Type 2 Curmudgeon

Irrational Exubera(nce)?

2007-11-01T14:43:20Z

Big news in the big business of diabetes:

Pharmaceutical company Pfizer announced, on October 18th, that its inhaled-insulin product, Exubera, was not living up to expectations, and was being scrapped.

"Expectations," in this case, had nothing to do with the medical benefits of insulin, which have been known and understood for a long time, or the effectiveness of this particular formulation and delivery method, which had proved to be safe and effective in lengthy, FDA-mandated clinical trials.

The expectations Exubera wasn't meeting were sales targets.

Digging into the numbers a bit (the story was widely reported in the business press, and the Wall Street Journal's coverage was exemplary), we find that Pfizer sold just $4 million worth of Exubera in the second quarter of 2007... and they took a $2.8 billion (with a "b") pre-tax loss on the product when they shut it down.

It seems that doctors and patients were slow to accept inhalable insulin as a delivery medium, and the cost of promoting Exubera was just too high for Pfizer to continue pouring money into marketing in the hope that things would improve soon.

Was Pfizer suffering from (with apologies to Alan Greenspan) Irrational Exubera(nce) when they said they expected the new form of inhalable insulin to be a $1.1 billion a year product by 2010?

Not necessarily.

A single "blockbuster" drug can lift a drug company's stock price into the stratosphere almost all by itself, and unfortunately, diabetes is a global growth industry.

The American Diabetes Association estimates that in 2002, diabetes, all by itself, accounted for 11% of health-care spending in America... some $92 billion in direct expenditures.

Who wouldn't want a piece of that business?

And let's face it, there are a lot of organizations, not just pharmaceutical companies, in the business of doing well by doing good and looking after the needs of diabetics, including dLife.com, where you're reading this column.

But the very public haircut that Pfizer just took over the failed introduction of Exubera shows the dark side of the (as a whole) incredibly profitable pharmaceutical industry:

Medicine in the United States is a unique blend of commerce and science, good intentions and the bottom line. Research scientists and pioneering physicians have developed some truly incredible, novel therapies for illnesses and conditions that affect a lot of people, and have changed their lives for the better.

But at the end of the day, it's a business. And if a product isn't meeting commercial expectations, a company isn't going to continue to develop, promote and support it.

Diabetes is a terrific market for the American healthcare-research complex, so you can fully expect that the drug companies have plenty of new treatments in the pipeline, along with the Botox and impotence pills (come to think of it, I wonder what fraction of the Viagra/Cialis/Levitra market consists of male diabetics?)

But let's not kid ourselves about their motives.

This is one case where there is definitely strength in numbers, and where being targeted by marketers *can* be helpful, and not hazardous, to your health.

A Diabetic in Cold and Flu Season

2007-09-21T21:00:17Z

Events that are minor annoyances for non-diabetics--like catching "the cold that's going around the office"--can turn into major problems for people with diabetes if not carefully managed.

There are two main concerns that diabetics have with colds and flu that most people don't:

1. The risk of dehydration, which exists for anyone who gets sick, can be especially bad for people with diabetes.

2. When the body is under stress, as it is when you get sick, the hormones released by your body can further interfere with your metabolism.

The "cold and flu season" may not officially start until October. But if Harry and David can send me my Christmas fruit-basket gift list right after Labor Day, we can start talking now about self-defense for diabetics facing viral respiratory infections.

Especially since, dammit, I'm writing this column with a box of tissues and a cup of hot tea with lemon by my side. (Yes, I've got what's going around. Thanks for asking.)

Herewith, some thoughts (and links) for coping with cold and flu season.

FIRST, TRY NOT TO GET SICK

The best defense is a good offense: Try to avoid getting sick in the first place.

Yeah, I know... this sounds a lot like the wry wilderness survival advice that the Royal Air Force once famously used to give its pilots: "Try to crash in the summer months, when there's likely to be more edible fruit around."

But if taking commonsense precautions can keep you healthy, doesn't it make sense to try?

The number one recommendation: Wash your hands. A lot. (And definitely don't eat anything or touch your face before you've done so.)

BUILD UP YOUR DEFENSES: GET A FLU SHOT

When flu shots become available later this fall, get one. The Centers for Disease Control and Prevention recommends that anyone in a high-risk group -- and that very much includes people with any form of diabetes -- get a flu shot every year.

And if you haven't had one before, or if it's been several years, ask your doctor whether you need a pneumonia shot as well.

