This form was created by Annette Peery, RN, MSN, CDE in September 1998 for the Eastern Carolina Family Practice Center. It provides a structured daily record for people with diabetes who track their glucose levels at home, outside a clinical setting.
The form covers testing at key points during the day: fasting, before and after each meal, at bedtime, and at 3:00 am. Tracking readings at these times helps identify the factors that affect your blood sugar, including food choices, activity level, and medication timing. Your doctor can use this data to adjust your care plan, update your treatment, and set realistic glucose goals to support your long-term health.
By recording your name, physician contact, and prescribed testing frequency, the form creates a clear channel of support between you and your medical team. Logging your readings consistently helps you take an active role in your diabetes care and gives your doctor the data needed to guide the right treatment steps.
| Question | Answer |
|---|---|
| Form Name | Blood Glucose Monitoring |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | sheet glucose monitoring printable, flow sheet blood glucose, sheet home blood glucose, diabetes sugar log pdf |
