Blood Glucose Log
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1
2INSULIN ABBREVIATIONS
NovoLog (Insulin Aspart) = A
Humalog (Lispro Insulin) = H
590 Court Street, Keene, NH 03431 Tel. 603-354-5400
NPH=
N
Regular=
R
UltraLente=
U
Lente=
L
BLOOD GLUCOSE LOG
Lantus (Glargine)=
LAN
70/30 =
70/30
75/25 =
75/25
Name: _____________________________
Provider: __________________________
D.O.B.: ____________________________
Phone: __________________________
Phone:_________________Fax: _________
Fax: _________________________
Date
Breakfast
Lunch
Dinner
Bedtime
Comments: changes in
Before 2 hours
Before 2 hours
Before 2 hours
diet or activity, stress,
after
after
after
illness, ketones,
hypoglycemia, etc.
PLEASE LIST DIABETES MEDICATION AND DOSE ON THIS SHEET! (INSULIN AND ORAL MEDS) PLEASE CALL IF BS <70
NAME AND DOSAGE OF DIABETIC MEDICATION:
dietary 4/18/05
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