Blood Glucose Testing Record
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1
2BLOOD GLUCOSE TESTING RECORD
The Jones Center
265 Sheraton Blvd.
Name: __________________________________
Age:___________
Macon, GA 31210
Phone: _________________________________
DOB:___________
P: 478‐‐314‐0925
Fax: ____________________________________
F: 478‐314‐0879
Cell: ____________________________________
BREAKFAST
LUNCH
DINNER
BEDTIME
Date Before
Insulin
Carbs 2 Hours Before
Insulin
Carbs 2 Hours Before
Insulin
Carbs 2 Hours Before
Insulin
2‐3AM
Meal
Type/Units
After
Meal
Type/Units
After
Meal
Type/Units
After
Snack
Type/Units
Correct for high blood sugar (over _____):
Current Medication Regimen:
Carbohydrate Ratio:
(BG‐100)/______= extra units to take
________________________________
breakfast: ____ Lunch: ____ Dinner: ____Bed: ____
Note: Bedtime Correction may be different
________________________________
________________________________
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Parent category: Medical