One of SweetSpot’s advisors, Michael Fulop, and I were giving a talk titled ‘Nag, Shame, and Blame: not working for you?‘ We had all the ingredients needed to keep it interesting, and not necessarily in a good way: it was at the end of a very long day at the Expo, it was the first time Michael and I had tag-teamed for a talk, my folks were quietly sitting in the audience, and generally I would rather eat barrels of overcooked spinach than talk to a large group.  In the end, things turned out quite well, I’m glad we did it, and we’ve talked about doing a few more. Watch out!

We covered many topics, but someone asked about eating habits causing diabetes and expressed a sense of deep guilt and shame. Michael, being an experienced psychologist, quickly addressed this, not able to let such a toxic topic fester.

I’ll admit that the comment surprised me. I realized afterward that I rarely hear someone completely blame themselves for their diabetes. I’ve been in a rather insular world with people who have Type 1 or who have had the disease for a long time, so this sense of guilt and personal fault doesn’t often come up. I’m glad Michael jumped in, because I was sitting there feeling a bit stupefied.

I’m somewhat sheepishly going to bypass the issue of what lead up to this person’s guilt: eating habits. It is not an area I am familiar with and it is a minefield of raw emotion. The debate has become incredibly brutal. For example, a study titled “Changes in Perceived Weight Discrimination Among Americans…” was recently published in Obesity, a scientific journal owned by Nature, and here is a group of responses to that article that actually highlight the articles points about discrimination quite well (update: the forum I linked to is self-moderating, so some of the more acidic comments have been demoted).

Instead of focusing on the fault, how can we address that guilt and move forward?

Going back to this particular case, Michael hit it from two angles (we didn’t have a lot of time since this was during a Q & A at a public talk). One was to talk about the root cause of the guilt, which was the belief that eating habits (weight and lifestyle) caused the diabetes. Michael pointed out that the literature doesn’t talk about diabetes as having a single cause so much as a series of risk factors. This long and growing list does indeed include weight and lifestyle, but also age, family history, and race. Outsiders tend to underestimate the complexity of this disease. The second angle was about the need for support in moving through the guilt.

These points seem straight forward, and perhaps self evident. Yet the response from this person was part surprise and part relief; it seems their doctor just handed over some pills, said lose some weight and see you in six months.  There was no framework in which to come to terms with and understand this complex disease.

The challenges of living with diabetes do not lie in the traditional medical realm (barring the search for a cure, of course!). If it was as simple as following exactly what the doctor orders, which could include testing 3-12 times a day and taking the occasional shot of insulin, diabetes would be a significantly lighter burden than it really is. The mental trials facing those who live with diabetes are too seldom addressed.

Hello everyone!

We have started a blog: yes, another company blog is on the internet!  Yippee.  But hold on, we’ll be doing things a bit differently.  We’ll cover a wide range of topics about dealing with diabetes, startups, and policy chit-chat.    We are sharpening the pencils, throwing away the erasers, and diving in.  Come on over and say hi.  Here are some recent posts you might find of interest:

• Here is where we draw the line.
• The obligatory family story.
• And about life inside a startup.

SweetSpot Fetch improvements, and more devices supported

Before I dive into specifics, we would love to hear from you which devices you would like to see supported next.  Do you use a Cozmo insulin pump or one of those new fancy glucose meters?  Letting us know what you would like to see will help us prioritize what to work on next.

As for new device support, about time, I say!  We are currently rolling out Accu-Chek support and could use your help.  We will be following the Accu-Check compatibility with support for the Dexcomm CGM.  With both of these devices, we could use your help to verify they work on a wide variety of platforms before we open it up to the hordes.  If you are interested in testing one or both, please just respond to this email.

Fancy Reports

The reports that you can generate have been given a serious dose of beauty-juice!  We’ll constantly be tweaking them and making them more interactive, but they are much improved.

• Pretty reports can be scheduled here.

Improving Data Entry

Thank you for your input and suggestions; we’ve been paying attention!  Here is a digest of changes we have made.  It is now much easier to add entries manually.  You can send multiple entries at once by email.  (This is handy, for example, for the school nurse who is keeping track of those in-school numbers: have her email SweetSpot instead!)  You can import your data from CareLink, so add that insulin pump and cgm information! Twitter support is lurking in there as well.  Keep those suggestions coming!

