Instructions record your blood glucose at meal and

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BLOOD SUGAR MONITORING LOG

for addressograph plate

Instructions: Record your blood glucose at meal and bedtime.

****SAMPLE ****

? 2009 American Diabetes Association: Last Revision: 5/11/12

Diabetes Education: Tool - A

BLOOD SUGAR MONITORING LOG

for addressograph plate

Instructions: Record your blood glucose at meal and bedtime.

Diabetes Record (For Oral Medication)

Sun

Breakfast Before After

Lunch Before After

Supper Before After

Bedtime

Other

Comments (e.g., Medication Dose)

Mon

Tue

Wed

Thu

Fri

Sat

Number of measurements

Total of blood glucose values (After)

Average of blood glucose values (After)

? 2009 American Diabetes Association: Last Revision: 5/11/12

Diabetes Education: Tool - A

BLOOD SUGAR MONITORING LOG

for addressograph plate

Instructions: Record your blood glucose at meal and bedtime.

Target Levels

Before meals After meals*

A1C Blood pressure

BLOOD GLUCOSE (PLASMA)

People Without Diabetes

People With Diabetes

80?125 mg/dl

70?130 mg/dl

80?130 mg/dl

Less than 180 mg/dl

Less than 6%

Less than 7%

Less than 130/80

Less than 130/80

*Two hours after the first bite of food.

? 2009 American Diabetes Association: Last Revision: 5/11/12

Diabetes Education: Tool - A

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