A beautiful number

I slipped into the lab first thing in the morning, and flicked on the light. In the corner was the centrifuge. To the right the Piccolo: a machine that looks amazingly like the first Mac Plus computers, with their little one-quarter screens. It runs complete metabolic panels, lipids, and stuff like that. It weighs about two pounds and cost more than my Jeep. To the left is the complete blood count lab-in-a-box. It looks like a pregnant bread-making machine.

There are shelves of test tubes and all the supplies for blood draws. And rapid tests for strep, flu, HIV, and the stomach bug h. pylori.

Tucked back almost out of sight, next to the strip-reader for micro-albumin and urine analysis, and below the IRN and led testers, is the Bayer DCA 2000. An A1C machine.

When I started this Revel/Sentry adventure, I did a baseline test. I was planning a one-rat clinical study (the single low-down dirty rat being me) to see if all this integrated technology could improve my average blood sugar, which, frankly, has been less than stellar for a while. I’m too busy taking care of everyone else to do a good job of taking care of myself.

Yes. I realize that is a poor excuse, and I never accept it from my patients when they roll it out, either.

The baseline A1C was 7.3. Not horrible. Not great. Bad enough my medical chart carries a 250.03 diagnosis code: Diabetes, Type 1, un-controlled. It means my average day-and-night blood sugar for the previous three months was 163mg/dL. It was actually an improvement. My previous score, sometime back in September had been 7.6. Blah.

But like most type 1s, actually most persons with diabetes of any stripe, my A1C plot resembles the blue prints for a roller coaster. Up and down, and up again.

I pulled a box of A1C tests off of one of the shelves, tore open the foil packaging to remove a cartridge, then lanced my bruised, battered, and callused index finger with a one-shot lancing device—being careful to hold it slightly above the skin. The disposables pack a wicked punch. I got a nice sized drop of deep crimson blood. Next, I whisked half the drop up into a capillary tube and snapped the tube into the test kit. Licking my finger off, I swiped the test kit past the bar code reader, snapped it into the machine, pulled the start tab, and closed the lid. The DCA made some coffee-grinder noises and “Test in progress, Six minutes remaining” appeared on the blue-green LED readout.

Here’s where I always think it should play the Jeopardy music. You know, the jingle they play during final Jeopardy. The game show?

DaDo-da-da-do-doo-doo. Do-dupe. Dupe. Dupe.

I’ll take “blood sugar terror,” for $200, Alex.

The machine beeped.

7.0

Now remember, A1C tests carry the sins of the past. Blood cells, once exposed to high glucose levels never recover. They carry the scars of their encounters with glucose molecules with them to their graves in the spleen at the end of their mosquito short lives: three months after they were made in your bone marrow.

Right now, as you sit reading me (I assume you are sitting, not driving), the oldest red blood cell in your body, the half blind one with the walker, is about three months old. Any test of blood will include brand new cells and old cells. This is why we do the A1C every three months: that’s how long it takes to turn over all the old cells and replace them with new ones. But if your blood sugar improves rapidly, your A1C will be higher than you expect, because of the legacy cells in the mix. Still, either you see improvement or you won’t. If your blood sugar is getting better, doing an “early” A1C will still give you a better number, if not one that’s a 100% accurate depiction of the state of your current blood sugar.

A 7.0 means my average day-and-night blood sugar dropped to 154. It also means I can still be in the next Diabetics Gone Wild video. To be considered to be in-control, my A1C needs to be 6.9. At least as of today. This summer the guidelines are-a-changin.

Still, that’s a damn good drop for such a short time period. So when Revel wasn’t trying to kill me it was actually helping me be healthier.

Hmmmmmmmmmmm….

I wish for fuck’s sake the geniuses at Med-T could figure out what the Sam Hell is wrong with the pinche pumps. If I had a smoking gun—ah, so it was Mrs. Peacock in the Kitchen, with the gun—maybe I could move forward with Revel with some confidence that she won’t stab me in the back. Again.

And again, and again, and again, and again.