• Learn about sending email here.
• Import data from your old diabetes program.
• Set up Twitter — it couldn’t be simpler.

Website Updates

The housecleaning has not abated!  It is a bit like “Where’s Waldo:” can you spot the tweaks?  If you notice something that we can change to make your life easier, as always, just let us know.

About Us

Curious about who we are?  Here is a virtual introduction.  

I’ll be in New York City the week of May 19th and in the Washington DC/Baltimore area the following week.  It would be great to sync up with those of you located nearby.  So contact me by replying to this email and we can meet up for coffee or lunch/dinner.  My treat. 

Have a nice day!

Adam Greene and the SweetSpot Team

Umair Haque has written a poignant essay titled “An Open Challenge to Silicon Valley“. His main concern is that Silicon Valley is throwing money after incremental improvements under the guise of being ‘revolutionary.’ He calls out these self-proclaimed techno-leaders as sheep in wolves’ clothing, who are too busy partying to pursue strategically radical ideas.

I love essays like these! They purposely bait you, and if they are well written (a little spice is a must), the argument is sound, and they are passionate, as this one is, you can’t put the related thoughts aside. Umair is sounding an alarm bell about lost opportunities to benefit the common good, and I only have respect for his thoughts and critiques.

However, innovation no longer happens with a lightning strike in a laboratory. This idea of aiming for revolutionary ideas is sexy, but empty. What is revolutionary often takes years of incremental improvements and won’t be embraced immediately (the automobile comes to mind). Of course there are exceptions, but generally speaking, thinking big is not the same as delivering big. This has been shown again and again; the graphical user interface was in development for multiple decades before Apple Computers picked it up, and the Internet existed for almost 40 years before the web pushed it into the limelight. Umair’s essay brings up many thoughts of my own — too many to list here at this time, but here are two very different examples from the diabetes world that come to mind:

• iSense is a local Portland, OR company that set out over ten years ago to create a continually running long-term glucose sensor. When I first heard about it way back in the beginning, I was giddy with excitement: a 30-minute appointment to implant the tiny device under your skin, pace-maker like longevity, and continually sending back information to a wristwatch? That is worthy of the over-used ‘revolutionary’ label! Yet as they enter the last phase of trials, they are looking at a competitive marketplace with three similar devices already on the market. To be able to deliver in the face of technical and scientific limitations, iSense has had to scale back the scope. I had the opportunity to visit their labs a few months ago, and what I saw is still an incredibly exciting device with the potential to provide real benefits to people with diabetes. The iSense provides a solid foundation on which to move into artificial pancreas technology. It is a first-generation product with a bright future, but it is entering a marketplace where it will no longer be considered revolutionary.
• Amy Tenderich wrote a well-received piece last year imploring companies to make a drastic departure from the current M.O. when creating and designing diabetes equipment. I would argue that design advancements can indeed be a radical step forward in this space. For example, there is no reason why testing your blood sugar levels should take at least 12 steps every time you do it. This year she has followed up with a much more pragmatic call-to-arms by hosting a design contest to help push the process along. I enjoyed her open letter last year, but I think the design contest is where progress can be made. Yet the scope has had to be scaled back drastically, which will lead to more incremental advances rather than an aggressive break with the current trends.

Only with the advantage of hindsight will we know what is revolutionary. Just as we now look upon Apple and the Internet as being revolutionary, perhaps we will look back at what companies like iSense or individuals like Amy are working on and see how they helped us leap forward.

Meanwhile, take a look at what is happening outside of the parties, the VC realm, and perhaps even Silicon Valley. In the margins that don’t make the news or the seminars at Harvard Business School we’ll find the companies that Umair is looking for.

———-

I highly recommend reading Paul Grams excellent essay The Power of the Marginal.

A warning for those of you who aren’t tech-crazed.  My wife mentioned that reading this was like having a bucket of gravel dumped on her brain.  I wish I could interpret that to mean she is in awe of all things tech, but something tells me that would be wishful thinking.

