Homepage Fill Out Your Blood Glucose Log Form
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Keeping track of blood glucose levels is an essential part of managing diabetes. The Blood Glucose Log form serves as a practical tool to help individuals monitor their blood sugar readings, meal plans, and medication intake. With this form, you can document times for breakfast, lunch, dinner, and snacks, ensuring that no detail is missed. It even allows space for comments about your meals and medications, promoting a more comprehensive approach to your health. If your levels fluctuate, the log encourages you to consult your healthcare team to evaluate potential adjustments to your meal plans or diabetes medications. Importantly, it provides guidance about recognizing low blood glucose levels, including common symptoms like dizziness or shakiness, and how to quickly address those situations. For ease of use, the log is designed for portability and can be copied for monthly tracking. By staying organized with this form, you can take a proactive role in your diabetes care and work closely with your medical team to maintain a healthy lifestyle.

Blood Glucose Log Example

TO MAKE MORE MONTHLY LOGS: Make one (1) copy of this page and two (2) copies of the next page. Cut the pages in half, placing this page on top. Staple in the upper left-hand corner and fold to fit in your pocket or
purse.©2009 by the American Diabetes Association, Inc. 11/09
CUT HERE

MAKE ONE (1) COPY OF THIS PAGE.

Ifyouhavehighbloodglucose,makenotesinyourlogandtalk withyourhealthcareteamaboutwhetheryouneedtochange yourmealplan,physicalactivity,ordiabetesmedicines.

Havinglowbloodglucosemeansthatyourbloodglucoselevel istoolow(below70mg/dl). Lowbloodglucosecanbe dangerous. Symptomsincludebeing:

•hungry •light-headedorconfused •nervousandshaky •sleepy

•sweaty

Ifyouthinkyourbloodglucoseistoolow,checkit. Ifit’sbelow 70mg/dl,have1oftheseitemsrightawaytoraiseyourblood glucoselevel:

•3or4glucosetablets

•1servingofglucosegel(theamountequalto15gramsof

carbohydrate)

•½cup(4ounces)offruitjuice

•½cup(4ounces)ofaregular(notdiet)softdrink

•8ouncesofmilk

•5or6piecesofhardcandy

•1tablespoonofsugarorhoney

After15minutes,checkyourbloodglucoseagain. Ifit’sstill below70mg/dl,haveanotherserving. Repeatthesestepsuntil yourbloodglucoseisatleast70mg/dl.

FOLD HERE

ToolkitNo.29

BloodGlucoseLog

Name:___________________________________________

Date:From________________ to____________________

MyDoctor

Name:___________________________________________

Phone:___________________________________________

MyDiabetesEducator

Name:___________________________________________

Phone:___________________________________________

ADATargetsfor

MyUsual

My

BloodGlucose

Results

Targets

Beforemeals:

______to______

______to______

70to130mg/dl

 

 

 

 

 

2hoursafterstartofa

below______

below______

meal:below180mg/dl

 

 

 

CUT HERE

Date

Time

Breakfast Medicine/Comment

Time

Lunch

Medicine/Comment

Time

Dinner

Medicine/Comment

Time

Snack/Other Medicine/Comment

Provided By

American Diabetes Association 1–800–DIABETES (342–2383) www.diabetes.org

©2009 by the American Diabetes Association, Inc. 11/09

MAKE TWO (2) COPIES OF THIS PAGE.

Date

Time

Breakfast

Medicine/Comment

Time

Lunch

Medicine/Comment

Time

Dinner

Medicine/Comment

Time

Snack/Other

Medicine/Comment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CUT HERE

 

CUT HERE

 

 

 

Date

Time

Breakfast Medicine/Comment

Time

Lunch

Medicine/Comment

Time

Dinner

Medicine/Comment

Time

Snack/Other Medicine/Comment

Provided By

American Diabetes Association 1–800–DIABETES (342–2383) www.diabetes.org

©2009 by the American Diabetes Association, Inc. 11/09

Form Characteristics

Fact Name Description
Purpose The Blood Glucose Log form helps individuals track their blood glucose levels over a specified time period, facilitating better diabetes management through consistent monitoring.
Emergency Response Low blood glucose can be dangerous. The form provides detailed instructions on how to respond if blood glucose levels drop below 70 mg/dL, including specific items to consume for a quick boost.
Monthly Tracking This form allows for easy duplication, enabling users to create multiple monthly logs. Clear instructions on how to copy and prepare the form make it user-friendly.
Contact Information Users are encouraged to include contact information for their healthcare team, including their doctor and diabetes educator. This provides a direct line for support and assistance when needed.

