On the downside, it can be hard to draw firm conclusions from AGP reports.
Very few people (with or without diabetes) follow a consistent, regimented schedule in terms of meals, snacks, exercise, and sleep.
An early morning “dawn phenomenon” glucose rise may not be captured in the AGP report if a person’s sleep schedule changes from day to day.
Postmeal glucose peaks may not appear for an individual whose meals start and end at different times throughout the week.
And it is often not possible to establish cause-and-effect relationships when looking at summaries of large sums of data.
Nevertheless, the AGP report is popular among those with limited time for evaluating glucose data, as it can reveal general patterns of high and low glucose levels.
Logbook Report
When looking at meter data, summary statistics (averages, percent in range, standard deviation) and modal day reports can be misleading.
Suppose you check more than once when your blood glucose is high or low?
What if you tend to check more often when you feel that something isn’t quite right?
These will skew the data and not provide a fair representation of what is typically happening.
Logbook reports permit a more accurate assessment of your blood glucose history, listing readings in chart form according to the time of day.
Once again, be sure to set up the software so that the time intervals correspond with your typical schedule.
A detailed look at your logbook can answer questions such as
• Do lows tend to occur after highs? (Perhaps you are overdosing for the highs.)
• Do highs tend to occur after lows? (Perhaps you are overeating or rebounding.)
• Do you tend to run several highs in a row? (Perhaps your correction doses are insufficient.)
• Do glucose levels change overnight or between meals? (Perhaps your basal insulin needs adjustment.)
• Are there patterns related to when you do, or don’t, exercise?
• Are there patterns after you eat restaurant or take-out food?
D. Carb Counting (and a Few Other Food-Related Things)
Being able to quantify the effect food will have on your blood sugar is essential for matching it with the proper dose and type and timing of insulin.
As mentioned in the previous chapter, carbohydrates are the primary blood sugar, raising elements in the diet. All carbohydrates (simple and complex), with the exception of fiber, convert into blood glucose fairly rapidly. Thus, quantifying the carbohydrates in our meals and snacks is of the utmost importance.
For those who are attempting to match their mealtime insulin to food intake, it is best to count carbohydrates in grams .
This is the most precise and practical way to count carbs.
Using carb “choices” or “exchanges” tends to make things more complex and less precise.
If you are accustomed to using the exchange or choice system, the transition to grams can be made by using Table 4-4 below.
Simply add the amount of carbohydrates you are getting from each exchange, and you have the total grams of carbs for your meal.
In other words, a meal consisting of two breads, two fruits, a milk, and three meats contains (2 x 15) + (2 x 15) + (1 x 12) + (3 x 0), or 72 g carbohydrate. Just make sure you have the right portion sizes for each exchange. For example, one banana may be one, one and a half, or two fruit exchanges, depending on the size of the banana.
When counting grams of carbohydrate, it’s best to count all carbs equally. True, there are differences in how quickly different carbohydrates raise the blood sugar, but all carbs (except for fiber) eventually turn into glucose. For example, 12 g of carbohydrate from milk will raise the blood sugar more slowly than 12 g of carbohydrate from bread, but after several hours the total rise will be the same.
If you consume a food high in fiber, such as whole grain bread, beans, or bran cereal, you may not see as much of a blood sugar rise as you might expect. Fiber is a carbohydrate that is resistant to digestion and does not raise the blood sugar. When looking at the nutrition information on a food label, subtract the fiber grams from the total carbohydrate. For example, a high-fiber cereal that contains 8 g of fiber and 31 g of total carbohydrate should be counted as 23 g of carb (31 minus 8).
The more accurate you are at carb counting, the better you will be able to control your blood sugar.
The more accurate you are at carb counting, the better you will be able to control your blood sugar.
There are several ways to count carbs.
One of the simplest and most effective is label reading.
Food manufacturers in the United States (as well as most industrialized countries) are required to list the serving size, total carbohydrate content, and carbohydrate breakdown on their food labels.
Note that food labels include the fiber in the total carbohydrate even though fiber does not convert to blood sugar.
Sugars (simple carbohydrate)
+ Starch/other (complex carbohydrate)
+ Fiber
= Total carbohydrate
Figure 4.18 shows a sample food label: a serving of Gloopers (a half cup) contains 20 g of total carbohydrate. If you consume a full cup, you would have 40 g of carb.
Some manufacturers of “sugar-free,” “reduced sugar,” or “low calorie” products may use sugar alcohols as artificial sweeteners.
Sugar alcohols such as sorbitol, mannitol, and xylitol are also included in the total carbohydrates on food labels.
Although slow to act, sugar alcohols will raise blood sugar, but less than most other carbohydrates.
As a rule, deduct half (50 percent) of the sugar alcohol grams from the total carbohydrate.
For example, if a food item contains 25 g carbohydrate and 10 g of that amount is sugar alcohol, deduct 5 g from the 25 g, for a total of 20 g.
Figure 4.18: Sample food label
Another tool for carbohydrate gram counting is a nutrient guide. There are many pamphlets, books, apps, and websites that list the carbohydrate content of various foods. Some cover specific categories such as restaurant food or certain kinds of ethnic cuisine; others cover a wide range of commonly consumed foods. Several are listed in