As we work on providing support for current and next-generation continuous glucose monitors, it has become clear that SweetSpot will soon be storing billions of glucose entries. Yikes! Numbers like these will send shivers through anyone running a lean-and-mean startup.

There are plenty of short-term fixes to improve the efficiency of the database: consolidate columns, move sparsely used columns into their own table, minimize the number of indexes, etc. The same methodology applies at the application layer: minimize interactions with the database, use bulk inserts, minimize object creation, blah, blah, blah. These techniques will actually buy us a fair amount of breathing room, but they aren’t long-term solutions.

Now we get into harder choices.  Microsoft sql server, mysql, postgres, and db2 are examples of Relational database management systems (RDMS) and are what most people think of when they think of a database. RDMS’s are very powerful software packages, yet they are notorious for not being able to scale out. You can throw a lot of expensive hardware at the problem to scale up, but fairly soon you’ll need to consider techniques like summary rollups, vertical and horizontal partitioning, data warehousing, and sharding to try and scale out (see this piece about the difference between scaling up and scaling out). I cut my teeth working on what was at the time one of the top 5 largest known RDMS’s in the world. One of my jobs was to pull information out of this behemoth system; I definitely experienced the pain of implementing some of these techniques. They sound straight forward but can be incredibly expensive to create and maintain. (I haven’t tried sharding, and it sounds like it might come the closest to being able to scale out the database bottleneck. It is a fascinating idea.)

OK, enough of this lecture! Where does CouchDB come into play?

The CouchDB documentation is dripping with drool-worthy keywords: erlang, shared nothing clustering, a RESTful and JSON interface, lock-free concurrency, and ad-hoc and schema-free querying running through a map-reduce system. This all adds up to what can awkwardly be described as a distributed document non-relational database system.

This triggers some serious geek lust (my wife really begs to differ, but I love her anyway).

How does this affect SweetSpot?

• The relational aspect of RDMS’s, being able to say I want to join this information with a little information over here, and mix in from there, is not really needed. SweetSpot’s main data store contains minimal reference information, so it is pretty much storing documents that are retrieved from the database, minimally modified, and then consumed by the calculation engine, a data feed, or the website.
• SweetSpot’s usage patterns tend to be many reads interspersed with large bulk inserts from medical devices and data imports. These two patterns will clash more and more as the system grows, so a lock-free system is very appealing.
• SweetSpot is a heavy user of the data stored within its system; it aggregates and pushes it out to users and eventually to research centers and hospitals (only when authorized by the users; we take our members’ privacy very seriously!), and it runs increasingly complex calculations. A replication and shared-nothing clustering framework gives us more options for structuring our architecture to deal with these cases. For example, we can build a calculation cluster which has a local replicated version of the entries, where it can just hum along running calculations as needed while not slowing down the main application.

I’ll stop right here and proclaim that I am guilty of being a bit too starry-eyed about CouchDB; for one it is terribly slow and resource heavy, it lacks an authorization and security layer, and the API is not quite as flexible as it needs to be.  While there is a long way to go for it to play the sort of role I imagine, it opens up a wide range of possibilities for web applications in general. For example, a web application can have javascript running on the client’s machine, requesting and manipulating JSON directly from CouchDB without the need for a middle layer like RubyOnRails or Spring.

CouchDB is an impressive piece of alpha software, starting with the admin web-interface and finishing with the stupidly simple replication setup. The database is only accessible via a RESTful interface using JSON objects, with views onto data being constructed from javascript functions that wrap a map-reduce system. The developers are moving like wild hares, fixing and improving the system at an incredible rate.  Spend a little time on the IRC channel irc.freenode.net#couchdb and you’ll see what I mean (the performance tuning is just about to get underway, so I was told).  

This is a project worth keeping your eyes on.

Thank you for making it this far, and as a little reward, here are some commands you can use to get started with CouchDB.

