Happy fifth birthday, Dispatches!

A lot has happened in my life in the five years since that first post just before our trip to India. I thought you were a goner during my last year of grad school, when I didn’t post anything for more than a month, but National Blog Post Month last November seems to have restarted a more regular rhythm.

I never really knew what you were going to be about. That’s fine with me. I’m a multifaceted individual, who is easily distracted. So, instead of mining the same vein of subjects to gather a steady stream of loyal readers, I’ve written about anything and not quite everything. For a little while I thought about getting you, my weblog, a little brother or sister, turning one of you into a single-subject weblog, and keeping the other one for random stuff. But I never did, because I know you like being an only child, and I don’t have enough time to devote to two.

As a result, you, my little weblog, are always meeting lots of new readers who are drawn in by the Google, stay but a brief while, and then move on. In fact, well over half of your visitors come from Google searches. You’re most popular when you’re unique and nerdy. Here are the top 10 most popular pages over the last five years:

1. The JPEG Family Circus (2008)
2. Fifteen is an Eternity in Photography Years (2007)
3. Ask Dr. Color’s Assistant: Tone-mapping in MATLAB (2007)
4. The Cognitive Style of Microsoft Project (2007)
5. Book Notes: The Looming Tower (2006)
6. Four Days in London (2007)
7. Deconstructing an Image (2007)
8. How a Digital Camera Works (2006)
9. Grandes Expectations, a.k.a. Four Days in Paris (2009)
10. Tractors (2008)

Okay, I don’t get that last one either. I guess there are a lot of people who, like me, enjoy 1/64-scale tractors. And almost 80% of the views of the JPEG article happened in the first week it was published, when Steve posted a link to it, which got a couple hundred views and was then Stumbled, garnering 30 times more readers. You, my little weblog, were almost famous.

But those things aren’t really what you’re about. Over the last five years, we’ve traveled a lot, started to talk a bit about diabetes, visited many cemeteries, thought about software engineering during and after grad school, played with a large format camera, worried about health care, learned many lessons, taken and posted tons of photographs, and tried to deconstruct the American experience. (Lisa, who is perpetually awesome, helped with some of the posts and many of the photos.)

So what next? What will happen in the next five years?

Given the randomness of posts over the last five years, it’s dangerous to guess, but I bet it looks like the last five years. Without a doubt there will be more travel: In two weeks we’re going a Australia for a month; next year, my mom and I plan to go cycling in Provence; and in 2012, we’re going to England and France with my in-laws. Unless amazing things happen, I’ll still have diabetes and will continue to write about that. No doubt, I’ll also visit some additional technical subjects, which will appeal mostly to the long tail.

You, my little weblog, were born near the beginning of an online historical moment when it seemed everyone was getting a “blog.”* A lot of people moved on — to MySpace and Facebook and Twitter — and let their online journaling end. Meanwhile the idea of the weblog became the basis for a lot of mainstream media and corporate sites. The weblog became the scaffolding for interactive, moderated, medium-to-long-form medium.

I’m excited to see the re-emergence of “microblogging” sites like Tumblr, where people post short things: videos, links to other pages, excerpts from articles with reactions, etc. It’s bringing the social back into “social media.” Now, instead of thinking about getting you a weblog sibling, I’m trying to figure out the right way to integrate shorter snippits with my regular fare.

Because what I really want is to have something like a magazine, with its mixture of time-relevant mini-articles and long-form features: something that combines what has traditionally appeared here with some of the stuff that I’ve offloaded to Delicious or Facebook or Twitter. But that’s all in the future.

Once again, happy fifth birthday, weblog!

p.s. — I haven’t gotten you a present yet, but I know you want a new theme so that you can look a little more hip. And I think I heard you say that you want better comment management, too. I’ll see what I can do.

