Monthly Archives: April 2010

Let’s Cure Diabetes

Every so often I’m going to request that you to give to groups supporting diabetes-related causes. I understand that you want to spread your charitable giving dollars around. I do, too. I just hope as you’re planning your year, you’ll save a little bit of your giving for diabetes related research and advocacy.

Every year diabetes costs the US $175 billion, which includes $116 billion in excess medical expenditures and $58 billion in reduced national productivity. [1] It would be great if those costs could just go away.

Well, you have to speculate to accumulate. Suppose the US were to dedicate an additional $1 billion per year solely to find a cure for type 1 and type 2 diabetes. If those investments were to succeed, we’re looking at a possible return on investment of more than 100:1 — perhaps even more, since we wouldn’t have to spend the $175+ billion figure every year. A cure might involve on-going pharmaceutical therapy, but that should be modest in price compared to the costs of daily self-management, specialist visits, care for complications, lowered life expectancy, and lost productivity.

Can you imagine not investing in an endeavor with that kind of ROI?

So consider donating to JDRF: The Juvenile Diabetes Research Foundation, which actively funds programs to find a cure. You might also think about giving to advocacy groups that petition your national government to get increased funding for diabetes research and patient services. If you’re in United States, the American Diabetes Association is the main organization for this.

And now back to our regular programming. . . .

Posted in Diabetes, MetaBlogging | Leave a comment

Rowing Across Oceans

Roz Savage talks about rowing solo across oceans:

First off, what she has done — rowing solo across the Atlantic as well as two out of three legs across the Pacific — is completely amazing. She’s currently rowing from Tarawa to Australia. You have to be a bit touched to depart from the herd like this, yet her story (and the earnestness with which she presents it) is so inspiring.

You really should watch the sixteen minute video, but here are some choice bits:

  • “Getting outside your comfort zone is by definition uncomfortable.”
  • You don’t have to look like an adventurer [or athlete or revolutionary or . . .] to be one.
  • “The bigger the challenge, the greater the sense of achievement.”
  • Things break and challenges occur; you have to improvise.
  • We tell ourselves stories, and our interior dialogue makes us who we are.
  • Tiny actions by individuals accumulate to make an enormous difference (both good and bad). What we do “spreads ripples” across the community.
  • We have the responsibility to make ourselves happy.
Posted in Australia, Diabetes, Life Lessons, This is who we are, Video | Leave a comment

On Shopping Bags

It’s Earth Day, so it’s time for a public service announcement. This is no “holier than thou,” tree-hugger BS — just a little something you can do to reduce waste. In particular, those plastic bags that end up tangled in tree branches or filling cow’s stomachs or littering the side of the highway or floating in the middle of the Pacific Ocean. You can do whatever you want, of course, but it’s quite likely that more place are going to eventually adopt something like Washington DC’s tax on plastic shopping bags. Consider getting out ahead of the curve.

Sometime in February I decided to try using as few plastic bags as I could. I don’t know why I decided then, it just seemed like it was time. In my mind it sounded easy enough — after all, we’ve been using them for grocery shopping for more than a year. It wasn’t quite as effortless as I had imagined, but it wasn’t very difficult either. And it has worked, too. We only have a couple disposable bags left in the house for our recycling and cleaning up after the kitty.

So what have I learned?

  • The flat bottom nylon fabric bags are where it’s at. They cost about $1. They’re really sturdy. You can put 20 pounds of whatnot in them, they won’t tip over in the trunk or on the counter, and you don’t have to worry about pulling off the handles. And I think they’re easier to fill than other kinds of reusable sacks.
  • If the bags aren’t with you, they won’t do you any good. Keep at least one in each car. Getting them back into the car from the house. . . . oy!
  • A family of two needs 3-4 bags to shop at the supermarket for 1-2 weeks.
  • When you’re sending your groceries down the belt, try to group the things you want in the same bag. (For example, send all of the cold things together.)
  • Cashiers/baggers are all pretty accustomed to reusable bags; but I find that you have to give the bags to them first thing, otherwise they default to plastic.
  • If you’re going to multiple stores (other than the grocery store), you don’t need one bag for each store. I’ve found that I can usually get by with two or so: one for the store I’m visiting and one (or more) that I keep in the car and transfer the stuff I just bought into. This leaves me with an empty bag for the next store, and fewer half-empty bags when I get home.

Well, that’s probably enough more-or-less obvious ramblings about how to use a shopping bag. Now just go and do it.

Posted in General, Life Lessons, This is who we are | 4 Comments

Some Patriots’ Day Thoughts on Militias and Tyrants

Sometimes, things happen that almost immediately crystallize an aspect of one’s life, splitting it into a time before the event and after. Your parent takes a job in a sparsely populated Western state and moves the whole family. A plane crashes with a family member on board. You drive a U-Haul truck from Oregon to Massachusetts without a job to start post-college life with your new spouse. You buy a home. You take a trip to India.

Some other events are just as important but only in retrospect. These are subtle things, a turning of the tide. A high school student teaches you a bit of French in fourth grade and inspires a life-long interest in la belle langue and the nation of France. You go to camp a couple years later where you bicycle a couple hundred miles around Iowa and realize that cycling is the activity that you really love. You appropriate the family camera on a trip to Yellowstone and pick up the habit. You ride the 80 bus from Watertown to Cambridge and start to give up most of your conservative political views as you see that the working people (of which you are one) need more opportunity than they’re getting. The tragic, brutal death of a young gay man in your home state makes you rethink some of the other bullshit ideas you had.

Another thing that slowly changed me was the bombing of the Murrah Federal Building fifteen years ago yesterday.

I should note that I was in my second year at Grinnell in the spring of 1995. I loved Grinnell, but I felt like I lived in a cave. Very little news made it my way. That is, I consumed very little of it. I remember the Republican revolution of 1994 — I may have been one of the few students there who didn’t really mind it. I seem to recall there was (still) a war in the Balkans. And the farm bill was rewritten. It wasn’t that I didn’t want to know what was going in the world; I just wasn’t very connected to the media at the time.

McVeigh and Nichol’s act of terrorism really struck close to home — figuratively, of course. At the time, I still considered myself a Wyomingite. Like many people in Wyoming I felt that the federal government was a more-or-less foreign, colonial power. DC is almost 2000 miles from the Equality State, but unelected officials there ultimately control how most of the land in the mountains and plains can be used. With only three electoral votes, our Congressional delegation might have had disproportionate power relative to our population, but we felt marginalized on the national stage. It seemed like a lot of the issues that mattered to us didn’t matter to the rest of the country, and vice versa. People on the coasts and in the cities wanted to take away the guns we (truly believed) we relied on for our protection. We might not have had “Live Free or Die” on our license plates — we had a broncobuster — but we felt like we actually lived what New Hampshire was trying to claim.

I knew a guy — a sort of family friend/hanger-on — who taught me about the militia mindset. He spent a lot of time at the gun shop. (I should say one of the gun shops, for there were several.) And he would tell us what he heard and (thus) believed. He was a real life Dale Gribble. The government had designs on our guns and our liberty. For reasons I didn’t understand, the Clinton Justice Department was training a secret NATO army using black helicopters to impose the “one world government” under the auspices of the UN. The Federal Reserve was part of an ancient secret society that finally surfaced at the Bretton Woods summit in the 40s; they too were part of this enormous plot, and at the appointed time this unelected body would devalue the US dollar for their nefarious ends. Ruby Ridge and Waco and Vince Foster’s suicide were visible corroboration of the dozens of other insidious events for anyone who would just bother to connect the dots. He buried guns and ammunition in PVC pipe in the backyard so that once ATF agents came to take his “sacrificial” firearms away, he would be ready to carry on the fight. He stocked extra food and claimed to have survival skills. And he “knew people” who claimed to have shot down a helicopter that was scaring their cattle on BLM land. But the “real” militia action was always over the border in Montana, where the crazy people live.

(If it weren’t for the talk about aliens, it was almost conceivable as an alternate reality. After graduating college I watched “X-Files.” And I felt like I had heard all of the stories already. The guy I knew was a wannabe Western version Fox Mulder, uncovering the evil machinations of the Cigarette Smoking Man. After my first year working in tech support where I frequently helped people working in the defense industry on government contracts, it became crystal clear to me that the very idea of a “massive government conspiracy” crumbles because it’s just not possible to hold it all together secretly. Even people working on secret things need help completing their part of the secret.)

So when a couple of “lone wolves” put an actual plan into effect, I was stunned. I knew that some people believed the government wanted to make them slaves to its bureaucratic will. I knew that there were a lot of well-armed, slightly off-balance people out there. And I knew that there was a lot of angry — or, at the very least, agitated — rhetoric. (“Talking treason” the guy I knew liked to say.) But I didn’t think anyone would actually do this sort of thing. If I were old enough to remember the Weathermen, it wouldn’t have been so surprising.

