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Publications and ProductsTake Charge of Your DiabetesRecords
Call your health care provider if any of these happen to you:
If you feel sleepy or cant think clearly, have someone call your health care provider or take you to an emergency room. Tests and Goals for Each Visit top Things to Do at Each Visit with Your Health Care Provider
Have your health care provider do these tests and set goals with you. Record dates and the results in the boxes below.
Tests and Goals for Each Year top Things to Do At Least Once a Year
Have your health care provider do these tests and other services for you. You may want to set some goals for these. Record the dates and results in the boxes below.
Glucose Log Sheets top Glucose Log Sheet for People Who Do Not Use Insulin Use this log sheetor one like it that your health care provider may give youto keep a record of your daily blood glucose levels. Week Starting: May 26, 2001
Week Starting _______________
Glucose Log Sheet for People Who Use Insulin Use this log sheetor one like it that your health care provider may give youto keep a record of your daily blood glucose levels. Week Starting: May 26, 2001
Week Starting ___________
Primary Doctor or Health Care ProviderName: __________________________________________ Telephone number: ________________________________ Your questions: ___________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Important points: __________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Eye Doctor (Ophthalmologist, Optometrist)Name: __________________________________________ Telephone number: ________________________________ Your questions: ___________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Important points: __________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Foot Doctor (Podiatrist)Name: ____________________________________________ Telephone number: ___________________________________ Your questions: _____________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Important points: __________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ DentistName: ____________________________________________ Telephone number: ___________________________________ Your questions: ______________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Important points: ____________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ DietitianName: __________________________________________ Telephone number: ________________________________ Your questions: ___________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Important points: __________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Diabetes EducatorName: __________________________________________ Telephone number: ________________________________ Your questions: ___________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Important points: __________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ CounselorName: __________________________________________ Telephone number: ________________________________ Your questions: ___________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Important points: __________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ OtherName: __________________________________________ Telephone number: ________________________________ Your questions: ___________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Important points: __________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Return to Table of Contents
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Page last modified: December 20, 2005 Content Source: National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation |