Blood Sugar Log Template With Hours

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Hendricks Endocrinology
Blood Sugar Log Sheet
Phone 317-745-7445
Fax 317-745-7449
Patients Name________________________________
DOB________________
Phone Number____________________
Please list your diabetes medications:
Physician__________________
Insulin:
Humalog ________
____________
_________
__________
Novolog _________
____________
_________
__________
Lantus __________
____________
_________
__________
Levemir _________
____________
_________
__________
Apidra __________
____________
_________
__________
Supplemental pre-meal Insulin _______
_________
__________
Oral Medications ______________________________________________
Victoza _______________
Byetta ________________
Date
Breakfast 2 hr post breakfast Lunch
2 hr post lunch
Dinner
Bedtime
3 am

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