After the bombing — which thankfully didn’t actually touch my life directly — just about anything associated with the militia point of view rapidly lost whatever bit of Revolutionary-era-throwback legitimacy I had carved out for it in my mind. These are modern times; there’s no need to “water the tree of liberty with the blood of tyrants,” because we are so far away from tyranny. Government wasn’t the problem; it was the bulwark against domestic terrorists. Gun legislation might not always be consistent; but it seems like a necessity. There should be no such thing as a “well-regulated militia” except as run by the states.

Above all, the tremendous amount of lost life, the needless deaths, and the premeditated brutality of the Oklahoma City bombing shows us the danger of unchecked bullshit. I don’t claim to know what was in McVeigh’s mind, though I hear he was upset about Waco and Ruby Ridge (which were unfortunate and needless in their own way). But the idea that these events herald despotism makes no more sense than the gun shop hearsay that the family friend shared with us.

Looking at American history, we see that our form of government is more durable than we let on. We have never had periods of despotism. The Republic has never fallen, although it did crack apart from within during the Civil War because of or own inconsistent ideas of “liberty.” Neither fascism nor communism — the two greatest external ideological threats to democracy — took hold. (The methods of prophylaxis — Palmer raids, strike-busting, Pinkertons, McCarthyism, widespread FBI surveillance — may even have been worse than what the forces of stability were trying to prevent.) We have survived wars and contested elections and depressions. The historical power behind the idea of America is the strongest argument against militia activity.

In fact, militias have only gotten us into trouble since they peeled us off from the British Empire. (And depending on your point of view, maybe even then too.) Shay’s Rebellion helped destroy the first post-Revolutionary confederation. Armed white civilians moving into the interior of the continent committed ethnic cleansing and spread race-based tyranny. John Brown’s raids and the Missouri troubles hastened the Civil War, while the South Carolina militia’s siege on Ft. Sumter actually started it. The Ku Klux Klan began as anti-Reconstruction civilian militia. The Gilded Age’s corporate militias killed working men and their families. The counterculture’s left-wing terrorist/nihilist militias in the 1960s and 70s helped usher in the current generation’s culture wars.

So it bothers me very much to see a contemporary resurgence in the kind of sentiment and speech that I heard in my late adolescence, the kind of words and ideas that led McVeigh and Nichols to kill 168 people fifteen years ago. I didn’t say anything about the notions I heard before Oklahoma City because I thought it was diverting, idle chatter — a jester’s story, if you will. Now that I’m starting to hear the same BS, I must say that it’s time to stop . . . before our nation’s adolescent obsession with civilian militias gets people killed again.

Posted in Historical Record, History, Life Lessons, This is who we are, USA, Western Adventure | 2 Comments

Buckshot o’ Links – Software Development Edition

I’m a hoarder. I may not have lived through the Great Depression like my grandmother did, but I seem to have inherited the gene that led her to keep dozens of plastic Cool Whip tubs in her attic “just in case she needed them.” My grandfather kept used bolts and nails for reuse. Me, I keep articles about things I think I should know some day. From smart people on Twitter and e-mail lists and coworkers I gather links to articles, PowerPoint presentations, blog posts, and videos. And they hang out in my browser tabs — forever.

It’s time to clear some of them out. Here are some daytime-themed links. (If I had a Tumblr account, I’d just post there. But I don’t need another website no one reads.)

Parallel Computing
James Reinders of Intel TBB fame estimates that datasets (images, videos, etc.) have grown 10x larger over the last five years. Sequential systems are just too dang slow to process this amount of data. In the near future, “parallel programming” will just become “programming.” (I’m still hoping for better language support so that state synchronization and multicore memory issues are as easy to get right as the sequential aspects of programming are now.)

New memory models would certainly help. A new paper, DMP: Deterministic Shared Memory Multiprocessing by Joseph Devietti, Brandon Lucia, Luis Ceze, and Mark Oskin presents some of the problems with the current memory model and provides one possible solution.

Another post on SoftTalk (sponsored by Intel) describes some of the ways that Intel plans to make parallel programming easier this year: Parallel Studio 2010, a Cilk-based offering for task parallelism, “a data-parallel centric model with safety guarantee,” new SIMD instructions, and new array notations.

You might also want a high-level view of how Intel’s offerings work together.

Herb Sutter, who really knows his stuff, wrote an article for Dr. Dobbs a couple years ago about understanding parallel performance. It’s one of a series of articles about multicore/multithreaded programming, and this helps set expectations about what’s possible and gives pointers on where to start making changes.

