Self-Monitoring of Blood Glucose Diary

Name: Contact Information:

Instructions: Targets:
Input your blood glucose readings under the appropriate mealtime for each date. Before 1 hr after meals 2 hrs after meals
Double click the dates on the side and you can manually change the dates to reflect the correct time period. <5.3 mmol/L <7.8 mmol/L <6.7 mmol/L
Please update your diabetes medication on the provided table (right hand side).

Breakfast Lunch Dinner Night Food Journal/ Other Notes

Enter Date
Before After Before After Before After Bedtime Sleeping
Ketones Diabetes Medications List
Ex. 03-Mar
17-May 5.7 4.4 4.3 5.4 3.7 5.1 0% Insulin Dosage and Time
18-May 3.6 5.4 5.8 5.2 6.2 0% Novorapid
19-May 6.6 5.3 4.2 4.3 4.6 6.2 0% Fast-acting (Regular)
20-May 4.6 5.6 3.9 5.6 4.1 4.8 0% NPH
21-May 3.8 6.1 4 5.9 4.9 5.7 0% Premixed 30/70
22-May 4.4 7.8 5.8 5 4.9 5.4 0% Long-acting (Levemir)
23-May 4.6 7.6 5.3 6.2 Long-acting (Lantus)
24-May 6.8 6.9 3.1 5
25-May 5.2 6.7 5.6 6.3 5.7 Oral Hypoglycemic Agents Dosage and Time
26-May 5.6 5.6 4.6 5.8 6.8 6.7 Metformin
27-May 4.9 4.7 6.3 4.2 5.9 Diamicron
28-May 5.5 8 3.8 4.5 5 7.3 Glyburide
29-May Actos
30-May Trajenta
31-May Victoza

Office Use Only

SUMMARY BY MODAL DAY PERIODS

Breakfast Lunch Dinner Night
Before After Before After Before After Bedtime Sleeping
Average 5.2 6.3 4.4 5.6 5.0 5.9 #DIV/0! #DIV/0!
St. Dev. 1.0 1.2 0.8 0.9 0.9 0.7 #DIV/0! #DIV/0!
High BG 6.8 8 5.8 7.6 6.8 7.3 0 0
Low BG 3.6 4.4 3.1 4.3 3.7 4.8 0 0
# readings 11 9 11 12 11 11 0 0

SUMMARY BG BY DAY
17-May 18-May 19-May 20-May 21-May 22-May 23-May 24-May 25-May 26-May 27-May 28-May 29-May 30-May 31-May
Average 4.77 5.24 5.20 4.77 5.07 5.55 5.93 5.45 5.90 5.85 5.20 5.68 #DIV/0! #DIV/0! #DIV/0!
St. Dev. 0.76 0.99 1.01 0.72 0.99 1.20 1.29 1.79 0.60 0.81 0.87 1.64 #DIV/0! #DIV/0! #DIV/0!
High BG 5.7 6.2 6.6 5.6 6.1 7.8 7.6 6.9 6.7 6.8 6.3 8 0 0 0
Low BG 3.7 3.6 4.2 3.9 3.8 4.4 4.6 3.1 5.2 4.6 4.2 3.8 0 0 0
# readings 6 5 6 6 6 6 4 4 5 6 5 6 0 0 0