• You can kick the tires by following these commands
svn export http://svn.apache.org/repos/asf/incubator/couchdb/trunk couchdb
cd couchdb
#if you don't have a mac, check out the README
sudo port install erlang icu SpiderMonkey
#and go get coffee!
./bootstrap -C
./configure
make && sudo make install
#note: check README on security tips on how avoid running as root...
sudo couchdb
• Get started by going to http://localhost:5984/_utils/index.html. By using FireFox with the firebug plugin, you can poke around to see how the admin interface creates and receives JSON msgs from the database. Slick!
• create a new ‘database’ (it is not really a database but just a way to organize your documents):
  curl -i -X PUT \
-H 'Content-Type: application/json; charset=utf-8' \
http://localhost:5984/mydb
• create a new document:
  curl -i -X POST \
-H 'Content-Type: text/javascript; charset=utf-8' \
-d '{"something":"interesting", "with_goodies":["here", "and", "here"]}’ \
http://localhost:5984/mydb  
• let’s go read the new document you created! (take the id returned in the above response and replace ID_HERE with it:
  curl -i -X GET \
-H 'Content-Type: text/javascript; charset=utf-8' \
http://localhost:5984/mydb/ID_HERE
• now that we have a document, you can create views to sort, filter, and generally do some data munging:
  curl -i -X POST \
-H 'Content-Type: text/javascript; charset=utf-8' \
-d "function(doc){ if (doc.something=='interesting'){ map(null, doc.with_goodies); } }" \
http://localhost:5984/mydb/_temp_view  
• And I’ll leave you with this little trick:
curl -i -X PUT \
-H 'Content-Type: application/javascript; charset=utf-8' \
-d '{"_attachments":{"foo.txt":{"content-type":"base64","data":"VGhpcyBpcyBhIGJhc2U2NCBlbmNvZGVkIHRleHQ="}}}' \
http://localhost:5984/mydb/my_docs
  You notice how we use a PUT instead of a POST? PUT is what you use to either modify a document or to create a new document with a user-defined ID, which in our case is ‘my_docs’. Now go to http://localhost:5984/mydb/my_docs/foo.txt; pretty neat, eh?

Editor: We’ll be posting all future newsletters here at the blog. Here is the last one we sent out a little over two months ago; time to whip up another one! Oh, the poor Pats… but we don’t want to spoil the New England sports fans too much with championship teams in almost all the major sports categories.

Happy late New Year to everyone!

I’m very excited to announce a new feature at SweetSpot: Tips and the Tip Jar. We all have garnered ‘tricks of the trade’ from having to deal with diabetes. Some we have picked up from the doctor or from literature, but most of them have been passed by word of mouth or learned from hard trial and error. Enter SweetSpot’s Tips, a place to share what you have learned with others in the SweetSpot community. You can stash your favorite suggestions from other members in your tip jar so you won’t forget.
Fill up your Tip Jar here: https://www.SweetSpot.dm/tips

Snazzy Graphs

The graphs have been gussied up, but the changes go much deeper than a fresh coat of paint. Let me introduce you to the 24-hr digest, a new way for you to see what your glucose levels are doing. Instead of trying to make heads or tails of your glucose levels from Monday through Sunday, the 24-hr digest will show your weekly, bi-weekly, or monthly averages at each time of day. This is a great way to spot trends you may not have previously caught.

Snazzy graphs here: https://www.SweetSpot.dm/home

Changes at SweetSpot HQ

The new year finds us adapting to life with a sassy puppy. Lark chews firewood with abandon, but splinters all over the house are something I and the vacuum can deal with as long as she leaves the shoes alone.

Gratuitous puppy pictures here.

Entering and retrieving your data

We have thrown a handful of improvements your way based upon your fantastic feedback and requests. The data entry screen is simpler and easier to use, you can retrieve your notes and entries into spreadsheet documents, and we now have handy RSS feeds for your consumption. What is RSS? Think of it as your online paperboy delivering news and useful morsels of information right to your computer. Your team can use these feeds to see the team notes or perhaps those recent glucose entries that are outside your ideal range. Definitely contact us if you would like some further explanation or help in using your RSS feed.
Come get your feeds at: https://www.SweetSpot.dm/account/import_export

Website Updates

SweetSpot has had a little housecleaning. Nothing too outrageous,but we have tidied up the sidebars a bit and simplified launching ‘SweetSpot Fetch’ for Macintosh users. Now you can just click on the ‘Fetch device data’ without having to worry about downloading it yet again.