Visual Studio + Time Machine = IntelliTrace. Don’t just move up and down the call stack; now you can move forward and backward in time, too.

Everything you ever wanted to know about floating-point representation: Floating Point Guide. (Everything, that is, unless you work where I do. Then you just have to go down the hall to get that last 2%. Of course, you’ll be drinking from the fire hose. . . .)

What does Microsoft think are the key trends in software development? Cloud computing, the web as a platform, parallel computing, proliferation of devices (with their own capabilities, IO paradigms, etc.), agile development processes, distributed development. Nothing terribly futuristic here, and comments want to know why “mobility” (i.e., phones) isn’t on the list.

The C++0x “final draft” revision is ready for “final” comments. Here’s your chance to see the significant changes to C++ that will be part of the standard next year (they hope).

Posted in C, Computing, Fodder for Techno-weenies, Hoarding, Software Engineering | Leave a comment

A Brand-new Bag

A while ago, I posted pictures of my diabetes kit. And by “kit” I mean a bunch of stuff thrown into a gallon-sized Ziplock bag. I need everything in it, but that gallon bag! I can’t tell you how much I’ve wanted something different, something that doesn’t need to have the air squeezed out of it before I put it in my bag, something a bit less hobo, a bit more chic.

Well, I can stop searching. Yesterday at REI, I found this: a medium-sized “Pack-It System” travel bag from Eagle Creek.

Diabetes kit using a medium-sized Eagle Creek Pack-It System sac
Click for larger…

It’s great! It packs flat without needing to have the air squeezed out of it. It comfortably holds 5-7 days of insulin pump supplies, a spare pump, glucagon, “just in case” syringes, prescriptions, etc. It looks nice. It fits well into my bag. And it seems pretty sturdy, so I shouldn’t have to replace it every few months like that Ziplock bag.

Oh, and that little blue thing in the upper left? That’s a pancreas pin from I Heart Guts. Lisa — who can be as geeky as I can — gave it to me as a Christmas gift. The T-shirt is pretty sweet, too.

Meanwhile, the weather has turned lovely here. Over the last few weeks, spring arrived all at once. Torrential rains, sunshine, a couple 85-90ºF days, and flowering trees and gardens. I’ve been out on the bike a lot, too. (Today I put in more than 65 hilly miles around Worcester and Middlesex counties.) Here are a few pictures from the flower bed.

Click for larger…

Click for larger…

Posted in Diabetes, General | 3 Comments

Bring on the Nanoparticles

A vaccine may be on the way (eventually) that reverses type 1 diabetes, according to a report posted Friday on the Diabetes Health site. The vaccine, which uses tiny fragments of protein to bind to the T-cells that destroy insulin producing beta cells, seems to be working pretty well in mice; and the “nanoparticles that contained human diabetes-related molecules were able to restore normal blood sugar levels in a humanized mouse model of diabetes.” (Tee hee, “humanized moue model.”)

Because the protein nanoparticles are specific to the T-cells that are overly aggressive in destroying beta cells, the vaccine doesn’t appear to harm the other T-cells that keep our immune system healthy. And, it’s possible that this therapy can be tailored to other immune-related diseases beyond diabetes.

JDRF, the Juvenile Diabetes Research Foundation, supported this research. This is why I support them and why I hope you will donate to JDRF, too.

Combine this with some other recently reported research that alpha cells in the pancreas spontaneously become beta cells when the latter are deficient, and you have what we’ve always wanted: a cure for diabetes. I’m being cautious, since nothing has been tested in humans — even at a very basic level — and the process of converting from alpha to beta capabilities is described as “slow.” Still, this is what gives me hope that some day type 1 diabetes will be a thing of the past. . . . Some day soon, I hope.

Posted in Diabetes, Health Care | Leave a comment

Moving Healthcare off the “Mainframe”

I’m going to be writing about diabetes, patient-centered healthcare, online community, and what I’d really like in a diabetes self-management solution. But that’s too big for tonight.

As a precursor, consider Eric Dishman’s TedMed talk about “moving healthcare off the ‘mainframe.’”

In a nutshell, when people do free association with “healthcare,” this is what they say:

  1. Doctor
  2. Hospital
  3. Illness, sickness, disease

Dishman says this is the old “mainframe” model of health — a model based on reactive, crisis-driven, population-based treatment. Instead, he says (and I agree) that we should focus on a “personal healthcare paradigm centered on the home,” especially for our aging population. This new model would be proactive, pervasive and personalized and would be based on more than just biological lab data.

