's is 68%.
Mr. Brooks is also refreshingly realistic about the American psyche:
We're not literally moving west any more, but in the Tocquevillian tradition our lives are directed less by Washington politics and more by everyday jobs, church socials and soccer practices. As the leader of a think tank dedicated to public policy, I would love it if Americans were as obsessed with policy as I am. But let's be realistic: Most people don't have the time or inclination to contemplate the potential damage each government-spending predation—each tiny political sellout of our values—could cause.
This is the first policy pundit I've ever heard actually acknowledge what the so-called "independent" or "swing" voters really are: completely disinterested in politics and ill-inclined to become more so.

Like Mr. Brooks, I too believe that this apathy is "a charming part of the American DNA." I think our collective disdain for corrupt politicians makes us particularly able to handle their gross abuses of power. But - also like Mr. Brooks - I believe for that to happen, we have to actually invoke our disdain. At a certain point, we have to care about the millions of corrupt Washington D.C. Americans who are bleeding the rest of us dry.

Think it'll happen? I don't think it'll happen except by secession. 


Week 4: A Week Here, A Week There

Finally I am starting to feel my body get somewhere. The persistent exercise is starting to bring me back around. This begs the question: what happened?

Sure, I blogged about how my exercise regimen had diminished three weeks ago, and I guess it is a pretty accurate story. Still, there is something about hindsight that changes a person's perspective on things. Looking back at it now, I cannot help but be surprised that my body had fallen so far, so fast. Part of this is because when I left Ottawa, I was in the middle of making some very interesting progress with respect to running. I was coming off of long winter of cardio machines, and teaching myself how to run fast again. As tends to be the case, when a person dedicates time and effort toward a specific fitness goal, the goals on the periphery tend to fall behind. Therefore, as I was increasing the intensity of my daily run, I was losing upper body muscle mass more rapidly than I understood at the time.

When I arrived here, and found myself ill-equipped for runs as far and as intense as mine had been in Ottawa, it happened that now both my cardio and my strength training were suffering. I lost a lot of ground, and did so without really noticing.

However, if you've been reading the blog for the past month (and really, who isn't reading the blog these days, am I right...? *cue chirping crickets*) then you know that I have been very persistent with this exercise business lately. Now, at last, on my fourth week of maintaining patchwork training regimen, my body has clicked. My muscles are growing. My energy levels are returning to normal. I'm sleeping through the night again. Food seems appealing. I have all the tell-tale signs of a body returning to its normal, healthy, fit state.

And I'm still a long way from being done.

Week 4: Hitch Your Wagon to Kelechi Opara
So long as we're patching together a training regimen week-by-week, why not pull from all available sources? Sure, I'm an endurance athlete, a distance runner, and I love to run. But the fact of the matter is that even runners need upper body mass, and as I said in the previous section, I've lost a bit too much.

If mass is what I want, then why not pull Week 4's training regimen from a source of wisdom tailored specifically to that goal? That resource is the fantastic Bodybuilding.com, and the regimen is a week's worth of lifting workouts from Kelechi Opara.

Follow the link above for the routine's specifics. I will summarize:
  • Day 1: Legs
  • Day 2: Back/Shoulders/Abs
  • Day 3: Chest/Triceps/Calves
  • Day 4: (Rest)
  • Day 5: Legs/Abs
  • Day 6: Back/Shoulders
  • Day 7: (Rest)
Add to that a hefty dose of classic Stationary Waves cardio training, as follows:
  • Day 1: 60min light cardio
  • Day 2: 40min fartlek
  • Day 3: 40min run
  • Day 4: 40min fartlek
  • Day 5: 40min run
  • Day 6: 40min run
  • Day 7: (Rest)
Voila! A somewhat interesting Week 4 lies ahead of us. If I like how I feel after a week of body-building, I might continue on. We shall have to see. This is the beauty of not training for anything specific - anything goes. Train however you feel like training at the beginning of any particular week. Variety is the spice of life.