WHEN YOU GET SICK ANYWAY

Even when you do all the right things to take care of yourself, it's hard to get through the year without catching one case of the common cold... most adults catch two to four colds a year, or more if they're around potent reservoirs of infection, e.g., school-age children.

If you come down with the creeping crud, plan for some downtime, and manage your illness aggressively:

-- Drink plenty of fluids so that you don't get dehydrated.

-- Monitor your blood glucose levels carefully - you might want to check more often than you normally do.

-- Make sure that you're eating properly - always important, but doubly so when you're under the weather. (Chicken soup is good for you, for a lot of reasons!)

-- If you're experiencing vomiting and diarrhea for more than a few hours, get in touch with your doctor or go to the emergency room if you have to.

The American Diabetes Association has some other good guidelines for self-care here.

Getting a cold is a drag, no doubt about it, but you can do some elementary things that will keep it from developing into a major problem.

Diabetes in the News

2007-08-23T18:46:58Z

As I write this column, the most popular article on the New York Times web site (as measured by the number of times it's been e-mailed by Times readers to their friends) is Gina Kolata's "Looking Past Blood Sugar to Survive With Diabetes," part of her fetchingly named "Six Killers" series (the others are heart disease, cancer, stroke, chronic obstructive pulmonary disease, and Alzheimer’s.) It was published on Monday, August 20, and it seems to have struck a nerve or two.

If you've been *only* focusing on controlling your blood sugar (and measuring it with blood glucose and hemoglobin a1c tests), then you (and your doctor) really need to read this article.

You're absolutely doing the right thing by watching your blood sugar, but you aren't doing nearly enough:

Blood sugar control is important in diabetes, specialists say. It can help prevent dreaded complications like blindness, amputations and kidney failure. But controlling blood sugar is not enough.
Nearly 73,000 Americans die from diabetes annually, more than from any disease except heart disease, cancer, stroke, and pulmonary disease.

Yet, largely because of a misunderstanding of the proper treatment, most patients are not doing even close to what they should to protect themselves. In fact, according to the federal Centers for Disease Control and Prevention, just 7 percent are getting all the treatments they need.

Seven. Percent.

And the article goes on to document that most diabetics (the *vast* majority, in fact) are unaware that heart disease is a primary risk factor for them as a result of their diabetes.

Sorry if this is a downer, y'all... when I read this yesterday, I have to say that it spoiled the taste of the carefully carb-counted breakfast bagel in my mouth.

But I also said a silent prayer of thanks that my GP and endocrinologist are running my cholesterol numbers frequently (almost every time I go in for bloodwork) and staying on top of my blood pressure readings... and I have a little more sophisticated understanding about why my *very* mild hypertension (according to most sources I consulted, something that wouldn't be treated in a "normal" person) is being treated so aggressively.

Having a chronic illness means that you have to act aggressively to educate and advocate for yourself, or for a loved one who can't do it on their own.

If you're living with diabetes... do you know your HDL and LDL cholesterol numbers? What about your blood pressure?

Blood sugar is very far from the whole story.

Medical Urban Legends

2007-07-20T19:28:30Z

If you've been on the Internet for a while now, you have, no doubt, had the experience of well-meaning friends forwarding you implausible or even frightening e-mails that turn out to be completely untrue.

The term of art for this kind of rumor is "urban legend," and there are many sites devoted to the study and debunking of same; one of the best is Snopes, which is the first place you should check out when, say, somebody sends you an e-mail claiming that David Bowie and Mister Rogers were secret power players in a 9/11-related conspiracy.

(Snopes maintains a great list of the the top-25 urban legends circulating on the Net at any given time... check it out.)

Most of the bad information on the Internet is relatively harmless, if you don't count raising the blood pressure and stress levels of the gullible as "harm."

Bottom line: One of the side effects of the Internet making it easy to share information with each other is that it has also become much easier to share bad information with each other.

And some rumors and lies can do real harm.

Spammers sell pills and elixirs that claim to cure everything from cancer to ingrown toenails, and I think we’ve all quickly learned to ignore the obvious frauds.

And as dLife readers, we’re all savvy enough to recognize that there are authoritative web sites that we can consult for information about our diabetes, right? dLife’s Diabetes Resources page is chock full of good links including one of my very favorites, the National Diabetes Information Clearinghouse. There are many others.

