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Personal Metabolic Disorder Tracking Chart

Daily Progress Monitoring for Metabolic Health Management

Endocrinology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: ___________________
Date of Birth: ____________
Medical Record #: _________

Daily Measurements

Blood Glucose Monitoring

Time Reading Notes
Fasting
Pre-lunch
Pre-dinner
Bedtime

Other Vital Parameters

  • Weight: _______ kg/lbs
  • Blood Pressure: /
  • Temperature: ____°F/°C

Medication Log

Medication Dosage Time Taken Side Effects

Dietary Tracking

Carbohydrate Intake

  • Breakfast: ____ g
  • Lunch: ____ g
  • Dinner: ____ g
  • Snacks: ____ g

Physical Activity

  • Type of Activity: __________
  • Duration: _____ minutes
  • Intensity Level: □ Low □ Moderate □ High

Symptoms & Notes

  • Fatigue Level (1-10): ___
  • Thirst Level (1-10): ___
  • Other Symptoms: __________

Weekly Goals

  1. Blood Glucose Target Range: _____
  2. Exercise Minutes: _____
  3. Weight Goal: _____

Emergency Contacts

Physician: _______________
Phone: _________________
Emergency Contact: ________

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