Daily Type 1 Diabetes Management Log

Patient Information

Name: ___________________ Date: //___ Emergency Contact: ___________________ Phone: _______________

Blood Glucose Monitoring

Morning (Before Breakfast)

Time: : Blood Glucose: _____ mg/dL Insulin Given: _____ units | Type: □ Rapid-Acting □ Long-Acting Carbohydrates Consumed: _____ g

Lunch

Time: : Blood Glucose: _____ mg/dL Insulin Given: _____ units | Type: □ Rapid-Acting Carbohydrates Consumed: _____ g

Dinner

Time: : Blood Glucose: _____ mg/dL Insulin Given: _____ units | Type: □ Rapid-Acting Carbohydrates Consumed: _____ g

Bedtime

Time: : Blood Glucose: _____ mg/dL Insulin Given: _____ units | Type: □ Long-Acting

Additional Monitoring

Physical Activity

Type: _________________ Duration: _____ minutes Pre-exercise BG: _____ mg/dL | Post-exercise BG: _____ mg/dL

Ketone Testing (if BG > 250 mg/dL)

□ Negative □ Trace □ Small □ Moderate □ Large

Notes

Hypoglycemic Episodes: □ Yes □ No Time(s): __________ Treatment: ____________________

Other Comments: ________________________________

Target Blood Glucose Range: 80-130 mg/dL before meals, <180 mg/dL 2 hours after meals