A1C road show
Blood pressure cuff. Check.
Test strips. Check.
Disposable finger lancing devices. Check.
Looks like we are ready for a round of home visits. It is a beautiful autumn day. Not hot. Not cold. A taste of impending dry winter is on the breeze as we load up my assistant’s metallic-coffee colored Jeep Wrangler Safari Edition. Such a nice day for a road trip. What’d ya say we skip the home visits and go to Starbucks in Santa Fe? I get a very serious scowl in return. Sigh.
What are we forgetting?
Oh yes. I forgot the A1C machine.
What? You ask.
I pop back into the office and crawl under J’s desk to unplug it. Yep. Our brand-new DCA 2000+ is going on it’s first road trip. The machine is a hair smaller than an traveling typewriter (for those of you under the age of 30 a typewriter is a manual word-processing device that we all used before computers; back when we rubbed two sticks together to made fire to cook spaghetti) and half as heavy. In short: imminently portable.
I tuck the machine under my arm and head to the jeep. Let’s go.
We arrive at our first stop, a licensed day care center. The woman who operates it works longer hours than we do, so it is impossible for her to come to the clinic. Parents drop their kiddos off pre-dawn on the way to work and pick them up after dark on their way home. In such cases, we bring the clinic to the patient. The kids run to great us, “The doctors are here, the doctors are here!”
After getting the mandatory hugs, listen to my hearts, and do I have a fever todays out of the way, we can finally attend to our real patient. I plug the machine into an outlet under her kitchen window and set it on a chair. It flashes the software version on the screen and starts making all its little warm-up noises.
I check our lady’s blood pressure and begin to review her BGL log. I’ve also brought along a Levemir flex pen sample and a script; I might or might not add a new layer of therapy today. Depends on the A1C and sugar log, and of course, the patient’s level of compliance with the original plan.
She starts off with a “confession.” She hasn’t been remembering to check her blood sugar very often. Oh, yes, and about half the time she forgets to take her pills. She’s just soooooooo busy. In three weeks I have seven blood sugar checks. Growl.
OK, here’s the deal. I know you are busy. But how much time does it take to take a pill? What, maybe 15 seconds? And I want you to take two blood sugars tests per day. Now how long does that take? What, maybe 20 seconds? So I’m only asking for ONE MINUTE of your time out of each day to take care of your diabetes. How many minutes are there in a day, anyway? About 1400? I’m not asking for much here.
With a beep the A1C machine tells me she’s ready to go to work. I open the foil package that holds a test kit. Then I open the wrapper to a cartridge. I twist the baby-blue top off of a Johnson & Johnson lancet and hold it lightly to her fingertip. Even the “soft touch” disposable one-shot lancing devices can be pretty aggressive. My favorite two fingers are becoming callused from all the demo blood testing I do at the clinic. If you hold too tightly you’ll hurt the patient; too lose you don’t get blood. Older people have softer skin, but reduced capillary response. Manual laborers have thicker skin. Children have sensitive little fingers and bleed easily. You need to personalize your touch. Her hands are dry and smell like Dawn soap. Did you just do dishes? I snap the trigger. She doesn’t flinch. I put gentle pressure on her finger and a bright-red drop of blood wells up. I touch the capillary tube on the cartridge to the blood drop. In a flash it fills. I wipe the edge of the tube and hold it up for her to see.
Five million of your red blood cells, I tell her. Then I snap the cartridge into the test kit, swipe the kit down the reader track so the machine can read the bar code, and with a thunkkkk lock the kit into the testing well. I pull the silver foil tab to start the test and close the test well door.
The machine starts making happy little coffee-grinder noises. We’ll have our results in six minutes. In her kitchen. This is sooooooooo cool!
On our way out after we were done, I see a huge flat screen TV along the wall. It stops me in my tracks. The picture quality is amazing. Was that here before? She blushes, “no my husband got it. I hate BestBuy!” Huh. It’s beautiful, I allow. “Well, the kids like it,” she mutters.
And A1C machine cradled gently in both arms, I head down her stone steps to the jeep. We’ve got more people to see today. Accurate, on site A1C testing. It doesn’t get any better than this.