The first week in August marked the start of the 2010 run of the New York Renaissance Faire, an event in which the most popular exhibitions involve aiming long, pointy objects at impossibly small, circular targets. Whether it's an 8-foot-long lance hooking a three-inch-diameter ring, or a 26" arrow aimed at a bull's eye 100 yards away, or a sword or spear looking to unhinge a 1/2"-diameter ring of chain-mail armour, these are impressive displays of marksmanship and control -- kind of like trying to keep one's blood glucose levels between the mythical "102" and "104" (mg/dl) of glucometer-packaging displays, regardless of what one eats and when. The Other Half and I have also been following Top Shot, in which marksmen propel even-faster, not-as-long, not-as-pointy objects at even-smaller circular targets, from even further away. It takes a focused eye and a steady hand to hit those targets -- not to mention an understanding of the sun, the wind, and the rain -- in order to be able to aim the business end of the launcher at the correct point downrange that will cause the projectile to hit the target.
Not so coincidentally, the logo for World Diabetes Day looks a lot like a blue-and-white bull's eye. A target (no, not the superstore). Something at which to aim used lancets and dead strips. Something to place over the spot at which you're going to insert, inject, infuse, lance, or perform some other routine task of diabetes management. And that target is always moving.
Some people call the pursuit of this goal "tight control". For some, this means testing frequently and correcting just as frequently, if needed. For others, it is all about diet -- restricting calories, carbohydrates, particular ingredients, and particular foods in the quest for the Holy Grail (Holy Grail? Holy Insulin, PumpMan! still another round, ring-like image!) of Perfect Blood Glucose. For one subgroup of these folk, it's not just about the blood glucose level, the foods one eats, and the bolus corrections; it is also about total insulin use. They believe that the more insulin (and/or other drugs used in diabetes management) one needs to maintain Blood Sugar Nirvana, the more damage one is doing to one's residual beta cell function (if one is Type 2), and the more resistant to insulin anyone with diabetes (or prediabetes) is likely to become.
They advocate what we might call Aggressive Insulin Management (AIM).
For most of us, for someone to suggest that we remain between 102 and 104 at all times suggests to us that that person is "on drugs" -- the illegal type (I'm not talking about insulin -- you can get a Therapeutic Use Exception for that!). It's a good bet that the blood glucose measurements of most people without diabetes aren't that steady all the time. 102 to 104 suggests the pinpoint origin of the concentric circles that form the World Diabetes Day symbol, and the targets of healthy blood glucose management.
On the other hand, given the plus-or-minus 20% margin of error which many older glucometers claim, "a healthy 100" means a measured range from 80-120 -- the range that many of us have been told represents "tight control". Since this is a difficult goal for many people with diabetes to achieve, let's call this the white center of the World Diabetes Day logo. Staying in that center white area with minimal use of insulin (and/or drugs) is what AIM is all about.
Applying basic geometric formulas to the logo's specification, we find that the inner white area represents 49% -- roughly half the logo's total area -- and a range of 40 mg/dl in blood glucose readings.
If we take the real 80-120 range we're told represents "tight control" and apply that 20% margin of error, we come up with a range of 66-144, a spread of 78 mg/dl. If we take the AADE range recommendations of 80-140 mg/dl (depending on circumstances and time of day) and apply the plus-or-minus 10% margin of error that most modern glucometers claim inside the 100-200 mg/dl range, we get a range of readings between 72 and 154 -- a spread of 82 mg/dl. Compared to the "bull's eye", either is approximately equal to the area of the entire ring-around-a-circle of the World Diabetes Day logo.
Given what I've read from many people in the Type 1 community, I understand that even this range can be difficult -- if not impossible -- to maintain safely, evenusing the low-carb, micro-dosing, near-orthorexic techniques of practitioners of Aggressive Insulin Management. So like the typical "bull's eye" target, let's add some larger rings. For the second ring, let's take for the upper limit the ADA recommendation of keeping one's two-hour postprandial glucose levels under 180 mg/dl, and for the lower limit, the 60 mg/dl at which many veterans of diabetes first begin to sense hypoglycemia. Again using a 10% margin of error (yes, I know I'm stretching it on the low end), we come up with a range of 54-198, a spread of 144 mg/dl. The area of this circle, relative to the WDD logo, is that of a circle whose diameter is about one-third more than that of the AADE measurements. One might choose to color this ring red for the American Diabetes Association, but because I want to reserve red for the "Danger! Out-of-target range!" area, we'll stick to the World Diabetes Day color scheme and make it a 50% tint of WDD gray.
The last ring keeps the same 60 mg/dl lower range, since it's considered low even for people without diabetes. I've chosen 240 mg/dl as the upper end of the range because it's the "danger level" at which we are advised to check for ketones. Since we are out of the 100-200 range, glucometer accuracy may drop to +/-20%, giving us a range of potential readings of 48-288, a spread of 240 mg/dl and a circle whose relative area gives us a diameter roughly 55% larger than the outer edge of the blue ring. This ring is colored World Diabetes Day gray.
Keeping the left-to-right and top-to-bottom measurements in line with the "relative area" calculation for each target ring, the length and width of the red zone are equal to the diameter of a circle representing a lower "true" reading of 40 mg/dl (at which many people will lose consciousness) and an upper "true" reading of 450 mg/dl (above which some meters will read "HI"), plus-or-minus 20% error.
So there you have it -- a diabetes blood-glucose level target which you can tape to a corkboard and hurl your sharps at any time diabetes gets you down.
Oh... that little yellow dot in the center? That represents "102-104". Would you like to howl in laughter (or frustration) now, or later?
