Our Health Library information does not replace the advice of a doctor. Please be advised that this information is made available to assist our patients to learn more about their health. Our providers may not see and/or treat all topics found herein. Your name: __________________ Date: _______________________ You can make the most of your office visit by having this form with you when you talk with your doctor. What to bring to every appointment Measure Suggested target Today's result Weight lbs. lbs. Blood Pressure ______ / ______ ______ / ______ Time of day Target range Your goal After waking and before eating. 80–130 mg/dL mg/dL 2 hours after a meal. Less than 180 mg/dL mg/dL Another time of day: mg/dL mg/dL Other: mg/dL mg/dL Other: mg/dL mg/dL Call your doctor if your blood sugar is below __________ mg/dL or above __________ mg/dL. Test What it shows Guideline range Your result A1c How steady your blood sugar levels have been over time. Less than 7% for most men and for most women who are not pregnant _____% Cholesterol The amount and type of fat in the blood. mg/dL mg/dL Albumin-creatinine ratio Whether kidney disease is developing. Less than 30 mg/g mg/g Blood creatinine Greater than 90 mL/min mL/min Other: Over time, high blood sugar can damage the nerves and blood vessels in your feet. Check your feet every day to help keep them healthy. Ask your doctor to do a foot exam at every visit. Test How often Date Complete eye exam Once a year. If you don't have any signs of diabetic retinopathy, your doctor may recommend an exam every 2 years. Complete foot exam Once a year Dental exam and cleaning Every 6 months Liver function blood test Once a year Other: Questions Notes How often should I check my blood sugar? What should I do if my blood sugar level is too low? What should I do if my blood sugar level is too high? Current as of: April 30, 2024 Author: Ignite Healthwise, LLC Staff Clinical Review Board This information does not replace the advice of a doctor. Ignite Healthwise, LLC disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use and Privacy Policy. Learn how we develop our content. To learn more about Ignite Healthwise, LLC, visit webmdignite.com. © 2024 Ignite Healthwise, LLC. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Ignite Healthwise, LLC.Diabetes Care Plan
Your Plan
Keeping your blood sugar in your target range can help prevent damage to your body. It also helps you prevent low blood sugar by letting you know when you need extra carbohydrates.
Seeing your doctor and having certain tests on a regular schedule can help you watch for and avoid many of the problems caused by diabetes. These are some tests you may need. Your foot exam results
It's important to stay up to date with all your tests. These may include an eye exam, a foot exam, a dental exam, a liver function blood test, and a cholesterol test. Talk with your doctor about which tests you need and when you should have them.
Be sure to get answers to your questions. Write them here and discuss them with your doctor.
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
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