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Blood Glucose & Meal Log WEEK OF: ______________ NAME: __________________________
VA/DoD Clinical Practice Guideline for Diabetes Mellitus
https://www.qmo.amedd.army.mil
http://www.healthquality.va.gov
Date
Breakfast Lunch Dinner Bedtime
Time/BG
Time/BG
Time/BG
Time/BG
Time/BG
Time/BG
Time/BG
8am /148 10am /160 12pm /97 2:30pm /102 6pm /116
9pm /155
Example
Food/Carbs:
Food/Carbs:
Food/Carbs:
Food/Carbs
veg omlet - 6 Ham sand-34 1 orange- 20 Roast Beef - 0 ¼ c Almonds
Milk-11 carb ice tea-0 1 potato-37
Insulin:
2 unit aspart
3 unit aspart
4 units aspart
10 unit Lantus
Activity:
Walk 15 min Walk 15 min Walk 15 min
Time/BG:
Time/BG:
Time/BG:
Time/BG:
Time/BG:
Time/BG:
Time/BG:
MON
Food/Carbs:
Food/Carbs:
Food/Carbs:
Food/Carbs
Insulin:
Activity:
Time/BG:
Time/BG:
Time/BG:
Time/BG:
Time/BG:
Time/BG:
Time/BG:
TUE
Food/Carbs:
Food/Carbs:
Food/Carbs:
Food/Carbs
Insulin:
Activity:
Time/BG:
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WED
Food/Carbs:
Food/Carbs:
Food/Carbs:
Food/Carbs
Insulin:
Activity: