L
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Draw on me
Use it daily for recording your blood sugar, insulin and grams
of carbohydrates (carbs).
Write down your blood sugar results on the page marked
blood sugar log. Include the type and amount of insulin youve taken.
On the carb count page, write the amount of carbs (grams) youve eaten.
For example, if you eat pasta or fruit, jot down the amount of carbs.
Use the notes section to add information on any foods you might have
eaten, the types of physical activity you do, or if you dont feel well.
IF FOUND, PLEASE RETURN TO:
______________________________
Name
______________________________
Address
______________________________
City
______________________________
State Zip Code
______________________________
Doctors Name
______________________________
Phone
______________________________
Parents Name
______________________________
Phone
IN CASE OF EMERGENCY,
PLEASE CALL:
______________________________
Name
______________________________
Relationship
______________________________
Address
______________________________
Phone
OTHER IMPORTANT
PHONE NUMBERS:
______________________________
Diabetes Educator
_____________________________
Dietitian
______________________________
______________________________
T
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Blood Sugar Log for the W
eek of
___________________________
Breakfast Lunch Dinner Bedtime
During the Night
blood sugar
before
insulin
blood
sugar after
blood sugar
before
insulin
blood
sugar after
blood sugar
before
insulin
blood
sugar after
blood sugar
before
insulin
blood
sugar after
blood sugar
before
insulin
blood
sugar after
Weekly blood sugar notes
Use this side of the page to record your blood sugar,
and the opposite side to record the amount of carbs you eat each day.
Monday
Tuesday
Thursday
Friday
Saturday
Sunday
Wednesday
___________________________
Use this side of this page to record the grams of carbohydrates (carbs) you eat each day.
C
arb (G
ram
s) C
ount for the W
eek of
Weekly carb notes
Breakfast Lunch
Dinner
Snack Snack Snack
Monday
Tuesday
Thursday
Friday
Saturday
Sunday
Wednesday
HI73596 1011 PRINTED IN USA LILLY LLC, USA 2011. ALL RIGHTS RESERVED.
