Personal Details

Date:
Name: Age:
Address:
Tel.:
Name of treating physician:
Tel.:
Diabetes Type:
Treatment Type:

Normal blood glucose level

Fasting

Lower than 99 mg/dl

After 2 hours from eating a meal

Lower than 140 mg/dl

Glycosylated haemoglobin (average blood glucose levels over three months)

Lower than or equals 5.6%

Diabetes  

Glycosylated haemoglobin

More than or equals 6.5%

Fasting

More than 126 mg/dl

After 2 hours from eating a meal

More than 200 mg/dl

Treatment goals  

Glycosylated haemoglobin

Lower than or about 7%

Blood glucose level before eating a meal

80-130 mg/dl

Blood glucose level two hours after eating a meal

Lower than 180 mg/dl

Blood pressure

Lower than 80/130 mg/dl

Total cholesterol

Lower than 200 mg/dl

Bad cholesterol

Lower than 100 mg/dl

Good cholesterol

For men, more than 40 mg/dl For women, more than 50 mg/dl

Triglyceride

Lower than 150 mg/dl

Diabetes measurements (for pregnant woman)  

Fasting

Lower than 90 mg/dl

Blood glucose level two hours after eating a meal

Lower than 120 mg/dl

Daily check of blood glucose level    

Date

Time

Breakfast

Lunch

Dinner

Before sleeping

Before

After two hours

Before

After two hours

Before

After two hours

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please check your blood glucose at least twice a day.
(One is on a fasting basis and the other is two hours after eating)

Daily check of blood glucose level

Date

Time

Breakfast

Lunch

Dinner

Before sleeping

Before

After two hours

Before

After two hours

Before

After two hours

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please check your blood glucose at least twice a day.
(One is on a fasting basis and the other is two hours after eating)

Insulin doses

Date

Time

Insulin type

Breakfast

Lunch

Dinner

Before sleeping

Before

After

Before

After

Before

After

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diabetes Care

  • Visit your physician periodically
  • Take medication on time
  • Meet the diabetes educator on regular basis after Consultation
  • Visit a nutrition specialist
  • Check your feet daily and at every visit to the doctor
  • Have your eyes examined when diagnosed with diabetes, then do it every year
  • Have your teeth examined every six months
  • Perform a urine test (albumin for kidney functions) every year
  • Blood pressure should be less than 130/80 (mercury)
  • Avoid weight gain and maintain ideal weight
  • Avoid tension, anger and anxiety
  • Quit smoking and alcohol
  • Eat five to six small meals per day instead of two or three large meals
  • Eat three to four servings of fresh fruit and four to five servings of fresh vegetables
  • Eat food that is rich in fibres, such as green leafy vegetables, fresh fruits and whole grains such as brown bread
  • Eat moderately protein-rich foods such as meat, eggs, dairy products
  • Reduce salty food and the amount of salt added to food
  • Reduce fat intake and avoid fatty, creamy food, especially cholesterol-containing foods
  • Reduce foods and beverages with high sugar content such as sweets, chocolate, soft drinks and canned juices. Do not add sugar to fresh juices or tea and coffee
  • Take part in sport or exercise regularly, such as walking or jogging for 30 minutes at least three or four times a week, as this reduces the need for insulin