That sounds very much like what I would like to see in a diabetes solution.

Posted in Data-betes, Diabetes, Health Care, Video | Leave a comment

How Much Are Hospitals Paid for Services?

A while back when I wrote about how much my healthcare costs my insurer, I mentioned that people with different insurance plans pay wildly different amounts for the same services.

Here’s an example from an an outpatient department from a real hospital* providing more or less the same billable health education service for each patient. The hospital dealt with 25 different insurers. The average payment for each of the roughly 2000 cases was $88.50. One private insurer paid as little as $46 per case, while another paid $146. Medicare provided $89** per case, and Medicaid reimbursed $183. Payments for all of the other cases were somewhere in between, mostly below the average cost . . . except for the smallest payors, who had an average payment of over $278. That’s more than three times the average cost!

Certainly the Medicaid patients aren’t getting $94 more service per case than Medicare patients. And it’s definitely not fair to the patients paying $278 per visit for a half-hour of medical education. Furthermore, I doubt that the hospital would let the department continue to provide its excellent service if it were only getting $46 per patient.

Why is there such a disparity in reimbursement? For one thing, insurance companies can’t collude with each other or with hospitals to say, “We’ve all decided to give you $88.50 per half hour of this kind of medical education.” (But all of the insurers know how much Medicare will pay, so there’s some kind of sharing anyway.)

Beyond regulations to encourage competition, I actually don’t know why there’s such a large difference. I hope that if you know you can tell me. Honestly, I’d love to know more about this. Leave a comment.

* — I haven’t been given permission to say which hospital or which department.

** — Medicare was only about 1/7 of the cases, so it’s not artificially affecting the average payment.

Posted in Health Care | Leave a comment

Insulin and Exercise, Part 2

It was beautiful outside this afternoon, and I felt a bit chagrined about not going for a ride or a run. But it’s my rest day, and the only thing worse than not going for a ride in beautiful weather is being injured and knowing that you can’t get back on the bike tomorrow.

And I did need the day off. I rode 60 miles on Saturday — I was rather amazed seeing how much flooding there still is out there — and then ran almost 9 miles yesterday. Even though I’d been telling myself all day that I was going to rest my legs, I didn’t really believe I would be able to resist getting back in the saddle until I bolused the full amount for my afternoon snack. That extra bit of insulin sealed the deal for me. I would probably have had hypoglycemia if I’d gone.

I think I’m finally getting a hold on how to balance exercise, food, and insulin. Everybody’s diabetes is different, of course — talk to your doctor, and don’t simply copy what I’m doing — but here’s what tends to work for me.

  • First off, active insulin really drives down blood glucose. On weekdays I exercise after work, so I usually have somewhere between one and two units of insulin on board; that usually guarantees a sizable drop that I have to compensate for with extra carbohydrates. But exercising first thing in the morning makes this moot. Of course, I do have to eat something first thing in the day, but I try to eat a small enough meal (<40g carbs) that I'm not going to send my blood glucose up a bunch without extra insulin. (Eventually, I'll figure out the right carb:insulin ratio for eating before exercise.)
  • During exercise, a couple of things happen that make insulin more efficient — as long as there’s some basal insulin present. More blood flow causes insulin to get to the cells where it’s used more quickly. (Remember, insulin is the metabolic “key” that moves glucose into certain kinds of cells, like muscles.) And the action of muscles expanding and contracting during exercise actually pumps glucose into cells with less insulin than when the muscles are at rest. So, I have to bring my basal insulin down a bunch (roughly 60-75% less than “normal”) about an hour before I head out.
  • Of course, just like people without diabetes, I have to get energy to my muscles; and that means eating. Over the four hours of my ride on Saturday, that translated into about 60g of fast-acting carbs (in the form of Gatorade) and 80g of more complex carbohydrates (Clif Bars . . . yum).
  • After exercise, it’s not quite like my type 1 diabetes is “cured” but I certainly don’t need as much insulin for my food. Exercise depletes muscle glycogen, which has to be replaced, drawing down blood glucose levels. I find that sometimes — but certainly not every time — I need to take off about 20-30% of my meal boluses, much less if I only go for an hour or so.

As always, I’ll keep fine-tuning and sharing what I know. What works for you?

Posted in Cycling, Data-betes, Diabetes, Life Lessons, Running | Leave a comment

Tora! Tora! Tories!

Elections are coming soon in the U.K. Here’s a little something for my British coworkers and readers:

Posted in Europe, General | Leave a comment