Scribd Logo
Upload

Welcome to Scribd!

  • Self Monitoring Blood Glucose (SMBG) Chart Name: Month/Year: Medication Name / Dosage

    Uploaded by

    kenny roy Clement
    20 views1 page
    This document is a self-monitoring blood glucose chart for tracking a patient's name, medication, dosage, dates, times, insulin dosage, meal sizes, activity levels, and blood glucose readings over multiple days. The chart includes spaces to log breakfast, lunch, dinner, before meal, and bedtime blood glucose readings each day along with corresponding insulin dosages and other details.

    Original Description:

    Original Title

    SELF MONITORING BLOOD GLUCOSE

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document is a self-monitoring blood glucose chart for tracking a patient's name, medication, dosage, dates, times, insulin dosage, meal sizes, activity levels, and blood glucose readings over multiple days. The chart includes spaces to log breakfast, lunch, dinner, before meal, and bedtime blood glucose readings each day along with corresponding insulin dosages and other details.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    20 views1 page

    Self Monitoring Blood Glucose (SMBG) Chart Name: Month/Year: Medication Name / Dosage

    Uploaded by

    kenny roy Clement
    This document is a self-monitoring blood glucose chart for tracking a patient's name, medication, dosage, dates, times, insulin dosage, meal sizes, activity levels, and blood glucose readings over multiple days. The chart includes spaces to log breakfast, lunch, dinner, before meal, and bedtime blood glucose readings each day along with corresponding insulin dosages and other details.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    SELF MONITORING BLOOD GLUCOSE (SMBG) CHART

    NAME: MONTH/YEAR:

    MEDICATION NAME / DOSAGE:


    DATE: DATE: DATE: DATE:

    BREAKFAST

    BREAKFAST

    BREAKFAST

    BREAKFAST
    DAY 1 DAY 2 DAY 3 DAY 4

    DINNER

    DINNER

    DINNER

    DINNER
    BEFORE

    BEFORE

    BEFORE

    BEFORE

    BEFORE

    BEFORE

    BEFORE
    BEFORE

    BEFORE

    BEFORE

    BEFORE

    BEFORE

    BEFORE

    BEFORE

    BEFORE

    BEFORE
    LUNCH

    LUNCH

    LUNCH

    LUNCH
    BED

    BED

    BED

    BED
    TIME: TIME: TIME: TIME:
    INSULIN UNIT: INSULIN UNIT: INSULIN UNIT: INSULIN UNIT:
    MEAL SIZE : MEAL SIZE : MEAL SIZE : MEAL SIZE :
    (S, M, L) (S, M, L) (S, M, L) (S, M, L)
    ACTIVITY LEVEL: ACTIVITY LEVEL: ACTIVITY LEVEL: ACTIVITY LEVEL:
    (1, 2, 3, 4, 5) (1, 2, 3, 4, 5) (1, 2, 3, 4, 5) (1, 2, 3, 4, 5)

    BLOOD GLUCOSE BLOOD GLUCOSE BLOOD GLUCOSE BLOOD GLUCOSE


    > 16.7 > 16.7 > 16.7 > 16.7
    mmol/L mmol/L mmol/L mmol/L
    14.5-16.7 14.5-16.7 14.5-16.7 14.5-16.7
    mmol/L mmol/L mmol/L mmol/L
    12.3-14.4 12.3-14.4 12.3-14.4 12.3-14.4

    HIGH
    HIGH

    HIGH

    HIGH
    mmol/L mmol/L mmol/L mmol/L
    BLOOD GLUCOSE RANGE

    BLOOD GLUCOSE RANGE

    BLOOD GLUCOSE RANGE

    BLOOD GLUCOSE RANGE


    10.1-12.2 10.1-12.2 10.1-12.2 10.1-12.2
    mmol/L mmol/L mmol/L mmol/L
    7.8-10.0 7.8-10.0 7.8-10.0 7.8-10.0
    mmol/L mmol/L mmol/L mmol/L
    AFTER MEAL 6.2-7.7 AFTER MEAL 6.2-7.7 AFTER MEAL 6.2-7.7 AFTER MEAL 6.2-7.7
    GOAL mmol/L GOAL mmol/L GOAL mmol/L GOAL mmol/L
    FASTING/BEF FASTING/BEF FASTING/BEF FASTING/BEF
    ORE MEAL 4.5-6.1 ORE MEAL 4.5-6.1 ORE MEAL 4.5-6.1 ORE MEAL 4.5-6.1
    GOAL mmol/L GOAL mmol/L GOAL mmol/L GOAL mmol/L
    2.8-4.4 2.8-4.4 2.8-4.4 2.8-4.4
    mmol/L mmol/L mmol/L mmol/L

    LOW
    LOW

    LOW

    LOW
    < 2.8 < 2.8 < 2.8 < 2.8
    mmol/L mmol/L mmol/L mmol/L
    DATE: DATE: DATE:
    BREAKFAST

    BREAKFAST

    BREAKFAST
    DAY 5 DAY 6 DAY 7
    DINNER

    DINNER

    DINNER
    BEFORE

    BEFORE

    BEFORE

    BEFORE

    BEFORE
    BEFORE

    BEFORE

    BEFORE

    BEFORE

    BEFORE

    BEFORE

    BEFORE
    LUNCH

    LUNCH

    LUNCH
    BED

    BED

    BED
    TIME: TIME: TIME:
    INSULIN UNIT: INSULIN UNIT: INSULIN UNIT:
    MEAL SIZE : MEAL SIZE : MEAL SIZE :
    (S, M, L) (S, M, L) (S, M, L)
    ACTIVITY LEVEL: ACTIVITY LEVEL: ACTIVITY LEVEL:
    (1, 2, 3, 4, 5) (1, 2, 3, 4, 5) (1, 2, 3, 4, 5)

    BLOOD GLUCOSE BLOOD GLUCOSE BLOOD GLUCOSE


    > 16.7 > 16.7 > 16.7
    mmol/L mmol/L mmol/L
    14.5-16.7 14.5-16.7 14.5-16.7
    mmol/L mmol/L mmol/L
    12.3-14.4 12.3-14.4 12.3-14.4
    HIGH
    HIGH

    HIGH

    mmol/L mmol/L mmol/L


    BLOOD GLUCOSE RANGE

    BLOOD GLUCOSE RANGE

    BLOOD GLUCOSE RANGE

    10.1-12.2 10.1-12.2 10.1-12.2


    mmol/L mmol/L mmol/L
    7.8-10.0 7.8-10.0 7.8-10.0
    mmol/L mmol/L mmol/L
    AFTER MEAL 6.2-7.7 AFTER MEAL 6.2-7.7 AFTER MEAL 6.2-7.7
    GOAL mmol/L GOAL mmol/L GOAL mmol/L
    FASTING/BEF FASTING/BEF FASTING/BEF
    ORE MEAL 4.5-6.1 ORE MEAL 4.5-6.1 ORE MEAL 4.5-6.1
    GOAL mmol/L GOAL mmol/L GOAL mmol/L
    2.8-4.4 2.8-4.4 2.8-4.4
    mmol/L mmol/L mmol/L
    LOW
    LOW

    LOW

    < 2.8 < 2.8 < 2.8


    mmol/L mmol/L mmol/L

    You might also like