6. Something Sweet

Dearest Family and Friends,

Children in the backseat quickly forget there is an adult driving the automobile. Car trips are a terrific opportunity to hear young people’s unfiltered thoughts. In California, you might hear a backseat conversation such as this:

Vivian (our seven year old grandchild, to her twin sister, Irene): “What’s your life source, Renee?” Irene: “I feel a deep connection to jump rope.” Vivian: “I think jump rope is my life source too.”

What is your life source? My wife Marcia’s life source turns out to be glucose. I don’t mean glucose as a source of life’s energy — the fuel for cellular respiration. Marcia’s life source is knowing her glucose level — the number — as measured by her new continuous glucose monitor (CGM), a white dime-sized device she wears on the back of her arm under an adhesive patch. Marcia’s continuous glucose monitor measures the glucose concentration in her body tissue fluid and transmits the result to her phone, refreshing its output every minute. 

Granting Marcia contemporaneous access to her glucose level has transformed her as a person, and she is determined to help others reach the enlightened state in which she now finds herself. Glucose is all she talks about. Marcia’s continuous glucose monitor enables her to have a continuous glucose conversation (CGC) with everyone in her vicinity — me, her daughters, our neighbors, people next to her in the checkout line at Berkeley Bowl. 

“Want to know what it is now?” Marcia asks. 

“Sure!” I respond cheerily, hoping to earn another Devoted Husband Coupon (DHC) that I can redeem later for a favor, such as discussing something other than glucose for half an hour.

“It’s one hundred twenty seven,” Marcia announces.

“That’s a prime number!” I beam enthusiastically.

“Very funny,” scowls Marcia, who has little use for disingenuous enthusiasm. “The point is not that it is a prime number. The point is that my levels are spiking after my oatmeal and it is time for another walk.”

I lace up my shoes. 

It all sounds funny enough when you read about it, but try repeating this same exchange with another person every twenty minutes. For the rest of your life. It’s like playing an endless game of fetch with a crazed golden retriever that drops the same saliva-coated ball at your feet again and again. And again. 

And again.

Of course my days are not quite as hopeless as I am making out. Every two weeks Marcia’s monitor must be swapped out for a fresh unit that I reposition on the back of her arm. After a new unit is installed the device takes an hour to self-calibrate and during that interval it doesn’t transmit glucose values to her phone. This means that every two weeks I get a sixty minute reprieve from our Continuous Glucose Conversation. For free — I don’t need to spend any of my Devoted Husband Coupons. See, not so bad. Right?

Monitoring glucose is important for people with diabetes. Which Marcia doesn’t have. But there is some medium-quality evidence that maintaining glucose levels within a reasonable range contributes to metabolic health and helps with weight loss. It is also a very Californian thing to do, and California is where we now live. 

Aristotle (who did not live in California) wrote that virtue lies in the balance. He advanced the idea of a “golden mean” — that virtue is found in the middle between two extremes or vices. For every virtue, there is an excess and a deficiency that are vices. For example, the virtue of courage lies between the vices of recklessness (excess) and cowardice (deficiency). In Marcia’s implementation of Aristotle’s teaching, virtue lies between 70 and 140. If you are a stickler who likes units of measure attached to your numbers, we are talking about virtue falling between 70 and 140 milligrams of glucose per deciliter of blood or tissue fluid. Hyperglycemia (excess sugar) is the vice of indulgence. Hypoglycemia (sugar deficiency) is the vice of asceticism or maybe rebound or — actually I’m not sure which sin produces low glucose, but it’s definitely a moral failing of some sort. Just ask Marcia.

If you are one of my readers who is a driven, competitive sort of person (and you know you are) then you will be interested in hacks to keep your glucose values within the virtuous range. Remember that after you die and are brought face to face with your maker you will be judged by your average lifetime glucose level, so this is important stuff. Obviously, not washing down sugar-coated jelly donuts with lemonade is a good start. But did you know that refrigerating rice or pasta lowers that food’s glycemic index — the measure of how easily glucose is absorbed? This is true even if you reheat the food later. Cooling causes starch molecules to crystallize in a way that makes them less accessible to digestive enzymes in the intestines. 

Eating your starches with protein or fat also helps. Proteins and fats cause starches to be released from the stomach more gradually, blunting glucose spikes. That is why Marcia now puts a dollop of almond butter in her oatmeal. 

But the biggest hack of all is going for a walk fifteen minutes after consuming carbohydrates. Exercise — even light exercise — drives glucose into muscle and out of the blood. Timed walks in the middle of dinner parties create a conversational challenge when Marcia dashes out the door after eating the potatoes, sometimes in mid sentence. But I’m getting used to it. I’ve taken to warning our hosts or guests in advance. What’s a little social awkwardness when staving off eternal damnation?

Every day during my three-block walk to our neighborhood health club I pass by the famous Fournée Bakery and have my own opportunity to practice virtue. I look through the window at each croissant in the display cabinet. Each croissant looks back at me. 

“Hello, Paul,” purrs a flaky double-baked almond croissant. “Beautiful California day, isn’t it? But it could be a little bit better.” 

 “Draw back!” I command. “I have no need for you! You are 38 extra laps in the pool.”

“Paul,” the croissant continues, “You know low blood sugar isn’t good for your health. Or your mood. You don’t want to be a cranky ascetic, do you? Remember, virtue lies in the balance.”

That is true, I think to myself. My levels won’t be elevated for long — I will be swimming soon enough. Moreover, the evidence favoring strict glucose control isn’t that strong for people like me. And what if always maintaining your glucose in the normal range makes you abnormal in some other way? Say, as a conversationalist? That’s the whole problem with Aristotelian ethics. It’s too compartmentalized. 

“That’s right, Paul. It’s too compartmentalized. Don’t let Aristotle tell you what you can and cannot do. You are seventy years old now — old enough to make up your own mind. Why don’t you come inside the bakery and have a look?” 

I have this dialogue every day. 

I’m like a crazed golden retriever playing fetch. With myself. 

More anon.

— Paul

P.S. — Here is a self-portrait I snapped on my 70th birthday, up in the Rockies at 12,000 feet elevation. I am a shadow of my former self, but still hiking.