But some rumors and lies sound more plausible – new dietary supplements that can replace your medication? Alternative therapies that can cure the medical condition your doctor told you can just be “managed?”

And what if the person sending you the “helpful information” isn’t a spammer, but a well-meaning friend or family member?

Wouldn’t it be great if there were a site like Snopes for medical mythology?

There is. Let me introduce you to Quackwatch (“Your guide to quackery, health fraud and intelligent decisions”), a labor of love by Dr. Stephen Barrett, who casts a skeptical eye on extraordinary medical claims and examines the scientific evidence (or, usually, the lack thereof) for their validity.

Here’s Dr. Barrett on “25 Ways to Spot Quacks” – on a line item that is unfortunately near and dear to my heart:

15. They Say It Is Easy to Lose Weight.
Diet quacks would like you to believe that special pills or food combinations can cause "effortless" weight loss. But the only way to lose weight is to burn off more calories than you eat. This requires self-discipline: eating less, exercising more, or preferably doing both. There are about 3,500 calories in a pound of body weight. To lose one pound a week (a safe amount that is not just water), you must eat about 500 fewer calories per day than you burn up. The most sensible diet for losing weight is one that is nutritionally balanced in carbohydrates, fats, and proteins. Most fad diets "work" by producing temporary weight loss—as a result of calorie restriction. But they are invariably too monotonous and are often too dangerous for long-term use. Unless a dieter develops and maintains better eating and exercise habits, weight lost on a diet will soon return.

The next time someone sends you a medical claim that sounds too good to be true, drop by Quackwatch and run a quick search.

When the Treatment Might Be Worse than the Disease

2007-06-18T19:48:58Z

A physician friend of mine once observed wryly, “I like to prescribe the new drugs just as quickly as I can, while they’re still working miracles and they don’t have any side effects.”

Ouch.

But there’s a lot of truth in that. New drugs come on the market, and they’re all the greatest thing since sliced bread... until the kind of data that you can only get when large populations of patients have been taking them for a while becomes available.

I’m not a doctor, and I don’t play one on dLife. I’m just trying to be an educated consumer and sort out the information that is available to me and make some sense of it all; I want to understand both the risks and the benefits of any medication that I take regularly.

Here’s the latest poser:

If you’ve been following the news lately, you know that researchers at the prestigious Cleveland Clinic have reported in the New England Journal of Medicine that GlaxoSmithKline’s diabetes drug, Avandia, may increase the risk of heart attack for diabetes patients by up to 43%.

Right now, some of you are thinking: Oh my God! The risk of heart disease in diabetes patients is high enough already... so we should all stop taking Avandia immediately, right?

The story got a lot of play in the national news media, and that kind of panicked reaction was the entirely understandable result.

But it’s just not that simple.

Here’s the word straight from the lead researcher who published the study:

Researcher Steven Nissen, M.D., is chairman of Cleveland Clinic's cardiovascular medicine department. Nissen, past president of the American College of Cardiology, was one of the first doctors to raise the alarm about the heart risks posed by Vioxx. Nissen says his findings are valid, but he warns that the data are not definitive and must be confirmed by further studies.
"What patients need to know is there is some evidence of cardiovascular harm from Avandia — but there is not any reason to panic," Nissen tells WebMD.

So what should you do, if you’re taking Avandia now?

Talk to your doctor(s). Figure out what the best decision is for you.

Like almost everything in life, you have to balance the known risks and make the best decision you can with the best information you have at the time.

If you’re responding to treatment with Avandia and you haven’t done well with other diabetes medications, you might decide that this is a compelling argument to stay with the medication.

Or you might decide that you want to get off this medication right away and try something else.

Right now, the science looks pretty scary. But early reports have been wrong before, and though more definitive studies are underway, the results won’t be in until next year at the earliest.

Ineffectively managed diabetes has all kinds of known bad effects. It’s too bad that, at times like this, anxiety over how you’re managing it has to be one of them.

Diabetic Nightlife

2007-05-21T18:36:51Z

Thanks for your patience as I've indulged my political side for the last couple of columns; this time around, we return to the personal: How, in a social setting and often with strangers, do you explain your dietary and "lifestyle" restrictions?

When I'm not writing for dLife, I'm a manager with a rapidly growing computer company. I work in the business development group, and wind up spending a fair amount of time wining and dining our current and potential customers.

New York City, where I live, is a wonderful restaurant town, and frankly, the bars ain't bad either. My company has a "work hard, play hard" culture, so we often find ourselves in some marathon eating and drinking sessions.