I know what you're thinking: Body-building? On Stationary Waves? That's crazy! But it's not crazy. Any part of the body can atrophy. Any aspect of fitness can fall behind the curve. Strength training is an important component of anyone's workout regimen. Sometimes, to climb your way over a plateau, you have to pull from sources from which you don't ordinary draw.


We Need More Of This

The Wall Street Journal has a wonderful story about two boys who fail to make the top baseball team.

Lamenting the hyper-competitive nature of American youth athletics, the author correctly points out that "Today's athletic tracking squeezes out not only average players but those who might excel later, after they hit adolescence."

This is a real dilemma. Like me, most Americans have a well-honed spirit of competition that keeps life interesting and sports robust. So we tend to embrace the idea that children should be taught how to lose gracefully, even if that means being the worst at something sometimes. But just because Little Johnny doesn't make the team in 201X doesn't mean he might not be able to make the team in 201X+1, right?

The problem the author faced was that her sons were nearly trapped into a second-rate baseball tier after just one failure. That's not exactly how things are supposed to work. Kids shouldn't have to suffer through inferior coaches and lousy rec-leagues just because they didn't succeed the first time they tried out, right?

So she devised a novel solution. She created a new team for her sons, with the more intense training and competition of the bigger league, but without directly competing with that team. The results speak for themselves: all the kids who didn't make the "A" Team greatly improved their baseball skills despite losing every game that season; and four of them went on to make the "A" Team next year.

When people lament competitiveness in sports, it really turns me off. Competition is the whole point, it's part of the fun! By exposing her children to failure, hard work, and ultimately success, this woman has given them a lifelong gift that modern parents often underestimate. It's not "how you play the game" that counts, it's how emotionally capable you are of winning or losing.

Many parents paralyze their children by shielding them from loss and teaching them that competition is bad and doesn't matter. These parents should take a lesson from the author of this article and instead teach their children that losing once doesn't automatically mean you have to lose forever, and that victors win precisely because they work hard.

Diabetes and Exercise Part I: Preparation

Today I thought I would kick off a new series of blog posts in which I intend to share information about Diabetes and Exercise that I have collected over the past few years.

When initially diagnosed with diabetes, patients hear a chorus of voices instructing them to exercise regularly, stay healthy, and of course watch what they eat. This advice sounds identical to Type 1 patients and Type 2 patients, despite the two types of diabetes mellitus being radically different conditions. As a result, much of the diabetes advice out there tends to paper-over the important details that differentiate the two. It results in some good soundbites, but also a great deal of confusion on the patients' part.

At least, that was my experience. As a result, much of what I know about diabetes and exercise so far is the result of my own reading and self-experimentation. That may not sound like a ringing endorsement of what I am about to write, but unlike the authors of the soundbites in your diabetes pamphlets, I embrace the fact that all bodies are different. Therefore, the most important thing to take away from this series is that each patient needs to exercise, observe, and carefully evaluate ever new exercise activity's impact on his/her body and adjust accordingly.

In short, no one set of "rules" will fit your own specific case. You need to become a "tinkerer" when it comes to figuring out what your body can do. The aim of this series is to share my own experiences with "tinkering," in hopes of helping you figure out how to do it yourself.

What You Need To Get Started
Any discussion of diabetes and exercise logically begins with a brief lesson on exercise physiology. However, I thought it best to delay that lesson for the time being to focus on more practical matters. If you're going to take on a new exercise regimen as a diabetic, you will have certain unique requirements that other people who exercise do not have to worry about.

Know Your Numbers
First of all, throughout this series - and elsewhere throughout my blog - I will be referring to various values for blood sugar readings. We in the United States measure those values in milligrams per deciliter, while those of you in other countries measure it in millimoles per liter.

A simple Google Calculator search will provide you the conversion directly, but if you'd like a bookmark to go back-and-forth between conversions, here is a handy online calculator for you.

Emergency Sugar
The first thing you need is an emergency source of sugar to protect you in the event that you experience hypoglycemia.

