Blood Glucose Testing Diary
For Insulin Pump Users

Date: 2am 4am 6am 8am 10am 12pm 2pm 4pm 6pm 8pm 10pm 12am
Blood Glucose                        
Basal                        
Bolus                        
Food/Carbs                        
Exercise                        
Comments:
Date: 2am 4am 6am 8am 10am 12pm 2pm 4pm 6pm 8pm 10pm 12am
Blood Glucose                        
Basal                        
Bolus                        
Food/Carbs                        
Exercise                        
Comments:
Date: 2am 4am 6am 8am 10am 12pm 2pm 4pm 6pm 8pm 10pm 12am
Blood Glucose                        
Basal                        
Bolus                        
Food/Carbs                        
Exercise                        
Comments:
Date: 2am 4am 6am 8am 10am 12pm 2pm 4pm 6pm 8pm 10pm 12am
Blood Glucose                        
Basal                        
Bolus                        
Food/Carbs                        
Exercise                        
Comments:
Insulin Type:
Basal Rate: 6am - 3am= .8 ----------3am - 6am= 1.0
Bolus Rate: Breakfast= 5.0-- Lunch= 4.0 ---Supper= 5.0
(This is an example of my routine, please replace the numbers with your own)
Sliding Scale: Blood Sugar: <80= -1.......80-160= 0.....160-200= +1
200-250= +2 ......... 250-300= +3 ........ 300-350= +4>.......350= +5 ... and CALL the Doctor
(This is the sliding scale I use, please replace the numbers, with the ones your Health Care Provider gave you)
Current Medications:

Please feel free to copy this page, or print it out, and then streamline it to fit your own needs, I am working on a Blood Glucose Diary, for non-pumpers as well.

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This page was last updated on 07/16/99 08:35:51 AM