As a guy voted "most likely to do a kegstand" in college, you'd think this would be right up my alley.

But these days, I've slowed down quite a bit.

I'm a fat man with a skinny man inside him who is slowly trying to emerge -- and also someone who shouldn't be rocking and rolling all night and partying ev-e-ry day, given the havoc that heavy alcohol consumption can wreak on a diabetic's metabolism.

So I often find myself having to explain, to perfect strangers, why I'm not drinking like a college kid when the next round of shots makes its way down the bar, or gorging myself on the appetizers, be they fried mushrooms or foie gras.

I am "out" as a diabetic at work, and my co-workers and managers are fine with it. My close friends know about it too.

But often, I find myself in a situation where I'm out with relative strangers, and I get a quizzical look when I order a Kaliber (nonalcoholic beer) or club soda while everyone else is drinking hard liquor, or when I make a single glass of actual wine last through three courses at dinner.

The usual explanation (can't afford the calories, trying to lose weight) satisfies most people. I encourage people to drink up and enjoy themselves, as the last thing I want to be is some kind of party pooper.

Every now and then, though, someone tries to press a drink or some kind of calorie-laden foodstuff on me, and won't take "diet" as an excuse why not. ("Come on, live a little.") And in a business setting--as Frank Zappa once memorably observed, life is like high school with money--you want to fit in wherever possible, and you *definitely* don't want to stand out as unusual.

It is at that point that I must explain that, for health reasons (without going into more detail) I really can't, but thanks so much.

If what's being offered is liquor or beer, it is then essentially assumed that I'm an alcoholic, which is fine with me if it gets me off the hook, but may not be the best thing in terms of building a business relationship because of the stigma still attached to it.

If what's being offered is some kind of delicious foodstuff, it is assumed that I am some kind of self-denying ascetic and possibly Not A Fun Guy. See above.

Some of you have been at this diabetic business a lot longer than I have. Do you have better ideas for how to handle these situations? Please share them in the Forum!

Anywhere But Here (Unfortunately)

2007-04-19T19:23:56Z

A story that ran in the LA Times on April 11, 2007, should have received wider play in US media than it did.

An article in the Journal of the American Medical Association, entitled (brace yourselves) "Autologous Nonmyeloablative Hematopoietic Stem Cell Transplantation in Newly Diagnosed Type 1 Diabetes Mellitus" reported, basically, early results of apparently successful treatment of Type 1 diabetes with stem cells.

Researchers have demonstrated for the first time that the progression of Type 1 diabetes can be halted — and possibly reversed — by a stem-cell transplant that preserves the body's diminishing ability to make insulin, according to a study published today.
The experimental therapy eliminated the need for insulin injections for months or even years in 14 of 15 patients recently diagnosed with the disease. One subject, a 30-year-old male, hasn't taken insulin since his stem-cell transplant more than three years ago, according to the study in the Journal of the American Medical Assn.

Stem cells are a politically charged topic in America, and I realize that I'm wading into potentially treacherous waters by bringing them up in polite discussion.

But they're a politically charged topic that is crucial to the lives of diabetics in America and around the world.

Here are two key points that everyone needs to understand:

1. This vital, groundbreaking research was conducted in Brazil.

2. They did it in Brazil because, due to the restrictive regulatory climate here, they basically *couldn't* do it in America.

While I'm glad that someone, somewhere is doing this absolutely vital research, it pains me that the land of my birth, where people from all over the world once yearned to come to study (and do) science, is missing out on what looks to be the Next Big Thing in biotechnology.

And it pains me that the "rights" of stem cells are apparently more important in the eyes of our legislators than the rights of human beings with chronic, serious illnesses that might well be successfully treated with stem-cell-derived therapies one day.

Let me suggest something that some of you may find a little radical. If you're a diabetic, your future has already been politicized, and you haven’t been given any choice in the matter.

The question is, what are you going to do about it?

Science should not be hamstrung by politics. That's the official position of groups ranging from the American Diabetes Association to Scientists and Engineers for America, and if you're someone with a chronic illness or someone who cares for or about someone like that, it should be your position too.

Communicate with your representatives in Congress about this. Track how they're voting (the Coalition for the Advancement of Medical Research is a good resource for both of these things.)

And definitely, absolutely take their performance on this issue into account when you vote. This is not a Republican issue, it's not a Democratic or Independent issue, it's a human issue.

