Blood Glucose Monitoring Form

Enter your blood glucoses, carbohydrate intake, and insulin or medication use on the form below:            (Use the 24-hour clock -- e.g., 1500 for 3:00 pm.; Date should be formatted such as 01/01/07)
#	Time	Blood Glucose			Insulin or Medication Use
	Date	mg/dL	Type		Description
1			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
2			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
3			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
4			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
5	Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
6			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
7			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
8					units or milligrams
9			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
10			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
11			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
12			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
13			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
14			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
15			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
16			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
17			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
18			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
19			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
20			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
21			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
22			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
23			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
24			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
25			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
26			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
27			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
28			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
29			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams
30			Fasting Pre-Brkfst Post-Brkfst Pre-Lunch Post-Lunch Pre-Supper Post-Supper Bedtime 3:00am Other		units or milligrams   Comments / Additional Information: