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Appendix C: Sample glucose monitoring record sheet

Name:_________________________
Target Blood Sugar Levels Remember, if your blood sugar is out-of-range:
Fasting No higher than 95
  • Write down what you ate and how much you ate in the Notes column.
  • Write down what exercises you did and how long you did it in the Notes column.
  • Write down any skipped meals or snacks in the Notes column.
1 hour after eating No higher than 140
2 hours after eating No higher than 120

Date Blood Glucose Level Insulin
Amount 		Urinary
Ketone
Levels 		Notes
Fasting 1-2 Hours
after Breakfast 		1-2 Hours
after Lunch 		1-2 Hours
after Dinner
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Last Updated Date: 09/11/2006
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