How do I get started?

When SugarPal launches for the first time, enter your name, birthdate, sex and weight, and select your preferred blood sugar units. Enter an e-mail adress for your monthly data overviews, and leave all the other settings at their default value. Do not worry, there is no urgent need to change them now. Leave the "Expert" switch in the "off" position. You are now ready to enter your blood sugar values and insulin doses using the + buttons at the top right of the respective screen. The first reading that needs to be entered is your blood sugar right before your next breakfast. After, record all your insulin doses and blood sugar readings at the moment they occur for a few days, and observe how the blood sugar and insulin screens fill themselves with your data. Make sure you have your iPhone always at hand, since it is difficult to enter results afterwards, and familiarize yourself with SugarPal. During this period, just take the insulin doses advised by your doctor, always select "update baseline", and do not worry about the dark gray blood sugar trend line. When, after a while, the insulin dose and blood sugar level predictions start to make sense, and you have gained some experience with SugarPal, it is time to personalize your blood sugar correction factor and carbohydrate ratio. Consult the built-in help (i) and the support page of this web site for detailed instructions on this. Adjust these parameters in small steps and take your time to evaluate their effect.

Example of bloodsugar screen

What's on the blood sugar screen?

Example of a result screen

How do I enter a blood sugar value?

Example of the insulins screen

What's on the insulins screen?

Example of the injection screen

How do I calculate and enter the dose for a new insulin injection?

Why is the insulin dose calculated in tenths of units?

SugarPal uses tenths of insulin units to give the right advice even for users with a high insulin sensitivity. When you are using an insulin pen that only allows you to dose in whole units of insulin, from time to time you will need to adjust the amount of carbohydrates in the meal a bit to be able to get to the desired blood sugar level with a rounded insulin dose.

Do I need to count carbs when using SugarPal?

It depends, if you, like me, take pretty much the same amount of carbs every meal, you can leave the “carbs” switch in the off state, which hides the option to adjust the amount of carbs before every meal in the insulin injection screen. This can be very handy, and will safe you some time. On the other hand, if you are already used to counting your carbs exactly, it is better to enable the option to take these into account when calculating your insulin dose.

Can I skip or add a meal?

In the past 20 years, I have noticed that keeping a certain daily routine, when its comes to meal intake and activities, makes it easier to control my blood glucose values. That is why the three meals can be shifted in time, as needed in the weekends, and can be changed in carbohydrate content, but can not be skipped entirely. Basically, all food taken during the day is assumed to be part of one of the three meals. As a result, the carbohydrates of any in between snacks should be added to those of the previous meal.

If you live a fairly regular live, SugarPal can help you optimize your insulin dose based on the results obtained on previous days, and probably few additional blood glucose measurements will be needed. If this is not your thing, you may need to look further for a diabetes management scheme that provides more flexibility.

When should I do an additional blood glucose measurement?

If you suspect that your blood glucose is too low, you must do an additional measurement to verify this. When recording the result, leave the right picker wheel of the input screen at 100 % to have SugarPal adjust its baseline for the calculation of the last insulin dose, in order to get a better value the next day. When the blood glucose level just entered is more than 30% below your target, an estimation of the amount of carbs needed to fix this "hypo" is given. If you're not ready yet for a next meal, take an appropriate snack. Then enter a new blood glucose result just before your next insulin injection, this time turning the right picker wheel of the input screen to 0 %, to let SugarPal estimate the extra carbs taken. After, the dose for a new insulin injection can be calculated the usual way.

Example of the settings screen

What's all there on the settings screen?

What should I use for the carbohydrate ratio and blood glucose correction factor?

The values of these factors can vary considerably from person to person. They depend, among other things, on your weight and your insulin sensitivity. A recommendation is given here. First familiarize yourself with SugarPal for a few days using the default values. Then adjust these parameters in small steps and take your time to evaluate their effects.

What blood glucose target values should I be using?

The glucose target values chosen by the program are generally accepted as a good starting point. They should be adjusted if you think they do not bring the desired results.

What should I do if I want to work out?

If you start exercising intensely, you will need less insulin. In particular, if you keep the amount of carbs in your meal the same. SugarPal Diabetes Manager can calculate for you how much you can reduce your usual dose of insulin. For this, SugarPal will keep track of three dose reduction factors. You must first add this specific activity in the list of sports and then select it before calculating the meal insulin. SugarPal can only calculate a proper insulin dose reduction if you practice this sport regularly, and each time with an approximate similar intensity. Be prepared that, when a new sport is practiced for the first time, the proposed insulin dose reduction will most likely not yet result in the desired blood glucose levels.

If you start exercising regularly, for instance to loose some weight, your insulin baselines may drop as well. Provided you let SugarPal adjust its baselines for the calculation of the insulin doses after each suitable blood glucose measurement, this will be accounted for automatically, and all your calculated insulin doses will follow the downward trend.

Example of a daylog

How can I view my daily data?

Why can't I add additional comments?

This option is unfortunately not available. You can use your favorite carb counter application, any former diabetes diary application you might own, or use the default Notes or Calendar application instead.

Why is a built-in carbs counter not included in SugarPal ?

A number of good carbohydrate counter applications are currently available in the app Store. Some of them, like the english Carbs & Cals are especially intended for use by diabetics. If you prefer not to rely on rules of thumb and/or product information, they can be very helpful to establish the amount of carbs in your meals accurately. It can therefore be useful to install one of these applications in addition to the SugarPal Diabetes Manager application.

Why can't SugarPal calculate HbA1c values for me?