Let's start at the elementary level and answer the question that the absolute-beginners might have at this point: I thought lowering my blood sugar was the point - what's the problem with hypoglycemia? It's true that we aim to decrease our blood sugar with exercise, but keep in mind that lowering it below 72 mg/dL (4.0 mmol/L) sends the body into shock and creates a risk of potentially fatal seizure.

More to the point, as your blood sugar falls below the normal range, you will experience impaired mobility and cognition, and will begin to be less-able to help yourself. If this happens, you need sugar fast, and that's where your emergency stash comes in.

The recommended approach for treating hypoglycemia is to ingest 15mg of fast-acting sugar, wait 15 minutes, then test to ensure your blood sugar is back in the normal range. Repeat as many times as it takes to get you back to normal.

What works? Lots of people use candy (such as LifeSavers), and some people chew dextrose (pure sugar) tablets. I was a competitive athlete years before ever having to think about diabetes, so I prefer using sport gels, such as my personal favorite, Hammer Gel:

It should go without saying that if you experience exercise-induced hypoglycemia, you should stop exercising for the rest of the day.

I haven't needed this one myself, yet. We'll get to the issue of exercise-induced hyperglycemia in a subsequent post, but for now, you should simply be aware that some people need to carry insulin with them in the event that their blood sugar increases dramatically to dangerously high levels. If this happens, a corrective bolus of rapid-acting insulin will be required to return your body into a safe state of being.

You can help avoid this by never exercising when your blood sugar is above 288 mg/dL (16.0 mmol/L), or when there are ketones present in the urine stream. If you are new to all of this, then you will get a feel for this stuff as you go.

Blood Glucose Meter
If you are worried about hypo- or hyperglycemia, you should take a blood glucose monitor with you when you exercise and test if you feel unwell. Fair disclosure: I skip this step myself, because I have done enough historical testing before and after workouts at various times of day and at various points before and after meals to understand what I am capable of.

But that is a level of experimentation I necessarily had to engage in. If you are less experienced, it is worth getting some blood glucose data behind you so that you can exercise in an educated manner.

A Spreadsheet
I have a spreadsheet that tracks my blood glucose readings. Various vendors make software that facilitates this, but I find a simple Excel spreadsheet or Google spreadsheet document does the trick just fine.

When you test your blood sugar, no matter how regularly, you often see a different picture when you're "in the moment," taking each reading one-by-one than you do when you collect all your readings by date, time of day, and relevant activity (before meal, after meal, before exercise, etc.) and go searching for trends.

When it comes to exercise, you will have to start assessing the impact of different kinds of exercise, and different levels of exertion, on your body and blood sugar. As we will see in subsequent posts in this series, the impact of exercise may be immediate, or it may be delayed up to twenty-four hours in the future! As you start out, these impacts seem erratic and unpredictable. So the better-informed you are and the better-aware you are of short- and long-run trends, the better you will be able to control your blood sugar with exercise.

Additional Tips For Starting Out
A few more things to keep in mind as you start out exercising with diabetes:
  1. For now, don't make radical changes to your diet. We diabetics have to tightly control what we eat to ensure that we stay healthy and keep control of our blood sugar. That means you will have to resist a lot of fitness-industry pressure to radically alter your diet in accordance with current fads. You may eventually choose to alter your diet according to what works best for you. But starting a new exercise regimen is a big change for your body. If you make two big changes at the same time, you are changing two variables, and it will be difficult to determine which of the two had a more relevant impact on your blood sugar. Change one, then change the other; don't change both at the same time.
  2. It is always a good idea to let someone else know where you're going. If you go for a walk, a run, a swim, a bike ride, whatever, take the time to let someone know what route you're taking and how long you think you'll be. You will probably not get into trouble out there, but if you do, you'll be glad that you let someone else know where to go looking for you.
  3. If you work out with a friend, let them know how to help you in an emergency. I wear a Medic-Alert dogtag and I always take time to let people know that if they see me pass out, they need to put sugar under my tongue and call an ambulance. Nine words that require less than two seconds to state could save your life some day: "Put sugar under my tongue and call an ambulance." Simple as that.
  4. If you have an insulin pump, turn it off.
In my next article in this series, I'll cover the physiological effects of exercise and what that implies about your blood sugar. Until then, give exercise a try and see what you can learn on your own!


