A1C

I love my iPhone.

To a truly embarrassing degree. This would be true regardless of my current status as a type II diabetic, but post-diagnosis, it is no exaggeration to say that my iPhone is an essential part of my daily routine.

On Monday morning, around 7am, my phone will remind me that it is time to test my blood sugar. Later in the day, I'll log into Couch-to-5K and head out for a run.

I could do all of these things pre-phone, but having a device that reminds and records these events (with snappy UI) makes them considerably more enjoyable.

More enjoyable = more likely to occur.

Now, testing reminders could be handled by the blood glucose meter itself - the thing is basically a clock that also logs inputs of blood - but there's a very basic reason why I don't use the meter to do this.

Here's a picture of my meter:

There are three inputs:

1. The M button
2. The C button
3. The place where you put in your test strip.

If I'm to get a good sampling of what my blood sugars are doing, I"m supposed to do daily tests that vary from day to day.

Task: Set seven different alarms - that repeat on the same day, each week - using an LED screen and two buttons.

The reward for this is having your meter beep at you at the specified time in the annoyingly tinny way cheap electronics have. If you're away from it at the time, you'll just miss it - oops. Too bad.

Setting digital clocks using two buttons is sucky. Setting digital dates using two buttons is worse. And obviously doing both seven times over is worse yet.

Rather like writing a book one letter at a time by signalling to an assistant with your eyelid. Sure, it's been done, but nobody wants that kind of motivation.

But over and above the entry suckage is this: one day, having endured all that pain and plugged your schedule into your meter using Morse code, you finish breakfast and remember that you were supposed to test before you ate. What happened to your reminder? You look down and see that your meter thinks the current day is Friday. Also, it insists that the current time is 9:18pm.

Yes, another of the (many) downsides of having only two input buttons is that one of them is the power button AND the button you hold down to put the meter into setup mode. Holding down a button for a few seconds isn't easy to do by accident - unless you say, put the meter in your pocket and sit down.

Once you've put pressure on the M button for awhile, perhaps your weight shifts a few times (M, M....M.....M) and you've toggled the setup control to the day of the week. Shift again and you've hit the C button and suddenly it's not Monday anymore...(C, C.....C) morning becomes evening. Time travel realized...!

And all of your careful programming is worthless now, and while you could go back and fix it, why would you want to?

Plus, assuming I get all this sorted out and manage to not sit on my meter - by doing something like leaving my meter in my coat pocket. This decreases the likelihood that I'll be around to hear the damn thing beep at me. Missed it? Oh well.

So I'm using my phone - something I carry and look at regularly. It also allows for easy entry of complex inputs.

My current scheduler of choice is Orchestra.
I tried my calendar app, but immediately realized I don't want my testing events to blackout my calendar.

Orchestra's UI is awesome. There's a very satisfying feeling in checking things off the list, plus reminders persist on the screen, so if I happened to (the horror!) be away from my phone during the second it beeped at me - I'd return to a phone with a reminder front and center on the home screen.

Score one for good UI.

Which brings me to Couch-to-5K, the other bit of life altering software. If you'd have told me even a year ago, that I'd be running 3 miles over lunch hour - I'd have laughed in your face.

Today I did over three miles. And it felt good.

Which is the polar opposite of where I was when the Parrot guy was asking if I wanted to go running over a year ago.

And yes, its fair to say my motivation has changed dramatically since then, but Couch-to-5K allows its users to offload a lot of the unknowns:

-How long should I run for to start with?
-How often should I run?
-How did I do? (How fast? How far?)

It logs past performance in a way that is visually appealing (plotting your route on a map) and allows you to review what you've accomplished.

And you get to check things off. I love checking things off.

Week 9 run 2. Done. Whoo hoo!

-----

But all of this reminding and logging was in service to a larger goal. Getting my blood sugar under control. Because it was way the hell out of control. My last blood draw was in December. Normal glucose levels are around 70-99 milligrams per deciliter - I was at 320. Worse, I had an A1C of 12.8% (not 12.7% like I'd put in a prior post).

The A1C samples your blood cells to see how much glucose is stuck to them. Your blood cells die off and get replaced over time - and it is possible to separate these cells into groups for testing based on how old they are.

Each group of cells can then be evaluated for its glucose content, which allows you to calculate an average glucose content across each group. Meaning you can get an average over time using a single blood draw.

Slick.

A normal A1C test should run between 4% and 6%. I was more than double the high end of the range. The A1C percentage can be converted into an estimated mg/dL and that math turns my 12.8% into me averaging a glucose level of 320 mg/dL over two three months.

I'm sure that factored into my new-found motivation to get off my butt and check my blood regularly.

But again, anything that makes those tasks easier, makes it more likely that those tasks will in fact happen.

I've been testing, I've been running. The phone apps have helped a lot. But my last A1C was in December. And a scheduled testing regimen is more than capable of falling prey to human tendencies.

The simplest being: If there's a dessert in the house that I want, I don't eat it until after I test for the day. Less simple: The Sunday and Monday tests are grouped close together. If I'm good on Sunday night, I can net two good scores to my average for the week.

And so on.

But the A1C will not be fooled. If you've been good at test time and bad all the time in between, your hemoglobin will catch you out. It accumulates glucose from all the intervals of the past months - regardless of when you chose to stick your finger.

So it's more or less the report card. And I've been dreading it, because I can think of every dessert I've had since December. Every impulse snack food. Every time I wanted to "treat myself."

And I've been wondering what they all add up to.

So when I get the email that tells me my results are in - my first thought is Grades are in.

I log in like a mad man.

    HEMOGLOBIN A1C     6.3%

    ESTIMATED AVERAGE GLUCOSE  134 mg/dL

            Standard Range 4.0 - 6.0 %

I spend a good long time looking at the screen before I go back to work.

Still smiling as I type this, too.