The next time you go to the polls, vote as if your life depended on it.

In this case, it very well might.

A Dose of Perspective

2007-03-20T19:07:41Z

Most days I do fine with it, but, you know, sometimes I get tired of this diabetes thing.

Lugging around a meter, test strips, swabs, and lancets, a pill-bottle containing my dinner medication in case I have to work late at the office, sugar tablets in case I overshoot the runway with the meds and get hypoglycemic (it's only happened badly enough to *really* scare me once... once was enough.) I'm never seen in public without a fashionable briefcase or shoulder bag, and it's *not* because I'm a metrosexual (okay, arguably I am, but the two syndromes are completely unrelated.)

Guesstimating and faithfully counting every single carbohydrate I ingest. ( Just how small is a "small baked potato," anyway?)

Drawing blood three or more times a day and recording my blood glucose in an Excel spreadsheet (hey, I'm a geek, it's what I do.)

Realistically, I know that when you're diagnosed with a serious illness, the only sane thing to do is take every step and precaution that you can to take care of yourself. And I've taken enough holidays from "realistic behavior" to know that if you don't take care of yourself, you can start feeling pretty bad in short order.

For the most part, I'm grateful that I know what's wrong with me, I know what to do about it, and that I have such a good support system in place.

Still, sometimes, I just get tired of it.

It is usually at about this time that reality, the Universe, or God (take your pick, more than one choice is allowed, no points will be subtracted for guessing) whomps me upside the head with some perspective.
Here's some perspective that arrived on my doorstep recently.

Last week, here in New York City, the International Diabetes Federation and Novo Nordisk held an invitation-only event called "Global Changing Diabetes Leadership Forum." Bill Clinton was the keynote speaker.

My invitation must have gotten lost in the mail. :-)

But the press release did land in my inbox. Check this out:

"Diabetes could become the worst pandemic of the 21st century. Today, already more than 230 million people worldwide have diabetes. This number increases by 7 million people every year, killing as many people as HIV/AIDS. At the present rate, this number may grow to more than 380 million people within 20 years."

And over at the International Diabetes Federation's website, I found a bleak rendition of the Pareto Principle, known popularly as the 80/20 rule (For an explanation of Pareto Principle, check out Wikipedia.):

More than 80% of expenditures for medical care for diabetes are made in the world’s economically richest countries.
Less than 20% of expenditures are made in the middle- and low-income countries, where 80% of people with diabetes will soon live.

Most of the problem, in other words, is about to be where the fewest resources are available.

Perspective.

I'm over my little snit, and back to sticking my fingers and counting my carbs without complaint. But I'm also starting to think about how I can make a difference for diabetics other than myself.
Ideas, anyone?

Last Tango in Hartford

2007-02-14T19:38:13Z

I changed jobs not all that long ago, and that, of course, meant a new insurance company.

I’m relatively used to dealing with insurance companies by now. Both of my parents had chronic illnesses to deal with, and my wife is, thank God, a cancer survivor (thanking God, of course, for the “survivor” part and not the cancer.) I learned more than I ever wanted to know about insurance-negotiating hardball during her illness and recovery.

So a little old thing like type 2 diabetes is like slow-pitch softball compared to some of the heat-seeking missiles that have come smoking across home plate in recent years.

I’ve been an independent consultant for much of my career, and so I know what it is to be underinsured - crappy coverage for high prices, if you can get coverage at all. I’ve got a good private insurance plan with the new job, and don’t think I don’t realize how fortunate I am.

Perhaps you’ll think I’m churlish for making the complaint I’m about to make. So be it.

My new insurance company did something last week that ticked me off. They did a little computerized data-mining on my medical records, came to the utterly reasonable conclusion that I was a diabetic, and “helpfully” enrolled me in their diabetes-management program, with one of their “partners”… without asking me, or notifying me, until the “enrollment package” (since I’m already “enrolled,” per their decision, this baffles me a bit) came in the mail.

Here’s what that amounts to: They shared my private medical information, without my consent, with another company, to whom they have subcontracted out the job of trying to make me a less expensive insurance customer.

As a participant in the program, registered nurses from the insurance company's partner would periodically call me at home to check on my progress and offer me advice and encouragement. I could, of course, the letter informed me, "opt out."

Right.

So I called the insurance company on the morning of the next business day, skipped past the “press 1 for this, press 2 for that” business (Tip from Uncle Walt: Check here to see whether there’s a known method for bypassing “voice-jail” for your insurance carrier) and got a helpful attendant on the phone, whereupon I notified her that I was opting out of their free diabetes management program.

She wanted to know why. It was free, after all, and could help me manage my illness. (At least she had the common sense not to tell me that it was for my own good.)

I told her that it was simple: If they wanted me to participate in such a program, they needed to ask first and secure my consent, especially before they started sharing my private information with other companies.

I have a metabolic disorder, and I have it well under control with my own medical team.

It’s not a form of cognitive impairment: diabetes doesn’t affect my ability to think or make decisions for myself, and I resent being treated as if it does.

After all, if I want unsolicited medical advice from meddling busybodies, I’ve got relatives for that, like everyone else.

Disclaimer

dLife's Daily Living columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team to find out what will work best for you.

New Year’s Irresolution

2007-01-16T15:14:34Z

We're already two-thirds of the way through January as I write this, but due to the special Monthly Columnist's Exception to the common-sense rules about holiday greetings, I can still wish all of you a Happy New Year *and* get away with writing a column about New Year's Resolutions... if I hurry.

Health clubs and diet centers do tremendous business in the first few weeks of any New Year, because everyone makes some version of the same New Year's Resolution: eat better, exercise more, shed some pounds and get into shape. Honey, I joined the gym!

It's a wonderful business opportunity for the owners of gyms and health clubs, because many or most of the monthly memberships that they'll sell on yearly contracts in early January will be going essentially unused by March... but the money will just keep flowing in until contract termination. (Wouldn't you love to get paid for *not* providing services to customers who won't complain or try to weasel out of their contracts because they feel guilty and sheepish, or because they tell themselves that next week, they'll start going to the gym again? Man, how do I get a gig like that?)

Avowed gym rats grit their teeth in January, knowing that the hordes of well-intentioned newbies are going to make them wait for the stair-climber and the recumbent bike in the morning, but they also know that in a few weeks, it'll mostly be back to the same old faces again. New Year's Irresolution is in play, and the discarded good intentions will soon be piling up faster than the paving crews can use them (on the road to you-know-where.)

Believe me, I do not write from a position of moral superiority; the ID photo from my gym membership card recently showed up on a milk carton. I know; I saw it in the corner store when I was buying some tortilla chips.

Managing diabetes, or any chronic illness that demands real lifestyle changes, consistently applied, is like dealing with New Year's Irresolution every day. Every morning is a fresh opportunity to take charge and take care of yourself better; every day you face every kind of temptation and opportunity to Do The Wrong Thing.

I have had some modest--very modest--success with making lifestyle changes in the past, and from my experience only, I can tell you that "today is the day I completely change my life!" has never worked for me or for anyone I personally know.

"Today, I can make some healthier choices," though... that works often enough to make a difference.

Have you already blown your New Year's Resolution? Take some friendly advice from a s-l-o-w-l-y slimming fat man: get out of the "change your life overnight" business, because there's no future in it. Take it one day at a time.

Eat a healthy lunch today instead of a cheeseburger--today--and take a long walk or get some other kind of exercise that you enjoy, just for today; don't worry about tomorrow and the rest of your life just now.

Get enough "just todays" under your belt, and you'll be able to tighten it a notch or two tomorrow.

Here's to a healthier 2007!

Disclaimer

A Challenging Menu

2006-12-16T14:42:36Z

The holiday season is at our throats again, as Dorothy Parker either once said or should have, and this month, I'm talking about cooking for crowds with special dietary needs.

When you've got diabetes, finding the right things to eat can be a challenge. I do the day-to-day cooking in the Raleigh household, and Mrs. Raleigh has happily adapted to my food requirements, though not a diabetic herself; this kind of loving support is one of the reasons I'm very glad I married her.

But when you're cooking for a crowd, it's harder.

Around the Raleigh Thanksgiving table this year, there were ten people.

Among our number were: a strict vegan (no meat or dairy products of any kind), two people with type 2 diabetes, a hard-core Atkins dieter, and a person with celiac disease (I'm not a doctor and can't explain this to you, but the dietary restriction involved with this condition is "no gluten in any form" - no wheat products or related grains.). Some of these diners were elderly folks who didn't like spicy foods much, and some were adventurous thrill-seekers who put hot peppers on their cornflakes, judging by how they seasoned my cooking.