* — Five years later, I still can’t stand that word “blog.” It’s just too ugly sounding. Like “atheist,” there’s just no happy-sounding, value-neutral way to say it. Of course, you who don’t have my hangups can call this site whatever you’d like. :^)

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Diabetes Blog Week finished Sunday. I really enjoyed being part of this, writing my own posts and (especially) reading other people’s contributions. I’m giving a huge “Thanks!” to Karen for coming up with the idea for this village green experience and for providing the essential scaffolding that the rest of us were able to use. It really made participating easier.

It’s wonderful to have a place — virtual though it may be — where people understand what I’m talking about on a deep level.* Because so many of us were conversing on the same subject on a daily basis, I found it much less isolating than the usual “I’m going to talk about diabetes now” experience. And I especially enjoyed the honesty that was possible when we were writing for each other; I didn’t feel like I had to have all my shit together before talking about my disease. (It often feels easier to talk to people with working pancreases, if I just pretend that I do — whether or not that’s the case.)

In fact, I think I finally get the real value in the diabetes online community (DOC). In the past I’ve tend to visit the DOC to get information that I felt could help me manage my illness better. But having read so many posts over the last week, I find myself thinking about it as a place that’s primarily about sharing other people’s experiences, talking about my own, and just being present. Certainly, I’m going to keep trying to learn as much as I can from the same sources as before, but being able to get extra perspectives has a ton of value in itself.

I wonder if you feel the same way, too. And I hope that if you’ve been reading me for the first time over the last week, you’ll stick around. Big things are going to happen in the coming weeks that you might want to read about — for example, we’re going to Australia for a month — and I’ve been enjoying all of your comments.

Now here’s the scary part (for me, at least). I want all y’all from the DOC to stick around, but I’m not primarily a “diabetes blogger.” I have a lot of stuff on my mind: diabetes, the US healthcare system, travel, photography, New England cemeteries, and a bunch of stuff that’s more like work than fun. (That last chunk of stuff actually comprises the majority of the traffic to my site, if not the majority of what I write about. . . . Go figure.) And I use this space to post on all of those things. Unless you’re actually me, some of my regular topics aren’t going to be your cup of tea.

So let’s make a deal. If you stick around and ignore the non-diabetes posts that don’t interest you, I promise to give you something worth reading more often than not. Just add me to your RSS feed reader or stop by regularly. Deal? Good.

. . . And now it’s time to put this new relationship to the test. I’ve been sitting on the next two posts (people’s exhibits a and b) for the last week so that they wouldn’t get in the way of your Diabetes Blog Week reading. It was enjoyable, but my! wasn’t there a lot of reading?! And I just didn’t want to add to that.

See y’all again soon!

* — I’m reminded of the time that I accidentally happened upon a little people’s convention in the late 80s in Des Moines, Iowa. Lots of people who are usually “the other” were running around doing their own thing in a supportive community. I felt like the odd one out. In the DOC, we’re on the inside.

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This is Diabetes Blog Week, and I’ll be writing all week on a variety of D-related issues. Today: A day in the life.

Diabetes is a strange thing. It’s part of me, but it’s outside my control. As Jessica Bernstein said on Diabetes Mine last month, the best I can do is influence my blood glucose numbers. I can’t hate diabetes without hating myself; but if the ‘Betes were another person, I would probably say that I hated it the way treated me on a regular basis. And yet, it’s also inspired me to make changes and take risks and to go beyond my comfort zone on an almost daily basis. Today was such a day.

Most of the time — for me at least — these excursions beyond my comfort zone aren’t very exciting. It’s not like I’m pushing the limits in adventure activities or in the Olympic games or in world-class professional bicycle racing. It’s true that I do like to ride my bike, which means almost daily changes to my insulin pump therapy. And I also like to travel and do (tame) “adventure” things, like going to crazy places and driving an RV. But the things that make me the most nervous are the ones where my diabetes might get in the way of working with other people.

For example, let’s consider this morning. I went to the dentist. The stuff of adrenaline-fueled adventure magazines or inspirational speaking, eh?

