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Notes:

PERSONAL DETAILS

Name

Date of Birth

Res. Address

Tel. (O)

Name of Doctor

Doctor’s Address

Tel. (Clinic)

Name of Diabetes Educator

Tel.

In case of emergency contact

Name

Tel.

(R)

M/F

Notes:

Checking your blood glucose levels can:

• Tell you what your blood glucose level is right away

• Show you how your activities, meals and medication are affecting your blood glucose levels

• Help you to understand what lifestyle factors affect your blood glucose

• Help you and your diabetes healthcare team make changes to your lifestyle and medication(s) to better manage your diabetes

Self-monitoring of blood sugar is the process of testing your blood sugar at home at regular intervals, through the use of blood glucose monitors to stay in the Diabetes Safe Zone. Diabetes Safe Zone refers to blood glucose levels considered safe by your doctor.

Why should you test?

What is Self-monitoring of blood sugar?

*A lo

wer

LD

L go

al o

f <

70 m

g/dl

may

be

an o

ptio

n fo

r th

ose

patie

nts

with

typ

e 2

diab

etes

and

est

ablis

hed

card

iova

scul

ar d

isea

se.

AD

A D

iab

etes

Man

agem

ent

Rec

om

men

dat

ion

s

Ever

y 3-

6 m

onth

: tes

t/ex

am

G

oal

Dat

e(s)

Re

sults

HbA

1c-

test

s av

erag

e bl

ood

suga

r (g

luco

se) l

evel

ove

r th

e pa

st 2

-3 m

onth

s

<

7%

Yea

rly: T

est/

Exam

G

oal

Dat

e(s)

Re

sults

Cho

lest

erol

/Trig

lyce

rides

Trig

lyce

rides

<

150

mg/

dl

HD

L

M

en >

40 m

g/dl

Wom

en >

50 m

g/dl

LDL

<10

0 m

g/dl

(<70

mg/

dl*)

Alb

umin

uria

- D

etec

ts p

rote

in in

the

urin

e

<30

mcg

/mg

crea

tinin

e

Foot

exa

m -

che

cks

for

num

bnes

s, c

oldn

ess,

se

nsiti

vity

to

touc

h, o

r ul

cers

Dila

ted

eye

exam

- le

ts d

octo

r ex

amin

e ba

ck w

all o

f ey

e

Flu

shot

The most effective way to manage your diabetes is to test around the events that affect your blood glucose the most: meals, exercise, medications, and mood swings.

Even if you are not on medication, testing your blood glucose will give you some valuable information to help you better manage your diabetes.

Testing should be done at different times of the day:

• Testing before and 2 hours after meals will tell you how certain foods affect your blood glucose

• Testing before, during and many hours after exercise will let you know how the activity affected your blood glucose

• Test more frequently when you are making adjustments to daily activity, food intake and medication

• Test more frequently if you are not feeling well

When should you test?

AD

A D

iab

etes

Man

agem

ent

Rec

om

men

dat

ion

s

Ever

y vi

sit:

tes

t/ex

am

G

oal

Dat

e(s)

Resu

lts

Dat

e(s)

Re

sults

Wei

ght

Bloo

d pr

essu

re

<13

0/80

mm

Hg

Bloo

d su

gar

(glu

cose

)

Befo

re m

eals

70

-130

mg/

dl

1-2

hrs

afte

r m

eals

<

180

mg/

dl

Dia

bete

s ca

n af

fect

man

y pa

rts

of y

our b

ody,

so

it’s

impo

rtan

t to

mee

t with

you

r hea

lth

prof

essi

onal

reg

ular

ly.

You

can

tak

e ac

tion

in h

elpi

ng t

o m

anag

e yo

ur d

iabe

tes

by

talk

ing

with

you

r he

alth

pro

fess

iona

l abo

ut t

he f

ollo

win

g te

sts

and

exam

s an

d m

akin

g su

re t

hey’

re d

one

as r

ecom

men

ded.

Dia

bet

es c

are

sch

edu

le

What you can learn from testing your blood sugar?

Possible times your doctor may tell you

to test*

What you can learn

Before and 1-2 hours after the beginning

of the meal

Before a meal

If your blood glucose has returned to target range

after your last meal. If you need to adjust the carbohydrates in

your meal.

How well your body is regulating your blood

sugar overnight. How well an evening

medication has worked to keep your

blood sugar steady overnight.

In the morning,before eating

How food and portion choices in a meal affect

your blood sugar. How well your

medication is working to control the

increase in blood sugar from your meal.

Blo

od

Glu

cose

Res

ult

s

Co

mm

ents

(Med

icat

ion

,fo

od

, act

ivit

ies,

si

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)

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chD

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fter

Res

ult

Possible times your doctor may tell you

to test*

What you can learn

*Always test according to the recommendations of your doctor

During activity

Many hours after activity

When you feel sick

As suggested by your health care

professional

If the activity causes a delayed effect on your

blood glucose.

If illness or stress is affecting your blood

glucose level.

How well your medication is working.

If you need a snack before you start an

activity.

How the activity affects your blood

glucose.

Before activity

Blo

od

Glu

cose

Res

ult

s

Co

mm

ents

(Med

icat

ion

,fo

od

, act

ivit

ies,

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ess

etc.

)

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chD

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ult

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icat

ion

Dat

e I

nsu

lin N

ame

Co

rrec

tive

do

se u

nit

s

Tim

e/d

ay

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od

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cose

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ult

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ents

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e O

ral D

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etes

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icat

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s

D

ose

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cose

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icat

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, act

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Start by asking your healthcare professional to set your blood sugar goals and your schedule for checking your blood sugar

What are your sugar goals?

When to check My goals

Fasting (before breakfast) mg/dL

Before Meal (lunch/dinner) mg/dL

After Meal (any meal) mg/dL

ADA guidelines for glycemic goals in adults with diabetes*

HbA1c

Preprandial (Before meals) glucose

Peak postprandial glucose (1-2 hours after start of meal)

<7.0%

70–130 mg/dL

<180 mg/dL

* Follow your doctor’s recommendation for testing Blo

od

Glu

cose

Res

ult

s

Co

mm

ents

(Med

icat

ion

,fo

od

, act

ivit

ies,

si

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etc.

)

Lun

chD

inn

erB

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me

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st

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Du

mm

y lo

g p

age

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akfa

st

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un

ch

D

inn

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me

Dat

e B

efo

re

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er

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ore

A

fter

Bef

ore

A

fter

Res

ult

Co

mm

ents

(Med

icat

ion

,fo

od

, act

ivit

ies,

si

ckn

ess

etc.

)

Inst

ruct

ion

s:1.

Fill

in t

he d

ate

& t

ime

2. W

hen

test

ing

bloo

d su

gar

befo

re a

nd a

fter

mea

ls, w

rite

dow

n th

e “b

efor

e-m

eal”

re

sult

in

the

Befo

re

colu

mn

and

the

“aft

er-m

eal”

res

ult

in t

he A

fter

col

umn.

3.

Whe

n yo

ur r

esul

t is

hig

h or

low

, circ

le it

so

you

can

see

it at

a

glan

ce.

4. U

se t

he n

otes

sec

tion

to r

emar

k on

any

thin

g im

port

ant-

like

diet

, exe

rcis

e or

str

ess.

5. T

est

your

blo

od s

ugar

as

reco

mm

ende

d by

you

r do

ctor

.

Tip

: to

min

imiz

e th

e pa

in o

f te

stin

g, c

hang

e th

e la

ncet

aft

er e

very

use

**l

ance

ts a

re s

teril

e an

d fo

r si

ngle

use

onl

y to

red

uce

the

risk

of in

fect

ion

8060

110

220

250

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od

Glu

cose

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ult

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icat

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, act

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chD

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ents

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icat

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chD

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