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Your name:
Date:
You can make the most of your office visit by having this form with you when you talk with your doctor.
___
Your blood sugar log.
A list of all your medicines and natural health products.
Your questions.
Other test results, if available.
Measure
Suggested target
Today's result
Weight
kg
Blood Pressure
______ / ______
______ / ______.
Keeping your blood sugar in your target range can help prevent damage to your body. It also helps you prevent low blood sugar by letting you know when you need extra carbohydrates.
Time of day
Target range for most non-pregnant adults
Your goal
After waking and before eating.
4.0–7.0 mmol/L
mmol/L
2 hours after a meal.
5.0–10.0 mmol/L or 5.0–8.0 mmol/L if A1c targets are not being met
Another time of day:
Other:
Call your doctor if your blood sugar is below __________ mmol/L or above __________ mmol/L.
Seeing your doctor and having certain tests on a regular schedule can help you watch for and avoid many of the problems caused by diabetes. These are some tests you may need.
Test
What it shows
Guideline range
Your result
A1c
How steady your blood sugar levels have been over time.
7% or less for most men and for most women who are not pregnant
_____%
Cholesterol
The amount and type of fat in the blood.
LDL 2.0 mmol/L or less
Albumin-creatinine ratio
Whether kidney disease is developing.
Less than 2.0 mg/mmol
mg/mmol
Blood creatinine
? Estimated glomular filtration rate (eGFR) greater than 60 mL/min
mL/min
Over time, high blood sugar can damage the nerves and blood vessels in your feet. Check your feet every day to help keep them healthy. Ask your doctor to do a foot exam at every visit.
It's important to stay up to date with all your tests. These may include an eye exam, a foot exam, a dental exam, a liver function blood test, and a cholesterol test. Talk with your doctor about which tests you need and when you should have them.
How often
Date
Complete eye exam
Once a year. If you don't have any signs of diabetic retinopathy, your doctor may recommend an exam every 2 years.
Complete foot exam
Once a year
Dental exam and cleaning
Every 6 months
Liver function blood test
Be sure to get answers to your questions. Write them here and discuss them with your doctor.
How often should I check my blood sugar?
What should I do if my blood sugar level is too low?
What should I do if my blood sugar level is too high?
Current as of: April 30, 2024
Author: Ignite Healthwise, LLC StaffClinical Review BoardAll Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
Author: Ignite Healthwise, LLC Staff
Clinical Review BoardAll Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
This information does not replace the advice of a doctor. Ignite Healthwise, LLC, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.