Guidelines on Utilizing Blood Glucose Log

Filling out the Blood Glucose Log form is a straightforward process that helps track your blood glucose levels effectively. Make sure to have your blood glucose measurement results at hand for accurate entries. Keep in mind that this log will aid you in managing your health in collaboration with your healthcare team.

  1. Begin by writing your Name at the top of the form in the designated space.
  2. Enter the starting and ending Date for the log period.
  3. Fill in your Doctor's Name and Phone Number below your name and date.
  4. Provide information for your Diabetes Educator, including their Name and Phone Number.
  5. In the section for ADATargets, rewrite your usual targets for blood glucose levels before meals and two hours after meals.
  6. On each date line in the log section, record the Date and Time for meals and snacks.
  7. For each meal or snack, note down the Breakfast, Lunch, Dinner, or Snack time and any Medicine/Comments.
  8. If needed, replicate the log by making one copy of this page and two copies of the next page, referring to the instructions on the form.

Once you have completed the form, review it to ensure all entries are correct. If your blood glucose levels have been consistently high or low, make notes and discuss them with your healthcare team. Remember, managing your blood glucose is essential for your overall health.

What You Should Know About This Form

What is the Blood Glucose Log form used for?

The Blood Glucose Log form is designed to help individuals manage their diabetes effectively. By recording your blood glucose levels, meals, and medications, you can track how different factors affect your blood sugar. This information is crucial for making informed decisions about your diet, physical activity, and medications in collaboration with your healthcare team.

How do I use the Blood Glucose Log form?

To use the Blood Glucose Log, you simply fill in the required fields with your name, dates, and contact information for your healthcare provider and diabetes educator. Each day, record the time, your blood glucose reading, meals consumed, and any medications taken. This structured approach allows for easier analysis and discussions with your healthcare team.

What should I do if my blood glucose is too high?

If you notice that your blood glucose levels are high, it’s essential to make detailed notes in your log. Seek advice from your healthcare team on whether you should adjust your meal plan, physical activity levels, or diabetes medications accordingly. Keeping track of your levels helps in making necessary adjustments to maintain a healthier balance.

What are the signs of low blood glucose?

Low blood glucose, defined as below 70 mg/dl, can be dangerous. Symptoms may include feeling hungry, light-headedness, confusion, nervousness, shakiness, sleepiness, or sweating. Recognizing these symptoms early can prevent serious complications, so it's crucial to monitor your levels regularly.

What should I do if I experience low blood glucose?

If you suspect your blood glucose is too low, check your levels immediately. If they are still under 70 mg/dl, consume something high in carbohydrates to raise them promptly. Options include glucose tablets, fruit juice, milk, or regular soft drinks. After 15 minutes, check your blood glucose again and repeat this process if necessary.

How can I make more monthly logs?

To create additional monthly logs, simply make one copy of the initial page and two copies of the subsequent pages. Cut each page in half and stack them with the first page on top. You can staple them in the upper-left corner and fold the logs to fit in your pocket or purse for easy access.

What targets should I aim for in my blood glucose results?

The target range for blood glucose levels before meals is typically between 70 to 130 mg/dl, while two hours after starting a meal, it should be below 180 mg/dl. These ranges can help guide your management plan and keep your diabetes under control.

Who can I contact for support regarding my diabetes?

You can reach out to your healthcare provider or diabetes educator for any questions or concerns related to managing your diabetes. Additionally, resources such as the American Diabetes Association provide valuable information and support. They can be reached at 1–800–DIABETES (342–2383) or through their website for further assistance.

Is there a proper way to store my Blood Glucose Log form?

It is best to keep your Blood Glucose Log in a safe and easily accessible location. Consider storing it in a designated spot, such as a binder or folder, where you can easily refer back to it during your medical appointments. Keeping it organized will facilitate better discussions with your healthcare team about your progress.

Common mistakes

Filling out the Blood Glucose Log form can be straightforward, but mistakes often happen. One common error is omitting essential personal information. Forgetting to fill out your name or contact details can make it difficult for healthcare providers to assist you effectively. Always ensure that your information is complete and accurate before submission.

Another frequent mistake is skipping date and time entries. Without specific dates and times, tracking your glucose levels over time becomes challenging. This can lead to miscommunication with your healthcare team, hindering their ability to provide tailored advice. Make a habit of noting this information consistently.

People often neglect to mention their current medications. If you’re taking diabetes medicines or other prescriptions, it’s vital to note this on the log. This information helps your healthcare provider understand how your medications might be affecting your blood glucose levels.

Not recording meals and snacks is another common oversight. Keeping a detailed account of what you eat and when is crucial for understanding how your diet impacts your glucose levels. Make sure to document every meal and snack, along with any significant observations or comments that may arise.

An easy misstep is failing to check glucose levels before meals and after snacks. The log is designed for this purpose. Skipping these checks can lead to inaccurate assessments of your control over diabetes, making it harder to adjust your management plan effectively.

Also, many individuals forget to follow the guidelines for blood glucose targets. It’s essential to understand what your target levels are before meals and after meals. Regularly review these targets and compare them with your logged results to monitor your progress accurately.

Finally, a less obvious mistake is not sharing your log with your healthcare team. This form serves as a communication tool. Regularly sharing your completed Blood Glucose Log allows your healthcare provider to see trends in your numbers and provide better guidance. Make it a priority to review this log together during your appointments.

Documents used along the form

Managing diabetes effectively involves keeping careful records and maintaining open communication with healthcare providers. Along with the Blood Glucose Log form, a variety of other documents may assist individuals in tracking their health and ensuring they receive proper care. Below is a brief overview of several key forms that can enhance diabetes management.

  • Diabetes Management Plan: This document outlines specific goals and strategies for diabetes management, including medication schedules, dietary recommendations, and exercise guidelines. It serves as a personalized roadmap for individuals and their healthcare teams.
  • Medication Administration Record (MAR): This log helps track all diabetes medications taken by the individual, including doses and administration times. Keeping an accurate MAR can prevent medication errors and help ensure continuity of care.
  • Carbohydrate Count Log: This form assists individuals in recording carbohydrate intake for each meal. Understanding carbohydrate consumption is crucial for effective blood sugar management, especially for those who use insulin.
  • Physical Activity Log: A record of physical activity helps individuals monitor their exercise routines. Regular exercise is important for blood sugar control, making this log an essential companion to the Blood Glucose Log.
  • Symptoms Log: Individuals can document any symptoms related to high or low blood sugar levels. Tracking these symptoms can assist healthcare providers in making necessary adjustments to treatment plans.
  • Doctor’s Visit Summary: This summary is a record of what was discussed during medical appointments. It can include medication adjustments, test results, and future care plans, ensuring that vital information is easily accessible.
  • Emergency Action Plan: This plan outlines steps to take in case of a diabetes-related emergency, such as severe hypoglycemia. Having clear instructions can provide peace of mind and ensure timely intervention.
  • Nutritional Journal: A daily log of food intake that can help individuals understand how different foods affect their blood sugar levels. This journal promotes mindful eating and can assist with meal planning.
  • Continuous Glucose Monitor (CGM) Data Report: For those using a CGM device, this report provides detailed information on blood sugar fluctuations over time. Analyzing this data is beneficial for adjusting treatment strategies.

Collectively, these forms and logs provide individuals with a comprehensive toolkit for managing diabetes. Maintaining accurate records fosters a proactive approach to health and facilitates better communication with healthcare teams. When everyone involved is well-informed, the path to effective diabetes management becomes clearer and more achievable.

Similar forms

  • Food Diary: Similar to the Blood Glucose Log, a food diary tracks daily food intake. This helps individuals identify how certain foods affect their blood sugar levels. Both documents involve recording details throughout the day which can guide dietary adjustments and meal planning.