India Proves That More Socialist Healthcare Is Never Enough

While many a US leftist insists that healthcare reform "had to happen" and that the system "needed" some kind of massive, sweeping, federal legal overhaul, those of us who have a longer cognitive time-horizon understand that there is no "endpoint" to socialism. Reformers of the US healthcare system will never be - and can never be - satisfied, no matter what the reform actually looks like.

Progressives have long been critical of the ACA because it stops short of publicly financed healthcare coverage for all human beings within US borders. An individual mandate is insufficient. A subsidized health plan for the poor is insufficient. Socialists will never stop, because there is always some increased level of socialism somewhere around the bend. So, while it may be the ACA today, it is universal, single-payer healthcare in the long run. And if you think they will stop there, don't fool yourself.

Case in point, India has a public "option." India's socialist health system professes to offer "universal" health coverage to the billions of starving, dying, and desperate poor throughout the country. Everyone else in the country patronizes the private healthcare tier. Why die if you have the money to save yourself? The short-run lesson here is that when public "options" are forced to compete with private healthcare, the private system always wins. The social "safety net" kills people. We see the same thing in the United Kingdom. (Moreover, India is host to a growing healthcare tourism industry and some of the finest doctors in the world. But note: this is only true in India's private healthcare system. Their public system is useless to the point of being deadly, and everyone knows it.)

But, as I stated in the lead-in to this post, "universal" socialist healthcare is not enough for leftists. Leftists always want more socialism, regardless of how much socialism already exists within their borders.

This is evidenced by yesterday's news that India plans to "give free generic drugs to hundreds of millions" of people. The point: "free" healthcare isn't enough - people have a right to "free" pills, too! Western European nations - and their tagalong baby sister, Canada - have long been calling for and in some cases supplying "free" daycare. Socialism doesn't stop, no level of socialism is sufficient to placate its true believers. They always want more.

Now, in this case, there is a larger political story playing out. India and China have been ignoring Western pharmaceutical patents for years now. For us free market types, this is actually a great thing. Patents stifle innovation, distort markets, and drive prices far higher than could be drawn under free market conditions; same as any other form of corporate welfare.

But we all know that India and China aren't interested in promoting laissez-faire capitalism. The real reason they have opted to ignore Western patents is to allow their own domestic generic drug manufacturers to make a lot of money copying patented medicines and selling them on the cheap. If you don't have to conduct any research and development of drugs, then any schmuck with a chemistry degree and a raw chemicals supplier can become a generic drug mogul in weeks, especially if there aren't any patents standing in your way.

So India and China don't want capitalism, but rather they want to promote their own domestic generic drug manufacturing industry. Oh, and by the way, many raw chemicals needed for the production of pharmaceuticals are produced in... India and China! Serendipity.

The one-two punch of ignoring pharmaceutical patents and subsidizing the generic drug industry (for, that is pricely what "supplying free generic medications" is, a government pill subsidy) is a significant blow to branded pharmaceuticals companies. Now they understand that any medicines they develop will quickly be copied by generic competitors in India and China, and sold directly to those same governments in a disgusting, literally incestuous act of cronyism.

No private firm can ever hope to compete with these tactics, which are already quite common in Canada (which hosts a large domestic generic manufacturing industry), are increasingly common here in the United States. So-called "Big Pharma" is shrinking fast, unable to find reliable ways of generating profits via the production of actual medicine. They have to resort to lobbying for protection. In no time at all, they may well become quasi-government labs.

I think we're headed toward a massive shortage of medications and, as Paul Gregory pointed out a couple of days ago, a complete and utter halt in the development of new drugs. Brand pharmaceutical companies may well become a thing of the past. The major players will expand into the generic drug space, moreso than they already have. The entire industry will be a creepy government racket.

It's a real shame, but not a big surprise.