I originally set myself the challenge of cooking a Thanksgiving dinner that everyone at the table could eat every bit of, but the permutations would have required a statistician to calculate and document, and aside from sitting an enormous raw salad in the middle of the table and encouraging everyone to "eat hearty," it seemed an impossibility.

So here's Uncle Walt's hint for de-stressing over holiday cooking: don't obsess over trying to cook the perfect meal for everyone at the table.

Instead, you should obsess over cooking a “whole bunch of perfect little dishes”, so that everyone can get enough to eat by mixing and matching what they can eat from what you've got on offer. (There, isn't that better?)

Once I hit on that strategy, the rest was easy.

I cooked two turkey breasts for the carnivores, and made gravy from the pan-drippings for the folks who didn't need to watch their waistlines.

The folks who could eat breads and grains enjoyed the cornbread dressing, a Southern classic; the folks who weren't counting every carbohydrate could pile on the mashed potatoes and the candied yams, too. (I reserved a portion of the mashed potatoes with no butter or milk in them for the vegan, and baked a plain yam for the diabetics--Mother Raleigh and myself--to split.)

And, as it turned out, there were a good number of dishes that everyone at the table could eat--pickled vegetables (a Raleigh family tradition), fresh cranberry sauce (tart and tasty), and this year, a new addition, the World's Best Carrot Salad, which was the consensus hit of the veggie entries on the sideboard this year.

The World's Best Carrot Salad is a Moroccan dish that our favorite falafel restaurant in New York City makes, and since the recipe has been published on the Web this year, thanks to New York magazine, I can share it with you. It's best made a day ahead and marinated overnight, and it's a real knockout.

Try it on your holiday table. The recipe calls for half a teaspoon of sugar, but if you can't bring yourself to use even that homeopathic quantity, Splenda works fine.

And remember, when cooking for crowds, you can't make it perfect for everyone, so don't try; aim for "everybody gets enough to eat," and have plenty of coffee to serve during the football game.

See you next year.

Disclaimer

A Wake-Up Call

2006-11-17T15:06:08Z

The day I found out I was a diabetic, going on two years ago now, a very nice (and concerned) osteopath at a New York City urgent care center offered to send me to the hospital in an ambulance.

Since the hospital in question was five blocks down Seventh Avenue from his office, you might say he got my full and undivided attention.

It was a Friday morning like any other, except that I was walking around with a Blood Glucose in excess of 500 mg/dl (27.78 mmol/l) without realizing it.

That Wednesday, I had woken up on the wrong side of the bed, and had called in sick to work. It felt like sort of a mild stomach bug. Fever, headache, cramps … in fact, a bad pain in my lower left side. Ick.

I make my living as a consultant in the computer business, and I had some important meetings that day, which I conducted from home via teleconference.

And then slept approximately eighteen hours.

Thursday: Lather, rinse, repeat, except that I was feeling too listless to work much at all.

By Friday I realized that things were getting worse, not better. I had been having trouble getting an appointment with my overbooked-and-popular internist, so I got myself to the local doc-in-the-box.

The osteopath who saw me there ran a couple of quick blood tests and, to use a technical term, freaked out.

He sent me straight to the emergency room at (hospital name redacted.) Going to a public hospital ER in New York City is quite an experience, not unlike being trapped for eighteen hours in an overpacked passenger car on an unusually poorly managed third-world railroad.

I was admitted to the hospital directly from my gurney in the hallway.

After four days of blood tests, x-rays, CT scans, and the like, they delivered the final diagnosis:

Pneumonia, lower lobe of left lung (say that five times fast);
Inflamed pancreas, verging on but not quite pancreatitis, and;
Congratulations, you're a Type 2 diabetic.

The diabetes "education" I got in the hospital was a joke: some drug company pamphlets read aloud to me by an earnest but overworked nurse who raced through them like a sleepy priest at an early Mass.

But they did do two very good things for me at the hospital: they hooked me up with a good nutritionist who likes working with diabetics, and with an endocrinologist who is an absolute Rock Star in his field.

Since the time I showed up at the hospital with a blood glucose that was about twice Google's stock price, I've dieted off about thirty pounds, but I'm still tipping the scales at over 300 (on a 6'2" frame.) I'm trying to get down to my "fighting weight" of about 225, but it's been a struggle every step of the way.

Some people eat to live, you see, but I live to eat. Call me "The Morbidly Obese Gourmet."

Disclaimer
dLife's Daily Living columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team to find out what will work best for you.