Have a wonderful day!
Adam Greene and the SweetSpot Team

P.S. For those of you in the States, the SweetSpot confessional will be open after a Sunday of junk food and commercials this Super Bowl weekend! Go Pats!

I’m in the middle of writing a post regarding diabetes guilt and fault, which is a dark and rarely discussed topic in the diabetes world.  Dark is something a business blog should not touch on, and in fact should stay away from like the plague!  You marketing types should avert your eyes.  However, it is in important topic to talk about if our interests are to help people deal with diabetes on a daily basis rather than just collect numbers and create pretty graphs.

But that is for a future post!  

I’m sort of slogging through this post because I’m sitting in a cafe in Portland, Oregon (perhaps I should admit that I’m taking up space) where delightful distractions abound!  The coffee shop is setting up their used and funky coffee roaster…and the smell is heaven!  There is a gorgeous, playfully mammoth dog outside (mix german shepherd and st. bernard perhaps?) and two little kids playing in the corner, wearing teddy bear overalls complete with hoodies and little furry bear ears.  The final distractions are the melodic remedies of Handel’s Semele and R.E.M’s new album Accelerate.  R.E.M. is back, and being a sucker for foot-tapping alternative pop, I’m really digging their new work.  

Diabetes guilt is a very serious topic, but good things happen around us that are worth noting.  I hope you don’t mind if I share them; they just seemed too good to keep  bottled up.

How is this for a non-business post!

Remember when the fad du jour was the South Beach diet? The modus operandi was to reduce your carbohydrate intake and increase the ratio of protein-rich foods. It was a regime developed by a cardiologist in Florida, and with a heavy dollop of marketing savvy (who would want to follow a diet described in a study as “A randomized, controlled clinical trial to evaluate the efficacy of a modified carbohydrate diet for reducing body weight and fat in overweight and obese men and women”?), the South Beach diet became a national phenomenon. And basically healthy folks looking to lighten the saddlebags got a taste of the dietary hurdles people with diabetes face every day.

Now, I moved out of New York City, so the conversations no longer move from the financial markets into politics then diets; in Portland, OR they tend to go from politics into biking and food! Perhaps the South Beach diet is now totally passé. But how many people do you know who stuck with it for eight months? How about two years? Drawing a blank? I know I am! Now imagine having diabetes, and needing to do this for the rest of your life.

Why is this so darn difficult? For one, saying you’re on a diet implies that it is an exception and not a part of your daily life: diet today, let freedom ring tomorrow! Diets are open to all sorts of misconceptions about what one is supposed to do, especially those with the South Beach diet’s emphasis on consuming a larger quantity of one type of food while reducing the intake of another. Case in point: One morning I stumbled downstairs to find my father pouring heavy cream on his cereal. He confidently explained to me that since he was having a smaller quantity of carbs, he could make up for it by using a more protein-rich liquid. There was a twinkle in his eye, of course — he loves a chance to trot out his degree in creative BS! But in all seriousness, the calculations necessary to keep a diet on track can take the joy out of food and the pleasurable ritual that is a meal. Who wants to do that every day for as long as they live?

This is why counting carbs is so darn difficult. But it is important — nay, a necessity — if you are living with diabetes. How do you balance healthy eating against carb-counting burn-out in the long term?

Here are my five strategies:

• Count religiously for one week, then ease up.

The bagel with just a wisp of cream cheese is only, say, 30 grams of carbs? That half sandwich is only half a serving, because it is a half! Easy!

It is amazing how wrong we can be when we eye-ball it. Do I really want to admit that lasagna is two servings instead of one? Yet really counting is tedious, because to do it right you need to count everything. You have to read packaging, measure, learn to accurately gauge what you’re eating. So dive in and and really go for it; but for one regular week. You’ll find that afterwards your guessing will be a lot more accurate, less stressful, and quick.

• Do it together.

