Weekly Diabetes Blood Glucose Check
DATE: _______________________ PATIENT NAME: ______________________ 650 625 600 585 575 550 525 500 485 450 425 400 385 375 350 325 300 285 275 250 225 200 185 175 150 125 100 90 80 70
Sunday Monday Tuesday Wed Thurs Friday Saturday
WEEK NUMBER : ________
Instructions: check blood glucose every day and write in your numbers in the appropriate column
and write date and time at the bottom . For results in between numbers write the actual glucose number in the closest number to your results.