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Type 1 Diabetes Daily Management Progress Chart

Track Your Blood Sugar, Medications, and Lifestyle Factors

Endocrinology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date: _________________ Diabetes Care Provider: _________________

Daily Blood Glucose Monitoring

Before Meals

Time Blood Glucose Insulin Given Notes
Breakfast
Lunch
Dinner

2 Hours After Meals

Time Blood Glucose Additional Action Notes
Post-Breakfast
Post-Lunch
Post-Dinner

Insulin Administration

  • Long-acting insulin: __________ Units Time: __________
  • Correction doses given: __________
  • Insulin-to-carb ratio used: __________

Physical Activity

  • Type of activity: __________
  • Duration: __________ minutes
  • Pre-exercise BG: __________
  • Post-exercise BG: __________

Carbohydrate Intake

  • Breakfast: __________ g
  • Lunch: __________ g
  • Dinner: __________ g
  • Snacks: __________ g

Additional Monitoring

  • Ketones checked: □ Yes □ No Result: __________
  • CGM readings reviewed: □ Yes □ No
  • Site rotation performed: □ Yes □ No

Notes

Symptoms/Side Effects: ____________________ Stress Levels (1-10): ____________________ Illness/Infections: ____________________

Weekly Review

  • Highest reading: __________
  • Lowest reading: __________
  • Number of hypoglycemic episodes: __________
  • Pattern identified: ____________________

Goals for Next Week

Next appointment date: _________________

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