Most blood glucose meters for home use have an error margin of about 15% due to the small amount of blood tested. This accuracy is sufficient to regulate the blood sugar levels in a meaningful way. However, this would lead to incorrect results if these measurements were used to determine a HbA1c value. Based on the provided blood glucose measurements, SugarPal Diabetes Manager calculates a median and 10% and 90% cdf values. When you enter your blood sugar in mmol/l the median value is a reasonable estimate of the expected HbA1c value in %.

sugarpal bloodsugar statistics

What is the purpose of the blood glucose analysis screen?

The blood glucose analysis screen becomes available when measurements have been entered for at least 10 days, and is aimed to provide an overview of the long term trends in your blood sugar results. However, when the blood glucose results collected over a period of months, would be shown as a cloud of discrete points, just as in the blood sugar screen, this graph would not be very insightful. Therefore, the individual measurements are analyzed first, before a graph is created. For this, all blood measurements taken over a period of one week are collected, and then sorted by ascending height. After, SugarPal runs along this row with graded blood glucose levels, and records representative values as respectively 10%, 50% and 90% of the measurements have been viewed. This is done for each series of seven consecutive days, and the values thus obtained are plotted in green, yellow and red in the blood sugar chart. Moreover, their averages are calculated. In the above example one can see at a glance that 80% of the glucose levels in the past period was between 87 and 197 mg/dl. Furthermore, half of the blood sugar levels have been lower than 124 mg/dl. Periods when the blood sugar levels were significantly higher or lower are easily recognizable. This analysis takes into account the original time between consecutive blood glucose measurements, and therefore the result is hardly distorted when a few extra deviant blood sugar results measured in rapid succession are entered.

Example of the settings screen

How can I transfer my blood sugar values to my computer or send them to my doctor ?

If you have entered an email account on your iPhone and provided an email address for yourself or for your doctor in the "Settings" tab, the app will create an email with a statement of your measurements in "CSV" format every month automatically. Alternatively, the email button from the "Settings" tab creates a similar mail with the data since your last "Maildate". The simplest way to share your data, however, is to rotate your iPhone either clockwise or counter-clockwise and take a screen shot. With the screen you want to share displayed, hold down the iPhone home button and press the power button briefly. The screen shot will be saved to your camera roll and you can print or email it from there.

What is glycemic control analysis?

The goal of diabetes treatment is to avoid diabetes complications by keeping HbA1c levels low. At the same time, it is desirable to avoid hypoglycemia as much as possible. At every email backup SugarPal therefore makes a glycemic control analysis.

Since fluctuating blood sugar levels can be described with a lognormal distribution, you will find the median values calculated from the geometric mean of the blood glucose levels before breakfast, lunch, dinner, night, and all together in the first line. In the second line you will find the spreads in the blood glucose values, calculated by the dividing blood sugar standard deviation by its median. The smaller this number, the better. In the third line, you will find the cross-correlation coefficients with the immediately preceding blood sugar readings. In the fourth line, you will find auto correlation coefficients with the previous measurements of the same type. These correlation coefficients indicate whether you have used a too large or a too small blood sugar correction factor. Positive correlation coefficients imply that your blood glucose fluctuations are not sufficiently corrected for, and you should set a somewhat larger blood glucose correction factor. Negative correlation coefficients indicate that your blood glucose fluctuations are generally overcorrected, and you would be better off using a smaller blood glucose correction factor.

A period of one month may be a bit short to get a good picture of your glycemic control. If you are considering to adjust your blood sugar correction factor it might be useful to also analyze a longer period of time.

What can I do best when I forget an insulin injection?

Suppose you discover, after measuring your blood sugar before dinner, that you forget to inject your insulin for lunch. Before lunch, you had a rather low blood sugar, and decided, this time, to eat first before taking your insulin. And then after lunch you simply forget to take the insulin. It is not so easy to tell what to do best now. You may need to consult your doctor first. What you should not do in any case, is inject the full lunch dose now. Very likely your remaining beta cells have done all their best to keep the rise of your blood sugar under control. If you inject your afternoon and your evening dose together now, your blood sugar will drop far too much.

My advice is this. First enter the missing insulin dose in SugarPal. Use a fictive dose that would provide the blood sugar you measured before dinner. In this case however, your remaining beta cells have actually provided this amount of insulin. Then you should change the timestamp of this insulin dose to the time when you took your lunch. To do so, enable the Expert mode and press the Organize button on the top left of the insulins screen. The upper record is the latest injected insulin dose. Enter into this record and adjust the time to when you took your lunch. Do not forget to save the adjustments and disable the Expert mode again. After, enter the blood sugar value you measured before dinner. In the blood sugar result entry screen make sure the baseline for the calculation of the lunch insulin dose is not adjusted, by turning the right picker wheel to 0%. Finally, you can enter the insulin dosage for dinner. SugarPal will now make sure that some extra insulin is added to correct your probably way too high blood sugar.

When you already discover that you have forgotten your insulin injection much earlier, because you do not feel so good anymore, it may be desirable to inject at least part of the missed insulin. Be aware of your possible enhanced activity of your remaining beta cells and measure your blood sugar regularly to avoid over correction of your blood sugar disorder. Again use the expert mode to adjust the time of the missed insulin injection and make sure when entering the extra blood sugar measurements that the baseline for the calculation of the lunch insulin dose is not adjusted.

How do I get my blood sugar data back if I lose my iPhone?

After you have purchased a replacement iPhone you can restore your data with a backup from iCloud or from your computer. You can then use the expert mode to add any missing blood-sugar or insulin values. You can also skip this, perform a new blood-sugar measurement and continue where you left off. If, for whatever reason, a proper backup is not available there is still no need to start from scratch since you can consult your most recent SugarPal email backup for the values of your personal settings.

Will there be Android or other OS versions?

Due to limited resources there are currently no plans in this direction.