I woke up with a high blood glucose: 300ish mg/dL, and I gave myself some insulin to correct for it.* I’m more sensitive to insulin in the morning than later in the day. At least I think I am; I’m getting closer to having better pump settings after losing about 35-40 pounds over the last year and after years of never really knowing the right settings. Anyway, I took a slightly lower than recommended amount of insulin for the correction, and then I had breakfast (and more insulin) at work about two hours after my first bolus. Before eating my Monday morning chocolate croissant indulgence, my blood glucose had come down nicely to 220.

An hour and a half later I brushed my teeth.** And then I thought, “I should test again, since I’m going to be driving and away from food, and I have that extra insulin platooning around.” I was expecting something sorta high but not too bad. So I was surprised by an otherwise very good 139.

And this is when I kinda freaked out . . . in my own stoic way. “139! I have to go to the dentist, which means I won’t be able to eat for an hour or so. And I’m on a downward trajectory. And I had expected to be higher. I mean 139 is very good. I should be happy. But I don’t wanna say have to say, ‘Doctor, can we stop with the filling? I feel funny and I need to check my blood and maybe eat something.’*** Ohmigod that would be so embarrassing and betray the fact that I really don’t have my shit together. Gosh, I really don’t want anyone to know about that. I should never write that down. Let’s just eat a banana, why don’t we? Ack! A banana after brushing my teeth. Ack! Well that’s done. You know what, Imma fill up my water bottle and hope that I can ‘clean’ my recently brushed teeth on the drive to the dentist’s office. I hope that doesn’t make me need to pee while I’m getting the filling. You know what, I’d better bring my toothbrush and toothpaste along, too. Awesome. I can hold onto my toothbrush along with my meter while I sit in the dentist’s chair. Gosh, I hope my blood sugar doesn’t go any lower. I’m a total freak show. Get it together.”

Okay. Banana: eaten. Water bottle: partially filled. Toothbrush and toothpaste and BG meter: check, check, and check. Dignity: mostly recovered. Confidence: bruised, but holding. Out-of-the-office e-mail: late, but sent. Car keys: let’s roll.

A mere twenty minutes later I’m sitting in my car in the commuter lot in Newton Centre checking my blood before walking the half-block to the dentist. 132 mg/dL. “W.T.F. Breakfast and a banana! I should be golden — or at least going up. Let’s eat some glucose tablets. I needed to brush my teeth again anyway.” It was probably unnecessary but at this point it’s the diabetes equivalent of holding on to a security blanket or whistling past the graveyard.

And everything goes fine. No low blood sugar while in the dentist’s chair. In fact, I finally start to go up and have to correct a tiny bit the other way afterward. And the rest of the day is golden.

And that’s today’s path through the Choose Your Own Adventure™ that is diabetes.

* — I say “300ish” because although my meter said 317, I suspect in retrospect it wasn’t quite that high. It seems that if I don’t get quite the right amount of blood into a test strip, my new-to-me meter will give a value that’s higher than it actually is. (I like my new meter, the One Touch UltraLink. It talks to my Minimed Paradigm pump, after all. But starting testing as soon as it sips the first drop of blood and then potentially being off by by 20% for an incomplete sample… Damn! But I only learned that this afternoon when I did a little impromptu experiment.)

** — I hate brushing my teeth at work. It seems a bit obsessive. At least that’s what I think about the people I see brushing their teeth at the office. But I believe it’s a felony — not to mention plain-ole nasty for everybody — to go to the dentist with anything other than freshly brushed teeth. So I brushed them for the second time in a few hours.

*** — Except that I would have gauze and a little mirror and a drill in my mouth so it would probably sound something like, “mmrphr mmm mee mrphp miff ma fiwwing?” etc.

Ah yes, eating at the dentists office. That reminds me of the kid at the clinic when I was young who was eating a Snickers bar in the waiting room. Someone casually said something along the lines of “Eating candy at the dentist’s, eh?” To which he responded, “I’m just here because my sister needs a filling.”

For the record, I was getting three “fillings” today — except that they aren’t really fillings. (Although if you’re my insurance company, they totally are.) It seems that over the last 25 years or so, I’ve been a bit too vigorous in brushing, and have “abrasions” on three molars, where I’ve worn away the enamel to expose the dentin underneath. My fantastic dentist is just putting some “enamel” back over it, so that I can “go to work on that over the next 10-20 years.”

