diabetes care record

Record your targets and the date, time, and results of your tests. Take
this card with you on your health care visits. Show it to your health
care team to remind them of tests you need.

A1C - At least twice each year Usual goal: less than 7					My Target
Date:
Result:
BLOOD PRESSURE (BP) - Each visit Usual goal: less than 130/80					My Target
Date:
Result:
CHOLESTEROL (LDL) - Once each year Usual goal: less than 100					My Target
Date:
Result:
WEIGHT - Each visit My Goal: _______					My Target
Date:
Result:

Diabetes Care	Date	Result
Each visit
Foot check
Review self-care
Plan
Weight check
Once each year
Dental exam
Dilated eye exam
Complete foot exam
Flu shot
Kidney check
At least once
Pneumonia shot

Self Checks of Blood Glucose

Record your targets and the date, time, and results of your tests. Take
this card with you on your health care visits. Show it to your health
care team to remind them of tests you need.

Before meals: Usual goal 90 to 130 My target:

1-2 hours after meals: Usual goal below 180 My target:

Bedtime: Usual goal 110-150 My target: