Blood Glucose Monitoring Log

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Print form and fax to:
The Portland Clinic: Diabetes Center
DT: 503-221-1920
Blood Glucose Monitoring Log
South: 503-924-2260
__ Michelle Grove, ANP
__ Christine Olinghouse, FNP
Name: _______________________________
Phone: _________________
Please list glucose numbers and add medication/insulin units in separate box.
Date
Before
2 hours
Before
2 hours
Before Dinner
2 hours
Bedtime
3AM
Comments
Breakfast
After meal
Lunch
After meal
After meal
7811 (6/13)

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