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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. . . .

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It took me forever to upgrade from Wordpress 2.2. (Thanks, Internets, for not hacking my site.) After almost obliterating my web log in the upgrade process — thank g-d for backups and reversible changes — I’m now running 2.9.1, and it looks really great.

Now on to bigger and better things.

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What a trip this last month has been. To be honest, the last week has been a bit of a struggle to find something interesting to say. In general, I found it difficult to write on demand. But it’s done. The daily updates and the eleventh hour races to post are over.

I’ll keep writing, of course. I feel like I’ve learned a bit about myself along the way, and I hope that I’ve taught a few people something new about diabetes. From time to time you’ll see more on that subject here. And there are still many things on all manner of subjects that I intend to write about; but they’re longer, and twenty-four hours just wasn’t enough time to get them finished — or even started.

So you can expect to see more frequent posting than in the pre-November, haphazard past, though most likely not daily updates. Until next time. . . .

What? Were you expecting more? Just wait for it. I’m watching television now.

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My mother — whom I love dearly and who made a delicious Thanksgiving dinner today — read about a billion pages of this here weblog last night. That’s great! She’s more-or-less the person I have in mind when I write about diabetes for people who don’t have it.

Imagine my surprise, when this morning over breakfast she said, “You’re really struggling with your diabetes, huh?” I have had my struggles and frustrations with diabetes recently, but I don’t feel like I “struggle” with it.

I asked Lisa about this. “Well, you have had a lot of frustrations with it recently. And you’ve been writing about them.”

It seems like all of this writing about diabetes and my process of trying to get my blood sugar to do what I want may be giving you, my dear non-PWD readers, the wrong impression. While I get frustrated when I do something and it doesn’t work, resulting in high or low blood glucose readings, I don’t feel like I’m struggling. I try to be pragmatic and learn something from the experience so that it doesn’t happen the same way next time. And although I’ve been known to wonder whether I’m ever going to be done with these teachable moments, I’m trying to maintain my charming stoicism and faith that there are solutions to my pancreas/paperweight-related issues.

Lisa is undoubtedly correct that it may seem like I’m struggling with diabetes more these days mainly because I’m writing about it more. In that case, perhaps I’ve missed the mark a bit. I was hoping (a) to humanize my illness a bit, to show that diabetes self-management is not mired in old one-size-fits-all rules, to get across the fact that people with diabetes can have as normal lives as anyone else and (b) to present useful information for other people with diabetes, to add to the repository of what works and what doesn’t, to teach what I know and what I’ve learned through experience and second-hand.

With all that said, I did want to share more successes with you than I have been able to present. I was kind of expecting that by this point in November I would be able to tell you that I have all of my basal rates and bolus ratios and sensitivity factors sorted out. And in particular, I was really hoping that I could show y’all what I do with exercise that leaves my blood sugar where I want it. But, while I’m making progress, it’s coming quite slowly. (Although, I feel happy to share that the last couple of times that I’ve gone for a run in the morning, my readings have stayed almost exactly unchanged. More about that later.)

So as I finish up this Thanksgiving dispatch, I want to say that I’m thankful for my Mom and all of her love, friendship, and maternal concern. And I’m thankful for Lisa, the best wife and friend I could ever hope for, who decided to love me even more after I was diagnosed with diabetes and who has helped me through the actual struggles and frustrations with it. I’m thankful for all of my friends and coworkers who enrich my life and treat me like just another person and yet have shown remarkable interest in my illness. And I’m thankful for you, my readers; without you these would just be self-indulgent ramblings.

See y’all here again tomorrow.

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I’m going to be writing a lot about diabetes over the coming month. Turns out, I have a lot on my mind about my chronic illness. Despite having had it for ten years, I feel like I’m still fairly unskilled at managing it. Basically, I know my readings could be better, and I’ve learned a lot recently about how to get where I want to be.

So why am I going to write about diabetes? Lots of reasons.

First, diabetes still has a lot of dark, mysterious corners. If I could have one wish — besides being cured — it would be to be able to predict with better accuracy what will happen from one day to the next. I hope to share helpful bits about what I’ve learned, what’s working, what could have gone better, and what still confuses me. And I hope to hear from other people with diabetes about what works for you.

Because diabetes is mysterious and evolving, it’s surrounded by misconceptions. If I can help any of my regular readers understand diabetes better, maybe I can prevent them from worrying so much about me. (Although I definitely appreciate all of your heartfelt concern.)

I want to contribute to a middle layer of knowledge on the web, a layer that fits between the insipid generalities that are too vague to help anyone but the absolute beginner and the overly technical information aimed at endocrinologists. I believe people with diabetes should be our own advocates, and that starts with having the courage to speak with our healthcare team members as peers rather than in the traditional doctor-patient hierarchy. Until we better understand what’s happening in our own bodies when we eat, take insulin, exercise, etc., we won’t be able to do that. And until we increase the visibility of what it’s like to live with diabetes, doctors are going to continue to discount our point-of-view.

(By the way, I very much put myself in the don’t-know-it-all-by-a-long-shot category. While I consider myself something of a “health geek,” I’m just a novice. I took an anatomy/physiology class many years ago. And while it was the most information dense and enjoyable class I ever took, it just scratched the surface of how a body works. Every time I read something in a medical book or article online, the depth of my ignorance becomes more profoundly obvious. But I’ll share what I do know, collecting shiny bits of diabetes knowledge here in my curiosity shop. :^) )

Sometimes I just have to write stuff down so that I don’t forget. On occasion this has saved my bacon. For example, on Columbus Day, while adjusting my pump settings at work, I managed to delete most of my basal rates. Fortunately I was able to call Lisa at home — unlike me, she had the day off — and she was able to tell me the values I had written in my journal for just such a “Holy shit!” moment. And, although logging might not be fun, it is useful. These dispatches can serve as persistent memory (not just shared memories).

And finally, for all of these reasons, my “control” over my own illness isn’t where I want it to be. My A1c of 7.6% (down from 8.6% a year ago) is higher than I want it. My ability to “follow the rules” (my own, much less my endocrinologist’s) is compromised by the knowledge that (for me) these rules are based on false assumptions about my insulin needs and sensitivity. So I flail around a bit, especially when it comes to exercise. Changing anything related to diabetes takes a lot of trial and error. Writing about it seems like good, inexpensive therapy. And if you’re in the same boat with me, maybe we can take this trip together.

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Dear Readers:

I want to thank those of you who regularly visit this site. I’m not exactly sure why you read these rather diverse dispatches. Some of you are family or friends wanting to keep up with what Lisa and I are doing. Others of you — I suspect — come back from time to time after finding something interesting on the site. And I’m sure that some of you just want a distraction to break up the workday or an evening television watching.

Whatever the reason, all of you regular readers have been forced to wait far too long for updates. (Although I was pleasantly surprised just now to see that I’ve posted 23 times this year  . . . often in closely-spaced batches.) “Well, that’s all going to change!” I declare yet again. I have decided to try posting everyday for a month starting on the first of November. This is a bit of a challenge, but I already have half of the month’s post topics sketched out.

I can’t guarantee Shakespeare everyday. And some days might only be photographs.

And I can’t promise you that everything will interest you. But with one post a day, the chances are better, right?

That brings me to back to my original observation: I don’t know why you’re visiting. I have a large and diverse set of interests I plan to write about.

• Photography
• Diabetes
• Australia
• Art
• History
• Modernity and post-modernity
• Cycling, hiking, running, swimming, etc.
• Travel
• National Parks

I’m sure there will be some techy things, too. But I can’t think of something I’ve done recently that I can actually write about yet. For those of you who want that kind of thing, stay tuned; they’ll show up eventually. (And feel free to check out my Delicious bookmarks to see some of the geeky things I might need to refer to again. Read between the lines if you want; it’s not that exciting.)

See you here again soon!

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