It is significantly easier to follow a regimen if you have allies in your camp. Nothing makes changing your habits harder than when you are having blueberries for dessert and someone sidles up with an ice cream sundae. If your family does this, feel free to bring out the Holy Hand Grenade.

O Lord, bless this Thy hand grenade that with it Thou mayest blow Thine enemies to tiny bits, in Thy mercy.

Don’t forget, ‘in Thy mercy’.

• One step at a time.

Forget grandiose plans for improvements. Instead, start with the low-hanging fruit. Perhaps you can replace that bagel and cream cheese concoction with ants on a log. It might not be as bold as declaring that you will swear off 24 oz steaks and trimmings in favor of lemon tofu drizzled with puree of sweet peas (hmmm, that doesn’t sound so bad… life with my vegetarian wife must be making me soft), but changes made gradually are more likely to become lasting habits.

• It’s not a diet, but a lifestyle.

As I mentioned above, saying you are on a diet implies that it will be ending and you’ll go back to your hell-raising days. If that is how it goes, I’ll save myself the pain and skip right over the diet, thank you very much. What we seek is a better lifestyle, not a rollercoaster of broken resolutions. So view it as such.

• Relax and enjoy.

Honestly, this is food we are talking about. The delicious flavors and companionable rituals that surround it can make it one of the greatest pleasures of a day. Bon appétit.

What are your thoughts, observations, and tricks?

I found this article in the NY Times to be terribly depressing.  When will this apply to diabetes patients?  (I know some of you would argue that it already does.)

Treatments for many chronic diseases are available to cure, slow the spread, or improve quality of life, but they are increasingly moving out of our financial reach.  I’m torn between knowing full well the burden placed on businesses and society to cover escalating health care costs and my notion of what is right.  This mix of cost-benefit analysis and ethics is a quagmire to navigate.  

For example, my godmother is fighting cancer and has used experimental $100,000+ drug regimens.  While she is not “cured”, she has been living a wonderful, full life way beyond the survival rate for this sort of cancer. (We are incredibly lucky to have her still with us; she is a lovely woman and a pistol!).  Is it within her right to receive such a treatment if available, or is it a gift?  Can it be both?

Using a model where insured patients have a co-pay of 20-33% of the costs of these Tier-4 drugs is the ‘easy’ solution, if one can call it that.  But, how is this ethical?  For starters, it does not take into account the age of the patient and whether or not we should give preference to younger people who have a life as a productive citizen ahead of them.  What about one’s ability to pay (which is, after all, how most income tax systems work)?

Yet I have no idea what a policy would look like that is an social responsible but also fiscally attainable.  This is an issue that we’ll be seeing more and more of in the diabetes community, and we need to start discussing it now.  

I don’t want to prattle on, so I’ll stop here because I would love to hear your thoughts.  

I need to briefly describe my dad. He is fairly tall, broad of shoulder, and can stop almost anyone in their tracks with the stare. He can pull off this gruff, curmudgeonly look with a fair amount of mischievous panache. I’ve been taking notes on how to pull this off for years, yet my wife just snickers at me.

One evening dad showed up to dinner wearing an insulin pump. At that time they were brand-new, we had high hopes for it improving life with diabetes, and being a gadget-head myself, I was overflowing with curiosity. Electronics, tubes, and little whirling worm gears, oh my!

A few minutes into the meal we all noticed a faint ticking sound. Dad stopped eating, leveled us with the stare, and in that gruff voice declared it to be the tick tock of the crocodile. Hah! It was the little gears in the pump slowly injecting insulin.

I like to think of him sitting at the prosecutor’s desk in a court of law, and after a pregant pause caused by a faint ticking sound, saying “it is the tick tock of the crocodile, your honor”.

Wendy, the first commenter on this blog (brave soul!), created the “Diabetes Life Balance” blog, which is a great premise (and is worth a post of my own some time in the future). The title made me think of the work-life balance in creating and running a start-up, which can be summed up in one clunky word: nonexistent. This is the third start-up I’ve participated in at some level and by far the most consuming. It is a blast, in both good and bad senses of the word: I wouldn’t want to be doing anything else, and hey, I might be helping the family deal with diabetes (if they are still talking to me when all is said and done!). But as successful entrepreneur James Hong has said, “If you’re not already bipolar, you will feel like you are.” And life, as in a life outside of work? Uhm, that would be a definite no.

