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Diabetes Blood Sugar Log

My current A1C is: My A1C goal is: My target blood sugar: Before meals: After meals:

My physical activity goal:

Date Breakfast Lunch Dinner Bedtime Snack Comments Physical Activity


BG* Time BG Time BG Time BG Time BG (sick, stress, medication)
Monday

Time
 Yes
 No

Date Breakfast Lunch Dinner Bedtime Snack Comments Physical Activity


Tuesday

Time BG Time BG Time BG Time BG Time BG (sick, stress, medication)


 Yes
 No

Date Breakfast Lunch Dinner Bedtime Snack Comments Physical Activity


Wednesday

Time BG Time BG Time BG Time BG Time BG (sick, stress, medication)


 Yes
 No

Date Breakfast Lunch Dinner Bedtime Snack Comments Physical Activity


Thursday

Time BG Time BG Time BG Time BG Time BG (sick, stress, medication)


 Yes
 No

Date Breakfast Lunch Dinner Bedtime Snack Comments Physical Activity


Time BG Time BG Time BG Time BG Time BG (sick, stress, medication)
Friday

 Yes
 No

Date Breakfast Lunch Dinner Bedtime Snack Comments Physical Activity


Time BG Time BG Time BG Time BG Time BG (sick, stress, medication)
Saturday

 Yes
 No

Date Breakfast Lunch Dinner Bedtime Snack Comments Physical Activity


Time BG Time BG Time BG Time BG Time BG (sick, stress, medication)
Sunday

 Yes
 No

*BG = Blood Glucose

 I will call my health care professional if my blood sugar is below: above:

© 2009, TPMG, Inc. All rights reserved. Regional Health


Education. 00679-002 (Revised 7-09)

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