  • Exercise Log: An exercise log focuses on physical activity, noting the type, duration, and intensity of workouts. Just like the Blood Glucose Log, it emphasizes the importance of regular monitoring to manage health and can indicate how different activities impact blood glucose levels.

  • Medication Tracker: This document helps individuals keep a record of their medication schedules, dosages, and any side effects. Both the Blood Glucose Log and the Medication Tracker serve the purpose of close monitoring, allowing users to see trends over time and discuss them with healthcare professionals.

  • Symptom Journal: A symptom journal records health symptoms and their frequency, similar to how the Blood Glucose Log captures blood glucose readings. Both promote awareness and are valuable for discussion with healthcare providers, helping identify patterns that may need addressing.

Dos and Don'ts

Here are some helpful guidelines for filling out the Blood Glucose Log form.

  • Do fill in your name, date, and contact information for your doctor and diabetes educator clearly.
  • Do accurately record blood glucose levels at the specified times, especially before meals.
  • Do make notes about your meals and any medications taken to help track patterns in your glucose levels.
  • Do double-check your entries to ensure they are legible and correct.
  • Don't skip any time slots; consistency is key for managing your blood glucose.
  • Don't use abbreviations that may confuse someone else who reads your log.
  • Don't ignore symptoms of low blood glucose when filling out your log; document them accurately.
  • Don't postpone talking to your healthcare team if you're noticing troubling patterns.

Misconceptions

There are several misconceptions regarding the Blood Glucose Log form. Understanding these can help manage diabetes more effectively. Below are some common misunderstandings:

  • Misconception 1: The log is only for people with high blood glucose.
  • This log is designed for anyone managing diabetes, regardless of whether their blood glucose levels are high or low.

  • Misconception 2: Only glucose readings need to be recorded.
  • The log also encourages users to note their meals, medications, and any symptoms, which provide valuable insights for healthcare teams.

  • Misconception 3: Low blood glucose is not serious.
  • Low blood glucose levels can be dangerous and warrant immediate action to raise levels back to safety.

  • Misconception 4: Once logged, the information does not need further discussion with healthcare providers.
  • Regularly reviewing the log with a healthcare team can help adjust treatment plans and improve outcomes.

  • Misconception 5: The form is too complicated to use.
  • The Blood Glucose Log is straightforward, with clear sections for entries that make tracking simple and efficient.

  • Misconception 6: Only one log is necessary for long-term tracking.
  • Multiple logs should be used to capture data over time, aiding in identifying patterns in blood glucose levels.

  • Misconception 7: You should only record readings during a medical emergency.
  • Regular tracking helps in establishing a baseline and recognizing trends that may require adjustments in treatment.

  • Misconception 8: The log format is unchangeable.
  • The log can be customized to better meet individual needs, including additional notes or personalized sections.

  • Misconception 9: Maintaining the log is optional.
  • Keeping an accurate and up-to-date log is essential for effective diabetes management and communication with healthcare providers.

Key takeaways

Using the Blood Glucose Log form can be an effective way to monitor diabetes management. Here are some key takeaways:

  • Make Copies: To create more monthly logs, make one copy of the first page and two copies of the next page. Cut the pages in half and staple them together.
  • Document High Results: If blood glucose levels are high, it is important to note these in the log and consult with a healthcare team to determine if any adjustments are needed in your meal plan or medication.
  • Recognize Low Levels: Blood glucose levels below 70 mg/dl are considered low. This situation can lead to serious health issues, requiring immediate attention.
  • Identify Symptoms: Common symptoms of low blood glucose include feeling hungry, confused, shaky, sleepy, or sweaty.
  • Response to Low Levels: If blood glucose is low, take immediate action with items such as glucose tablets, fruit juice, or regular soft drinks to quickly raise your levels.
  • Retest After Treatment: After consuming fast-acting carbohydrates, wait 15 minutes before checking blood glucose again. Repeat until it reaches at least 70 mg/dl.
  • Keep Contact Information Handy: Include the contact information of your doctor and diabetes educator on the form to ensure you can reach them when necessary.
  • Understand Target Levels: Familiarize yourself with your target blood glucose levels before meals and two hours after meals to help maintain control over your diabetes.