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©2016 Ascensia Diabetes Care US, Inc. All rights reserved.
CONTOUR® and CLINILOG are trademarks of Ascensia Diabetes Care US, Inc.
Clinilog®
Blood Sugar Logbook
Sample Log
Personal Information
Name _________________________________
Address _______________________________
City, State, Zip __________________________
Phone number __________________________
Emergency Contact Information
Name _________________________________
Address _______________________________
City, State, Zip __________________________
Phone number __________________________
Doctor’s Name
Name _________________________________
Address _______________________________
City, State, Zip __________________________
Phone number __________________________
Daily Testing
I need to test my blood sugar _____ times a
day at the following times _________________
______________________________________
______________________________________
Medication Needs
_____________________________________
_____________________________________
_____________________________________
_____________________________________
Target Ranges
Pre-meal Target Ranges
_____________________________________
Post-meal Target Ranges
_____________________________________
Legends of Symbols
Pre-meal test results
Post-meal test results
Legend of Symbols
Pre-meal test results
Post-meal test results
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Fasting
Week of __________________Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal Jan. 6
8:10 am
11511:45 am
1291:10 pm
1555:00 pm
997:10 pm
1579:30 pm
125Walked 20 mins.
after dinner
7:50 am
125 5 u9:50 am
13912:15 pm
250 6 u2:10 pm
1255:00 pm
99 5 u7:00 pm
15510:00 pm
130
7:00 am
10110:10 am
1451:25 pm
118
99 110 129
127 138 151
:15
50 6 upmp
25
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 6-7 2/9/12 2:22 PM
77
75
72
71
74
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Fasting
Week of __________________
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Fasting
Week of __________________
Pre-meal test results
Post-meal test results
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Fasting
Week of __________________
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Fasting
Week of __________________
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Fasting
Week of __________________
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Fasting
Week of __________________
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Fasting
Week of __________________
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Week of
Breakfast Lunch
DayMedication/
InsulinMedication/
Insulin
M
T
W
Th
F
S
S
Dinner Other Comments
Medication/Insulin
= Pre-meal = Post-meal
84311015_CntrNext_EZ_Clog_EN_FpB1_v0.indd 8-9 2/9/12 2:22 PM
Fasting
Week of __________________
