Blood Glucose Monitoring

Information entered here will not be seen by the physician immediately.  Any extremely high or extremely low blood sugars should be addressed immediately.  If you need assistance, call 812/842-4550 to speak with the nurse or on call physician.  For emergencies, call 911.

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Personal Information

 

 

 

 

Contact Information

 

 

 

Blood Glucose Levels

Dates of Testing
 


(Instructions: Please list the blood sugars for all of the days that you have tested in the boxes below.  Example: Fasting 86,92,88, etc.)


 








Additional Information or Concerns

(Record the meals and times for the results that are out of range.)