29 July 2006

Simple rules, not simplistic

What can I say, but that last night I was more in Dreaming than Waking, more towards shadow darkness than shadow light, and was a bit distracted also... I took the wrong insulin. An easy though not incredibly easy mistake to make. One gets used to the action of picking up, measuring, inserting, compensating, withdrawing and then actually giving oneself an injection that often times one does not check the actual bottle one is using. The insulin glargine (tradename Lantus) bottle is taller, thinner and has an unmistakable purple seal and cast to it. Sitting on the other part of my storage area, across from it, is my other insulin (tradename Levemir). My nightly dose is of the latter and not the former, as that is my morning regulatory insulin. Both have long uptake times compared to humalog insulin, and so the pharmokinetics and uptake rates are, within bounds, known. Of the two, the Lantus is longer lasting than the Levemir (24 hours +/-2, vice 8-10 hours), so the former is what gets me round the clock coverage and the latter for the nighttime highs I experience.

There, you now have the exact scientific information of them, but what does one do when such a thing happens. Well, first off, don't panic! Keep your towel handy!

Second, realize that there is a *derived* rule for how the human body reacts with this insulin as has been seen across thousands if not tens of thousands of users. And that rule is: the 3 day rule.

When taking such a long lasting insulin, your body adjusts to this uptake over *time* and that time period for full adjustment is: 3 days. If you make *any* systemic use change of glargine, you must use it for 3 days to understand what your body is doing with this change. So, I am saved by that, as this will *not* be a systemic change and is but a mere hiccup. And the next morning, which is this morning, what do I do?

Well, the pharmokinetics play in here. Last nights dose will last until about the same time *tonight*, and as it is MORE than my daily dose, trying to keep to the daily regimen this morning would over-insulinize my body: I would be keeping extreme track of my blood glucose levels to ensure that I did not drop into an insulin reaction or insulin shock. Thus, I ride out the larger dose with none today. At the end I restart where I left off, take the other insulin tonight and then my normal dose of glargine tomorrow.

So the metadata of this is the 3 day rule. This rule must needs encapsulate the entire pharmacological reactivity of the medication, normal human response to it and general outlook on the medication itself. You *cannot* derive this rule from the pharmokinetics *alone* unless your model system robustly describes the long term activity of the human body. That we do not have, so actual data points tell us how the system responds overall and is *also* encapsulated by this rule. Note that the rule itself explicitly states NONE of this, it tells you merely that your body needs 3 days to adjust to new long-lasting changes to insulin glargine, and so long as you do not make long-lasting changes and merely mis-apply a dose, you have time to think things out and recover.

This concept plays out in many areas be it science, math, politics, or system dynamics: simple rules often govern complex systems and will, of themselves, give rise to complexity.

As an example: Iran, Syria and Hezbollah made a mistake in assuming the world would act as they expected it to when staging a kidnapping of Israeli soldiers and staged an incursion into Israel. They knew the system and expected it to act in one way and one way *only*. But this system is complex, although governed by the simple rules of Nation States. In the complex system of the Middle East, the stasis of the Cold War had been held in place by an interplay of autocratic regimes and concrete lines of religious and ethnic outlook. All of that was built upon fault lines, and the fault lines had been given lubrication in the center of the Middle East where most of them run *through*: Iraq. That area is in heavy seismic shift in all the human realms of society, religion, ethnic outlook, commerce, and outlook. This shifting crosses Nation State boundaries and is re-aligning the Middle East. The simple action to remove a long-term threat in the support of State sponsorship of terrorism has done this. Now that the autocratic regime is gone, the sponsorship has evaporated and, for the first time in decades, the people of this cobbled together Nation finally get to start taking a look at each other as *people* and *individuals*.

There are old grudges there, and they are a leading cause of death these days. And there is sectarian strife due to re-alignment. And ethnic views change through this, too. They are forming the new and adjustable system of coping with the Middle East, and it is a damn hard thing to do. Makes the squabbles between Quakers and Puritans and Catholics and Anglicans and Native religions in the 13 Colonies that became the US seem quaint and naive in comparison. Yet those Colonies knew that if that was not dealt with at the *start* that the New Nation would be disunited and might even start taking up arms against each other on that basis. They opened their history books to the not so distant past and quivered: all that Europe had gone through for hundreds of years could be visited on this New Nation in full force. That was nipped in the bud, so while a Deistic approach that was generalized was *engendered* TO the system, it was not engendered WITHIN the system, so that EVERYONE would have common peace to abide by. That is a simple rule for approach: ascribe what you will TO the system to make it reasonable, but nothing WITHIN the system to make it unreasonable by ALL that must use it.

Iraq, after 3 decades and more of a single dictator, some decade and more of a Fascistic State Party in control and then having a turbulent time before that does *not* have that background and common near history in their minds. The outlook of Iraq is that of *ancient* grudges that have problems going away. Call it the 'Hatfield and McCoy' viewpoint, but writ large with thousands at beck and call, armed with nasty weapons of all sorts. They *also* need to find a system that is ascribed TO many things, but codifies only what ALL can agree to.

That perspective is changing the Middle East as a whole. The chatrooms and message boards are lit up with the free flow of information and ideas from Iraq and realizing that they are hammering out a new way of approaching the world. And desperately striving not to be thrown back into barbarism and sectarian violence forever more. Iran sees this in horror as that is *exactly* what it requires to dominate: a fractured State that it can impose Sectarian rule upon either by the proxy of Sadr or directly. They want Iraq to be one way, and the people of Iraq are heading in a totally different direction and gaining the admiration of the people of the Middle East in that doing. The Center of the Middle East will no longer HOLD the stasis.

These shifts and changes are now evident across the region and changing opinions. It has taken long weeks for regimes to try the old and worn out scripts of 'half a loaf now so the entire loaf might be grabbed later', and those are falling flat. The use of terrorist 'martyrs' are falling flat, when they are not just falling. The bluster of weapons is falling flat. The intimidation via threats is falling flat and starting a sea change of its own as Persia and Assyria conspire to dominate the rest of the Arab nations, including Babylon and Egypt. A simple change, deposing a government and letting things settle by a common assent, has now put a complex set of actions and actors into place. The Arab world *wants* to retreat to the safety of the old stasis. But that safety was ephemeral and now they either adjust... or they will *be* adjusted, either from inside or outside, but that adjustment WILL happen.

Here the simple rule of Nation State ability and outlook for needs is one that can save these Nations: apply them harshly and ask if your Nation will accept being dictated TO by an outsider or if it will stand UP for itself to do those things necessary to keep the Nation independent. Submit or fight. Neutrality gets you into submission as not taking an *active* hand aids those that seek submission.

And so I look upon Jordan, Egypt, KSA and many other States big and small and ask... will they submit and be dictated TO or will they protect themselves so they can BE themselves. At this point a stance *against* Israel is one of SUBMISSION and acquiescence to Persian domination of the Middle East. And so many want to go by the old script of stasis... so that they may be conquered and ruled over, yet again. Give in or stand up for yourselves.

In this case being one of the meek does, indeed, inherit you the Earth... the earth of the grave.

Simple rules to complex results. Never trust those that give you a complex actor and say that 'this is all there is at the start'. Simplistic concepts such as that hold nothing with me... and by keeping to simple rules and applying them to a complex world, I see complex results. Complexity from simplicity. Not given complexity with *no* good underpinnings. The first is attempting to understand, the second is wishful thinking.

As the old saying goes: 'Wishing is not a strategy'.

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