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My Diabetes Plan

Blood Sugar Goal: ____________

 

Before Breakfast

  1. Check your blood sugar. Record in logbook
  2. Take your scheduled insulin __________________________

                                                   __________________________

  1. If your blood sugar is over ____, add correction insulin.

 

Before Lunch

  1. Check your blood sugar. Record in logbook
  2. Take your scheduled insulin _________________________

                                                   _________________________

  1. If your blood sugar is over _____, add correction insulin.

 

Before Evening Meal

  1. Check your blood sugar. Record in logbook
  2. Take your scheduled insulin __________________________

                                                   __________________________

  1. If your blood sugar is over _____, add correction insulin.

 

Before Bed

  1. Check your blood sugar. Record in logbook
  2. Take your scheduled insulin _________________________

                                                   _________________________

  1. If your blood sugar is over _______, add correction insulin.

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 



The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 12/03/2008

Copyright © 10/24/2008 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #6790

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