This seems, at least to me, to be self evident. The start-up lore deifies naive kids working in a garage, subsisting on coffee, Jolt (more caffeine can’t hurt!), and copious amounts of cheap food, sleeping in their clothes under makeshift desks. People know this, but they still want to hear about the hours worked, rejections received, or hurdles overcome. Depending who’s asking, it’s voyeurism, schadenfreude, or sadly misplaced envy.

What is hard to explain to folks is the all-consuming nature of a start-up. SweetSpot is the last thing I think about before I fall asleep, and when I wake it’s the first thing back. Some mornings it crashes down on me, on others it sidles up seductively. My wife reports that I even talk about computer code in my sleep. Yikes! I’m a bit of a political junkie (’tis the season), and I make a point of spending some non-work time with my family every day, but few things beside reading the news and walking the dog break up the daily focus on the start-up. If I’m not actively working on it, I’m thinking about it.

If you want a more erudite account of why balance is hard to come by, I highly recommend Founders At Work, by Jessica Livingston. If you have worked in a start-up or you’re masochistic and dream about doing so, this book is fantastic. There are many brilliant bits, but the interview with Joe Kraus of Excite constantly rings true to me. Here are two gems:

The hardest part in a startup is that you wake up one morning, and you feel great about the day, and you think, ‘We’re kicking ass.’ And then you wake up the next morning, and you think ‘We’re dead.’ And literally nothing’s changed.

and…

It’s the whole sausage and sausage factory problem: when you’re outside and you only see the sausage coming out you think, ‘That’s pretty tasty.’ When you’re on the inside and you know how it’s made, it’s terrifying.

I think the hope of every start-up founder is to balance work and life over the long term. Initially this means work now and life later. Give it everything you’ve got while you’re young, and afterward there will be time for the pleasures and duties of family life, or travel, or participation in a community of friends. But we’ve all known people who never quite found that balance — couldn’t let go of the work routine, perhaps, or let an important relationship disintegrate through neglect.

The topic of work-life balance has been coming up quite a bit recently. For one, I happen to like my family quite a bit, so spending some time with them is a must. I’ve also found that while start-ups demand burst of intense energy, they can be, surprise(!), marathons instead of sprints. How do you avoid compromising the Life side of the equation, even when you are in the midst of start-up fever?

From the beginning I’ve been hesitant to start a blog of any sort. I’m the sort of person who loves to sit around the table having a conversation about anything, as long as it’s passionate. A blog can easily become a monologue (or rant) into the void, a soapbox from which to preach into the ether. No thanks, not interested!

Yet, many folks have pointed out to me that SweetSpot.dm needs a better web presence. It is not enough to strive to build a fantastic diabetes wellness service; we need to tell people about it, and I need to participate in the larger diabetes community as Adam, creator of SweetSpot, and not as a volunteer or anonymous commenter on others’ blogs and forums. Marketing and self-promotion leaves a soapy, gritty taste in my mouth, but I grudgingly agree.

All of this is a wind-up to the question in the title: Is it a conflict of interest to participate in the online diabetes conversation as a business entity? Does my web presence as a service provider necessarily hinder a free exchange of ideas to improve life with diabetes?

It seems like an easy line to draw, especially if my presence is honest, upfront, and fully participating, but one has only to spend a little time in the diabetes online world to be bombarded by hawkers of snake oil. Speaking of leaving a bad taste in one’s mouth!

So I’m hypersensitive to this line, and while I’ll try never to cross it, I can only make sure SweetSpot is always honest and forthright in our interactions on the web. I do have a service to offer, but that service was born of a sincere desire to help, and the more I can learn in the online forums of others’ experiences and needs, the better I can refine it.

We’ll see you out there!

Yes!!  Yet another company blog! 

But we’ll be doing things a bit differently.  Sure, we’ll be talking about the going-ons at SweetSpot.dm, but we’ll be expanding the horizons to cover all sorts of topics around diabetes, the family, starting a business… the works.  Stay tuned!