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October 26, 2016
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Highways and Byways

I had the privilege of spending much of Saturday at the first annual New Jersey Bicycle Summit, which was a convocation of engineers, planners, and cycling advocates to discuss common issues and ways of addressing them. The theme of the summit was "Complete Streets", which is shorthand for "designing an infrastructure which supports every mode of local transportation" -- cars and trucks, bicycles, pedestrians, mobility-assist vehicles (e.g. wheelchairs & scooters), public/mass transportation, and so on. One of the more important takeaways from this meeting was that the details of a "complete street" will change from community to community, from street to street -- kind of like the way the details of diabetes management will change from person to person, from year to year.


The other major takeaway was that small changes can create great results. For urban planners, painting a single stripe defining a narrower lane and a wider shoulder can make the difference between cars careening at 20 mph over the speed limit and frightening cyclists and walkers, and a thoroughfare on which your school-aged son or daughter would feel safe walking to and from school. (This is not to say that a town center might not benefit from a larger-scale redesign including wider sidewalks with trees providing buffers from the roads, grassy medians, color-coded bicycle lanes, and more elaborate intersection designs -- it's just that its streets might not need so radical and expensive a redesign to best serve all its users.)


It has been stated in several places that one of the biggest contributors to complications of diabetes is persistently elevated blood glucose levels. In the same places it has been suggested that high serum insulin levels contribute to insulin resistance and, over the long run, elevated blood glucose levels that cannot be brought down without relatively huge amounts of insulin. For many of us, making dietary changes to minimize (or for some of us with type 2, avoid) the need for insulin or other blood-glucose-lowering medications is a low-tech change that may stop, slow, or put off the development of complications of diabetes. It's a lower-tech, and often less-expensive method of treating our diabetes. On the other hand, if our blood glucose levels spike up high or remain consistently high, we may need that radical redesign -- oral medications, injectable medications, insulin pumps, and CGMs -- to keep us, and our body parts, "well-oiled and happy".


One of the reasons the simple method of street redesign -- remeasuring lanes and painting shoulders -- works is that it changes the expectations of all users. The motorists no longer expect to use the shoulders as part of their lanes, or a lane's additional width to allow less-precise handling of their vehicles, and therefore they behave in the more measured manner that makes the street safer for cyclists and pedestrians. At the same time, the non-motorist road users expect motorists to respect the marked shoulder -- allowing them to walk (or cycle) more confidently, making them more visible to (and more-easily avoidable by) motorists. In diabetes terms, this is similar to how many of us expect our blood glucose levels to remain in a certain range, based on our diet, medication, and other behavior.


Changing roads into "complete streets" is not a quick or easy process -- nor is it free from resistance. Municipal budgets, lack of community desire for change, and acceptance of the status quo make our streets less safe for our children, our elderly, and those of us who do not own cars. We stay indoors instead of riding, walking, and playing outside -- making us less healthy in the long run. Similarly, many of us resist the changes we know we should make, or need to make, for optimum diabetes care. We may accept doctors who treat us as unknowledgeable about our own bodies, treatment protocols which overtreat or undertreat our diabetes, or personal budgets that may favor "fat cat politicians" of leisure and discretionary spending over the basic "infrastructure" spending for our own health and well-being. Others of us lobby our "health governments" -- our health insurance companies, our healthcare providers, and the manufacturers of our healthcare products -- for the long-term cost-effective solutions or our "individual shares" of patient assistance programs, or we rearrange our budgets to put greater emphasis on own health.


Some of the solutions to road-sharing, such as green "bicycle boxes" at intersections, are still considered "experimental" -- they are not yet part of the Manual Uniform Traffic Control Devices, and planners are afraid to use them. Similarly, many doctors and insurance companies are afraid to prescribe or support diabetes therapies (like CGMs) that are not part of the American Diabetes Association's, or the American Association of Clinical Endocrinologists', Standards of Care for diabetes management. We lobby for, and are willing to document, these novel treatments because in the long run, we think they will make our towns -- and our bodies -- healthier.


Just as no two towns, and no two states, have the same approach -- or the same solution -- to "complete streets", no two people have the same approach or solution to diabetes management. Being able to recognize, target, and implement change -- no matter how incremental -- can greatly improve our quality of life, both with and without diabetes.

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