A DAILY LOG TO HELP YOU CONTROL YOUR …...Diabetes is a serious illness, but it can be controlled....

2520 – 4.16

MY DIABETES CHECKBOOK

A DAILY LOG TO HELP YOU CONTROL YOUR DIABETES

Name: ___________________________________________________

Call 311 to order more copies of this item.

Important Contact Information:

Home Number:

Doctor’s Name:

Doctor’s Phone:

Emergency Contact Information:

Phone:

Diabetes is a serious illness, but it can be controlled. This Diabetes Checkbook will help you manage your diabetes

by keeping track of important health information.

Blood Sugar Log

Breakfast Lunch DinnerBefore

BedDate Before2 Hours

AfterBefore

2 Hours After

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Know and Control Your NumbersTalk to your doctor about setting goals that are right for you.

Goal Date / Result Date / Result Date / Result Date / Result

A1C (Three-month blood sugar level)

Blood Pressure

Cholesterol

Total Cholesterol

LDL (“Bad”)

HDL (“Good”)

Triglycerides

Weight (pounds)

Medications List Write all the medicine you take. Update this list when there are

any changes in your medications. Talk to your doctor or pharmacist if you have questions about your medications or problems

while taking your medications.

Name of Medicine Dose How often per day? Special Instructions

1. Metformin 500mg 1tablettwiceaday Takewithmeals

Medications List Write all the medicine you take. Update this list when there are

any changes in your medications. Talk to your doctor or pharmacist if you have questions about your medications or problems

while taking your medications.

1. Metformin 500mg 1tablettwiceaday Takewithmeals

Medications List Continued

Type of Glucose Meter You Use: ___________________________________

Type of Test Strip You Use: _______________________________________

AfterBefore

2 Hours After

Before2 Hours

6/20/16 90 168 112 157 130 150 139

Blood Sugar LogAsk your doctor when and how often to monitor your

blood sugar levels. This log will help you keep track.

AfterBefore

2 Hours After

Before2 Hours

Blood Sugar LogBlood Sugar Log

Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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Blood Sugar Log

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2 Hours After

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Blood Sugar Log

Important Contact Information:

Home Number:

Doctor’s Name:

Doctor’s Phone:

Emergency Contact Information:

Phone:

Diabetes is a serious illness, but it can be controlled. This Diabetes Checkbook will help you manage your diabetes

by keeping track of important health information.

Blood Sugar Log

AfterBefore

2 Hours After

Before2 Hours

MY DIABETES CHECKBOOK

A DAILY LOG TO HELP YOU CONTROL YOUR DIABETES

Name: ___________________________________________________

Call 311 to order more copies of this item.

A DAILY LOG TO HELP YOU CONTROL YOUR …...Diabetes is a serious illness, but it can be controlled....

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