Joslin my db care plan 9 word by MfT85YYG

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									 Achieving More Together: Our Diabetes Care Plan

The Camden Citywide Diabetes Collaborative wants you to have the best diabetes care and control.

Name:                                                                                       DOB:                       Date:


My diabetes medicines are:                                                                                     ACE                       ASA

Time I take this medicine:

Notes:

Write your food and blood glucose readings down in the table below. Bring them to your next appointment. This will help you and
your provider look for patterns.
                 Breakfast        2 hrs after   Before        Lunch           2 hrs after    Before           Dinner           2 hrs after
Fasting BG       Breakfast                                    Lunch                                           Dinner                         Bedtime
                                  Breakfast     Lunch                          Lunch         Dinner                             Dinner




Goals:        Fasting Blood Glucose: 80 - 130                 2 hours after meals: 130 - 180                    Bedtime: 100 - 140
Labs and Exams                Goal/How Often                          My Results                             My Action Plan
                              Less than 7%                                                    Write down details for taking the rst step!
A1C                           2-4 times a year                                                □ Start new diabetes medicine
Blood Pressure                Less than 130/80                                                □ Check blood glucose at times listed

Weight                                                                                          above. Write down results.
                              LDL less than 100          70                                   □ Review                        medicines
                              2-4 times a year                                                □ Make appointment for dilated eye exam
Cholesterol LDL               Talk to your provider about                                     □ Check feet every day
                              Triglycerides and HDL
                                                                                              □ Attend Diabetes class
Microalbumin/Creatinine  Less than 30                                                         □ Take Healthy Nutrition class
Ratio                    2-4 times a year                                                     □ Hypoglycemia treatment

GFR                      Greater than 60                                                      □ Use the plate method
                         2-4 times a year                                                     □ Use of meter
Dilated Eye Exam         Once a year
Foot Exam                2-4 times a year                                                     □    Increase physical activity (how? )
Dental                   2 times a year
Flu Shot                 Once a year                                                          □    Make better food choices (how? )
Pneumovax                Once/lifetime
                         If over 65, talk to your provider                                    Other:
When to call the healthcare provider:
      If your blood glucose level is greater than 300 mg/dL for more than six hours.
      If you are unable to eat any food for more than a day.
      If you have persistent diarrhea for more than eight hours.
      If you have high (101.5°F) or rising fever, or a fever lasting over 24 hours.
      If you are sick for more than two days.
      If you have moderate to large amounts of ketones in your urine (type 1 only).
      If you have dry mouth, thirst, dry skin, decreased urine, vomiting, abdominal pain, shortness of breath or continual diarrhea.
www.camdenhealth.org                                                    My healthcare provider’s number:

								
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