Blood Glucose Diary

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Blood Glucose Diary WEEK OF: ______________
NAME: _________________________
Check with your provider for your specific targets, and how often you should test your blood glucose level:
WAKING-UP TARGET: _____ _____ BEFORE MEALS: NO MORE THAN _____ ; 2 HRS AFTER MEAL: NO MORE THAN _____ ; BEDTIME TARGET: _____ _____
Breakfast
Lunch
Dinner
Day Date
Medication
Medication
Medication
Medication
Bedtime
Before/2 hr After
Before/2 hr After
Before/2 hr After
M 2/10
Glip./met
126 /164
140/219
109/170
124
Start Walking 15 min twice a day. Had large pasta for lunch.
Comments
Breakfast
Lunch
Dinner
Medication
Medication
Medication
Medication
Bedtime
Before/2 hr After
Before/2 hr After
Before/2 hr After
Date
M
/
Comments
T
/
Comments
W
/
Comments
Th
/
Comments
F
/
Comments
S
/
Comments
Sun /
Comments
By writing down as much information as possible, your health care team will be able to help you understand how many different factors affect your blood sugars.
Be as consistent as possible with timing, portion and type of meals, and physical activity.
VA/DoD Clinical Practice Guideline
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