Diabetes Self Management

Take Charge of Your Diabetes
All people with diabetes need to be actively involved in managing their diabetes. Do you know what tests you need to take care of your health and help manage your diabetes? The information below will help you keep track of the basic tests you need and how often you need them. It will also help you to record and remember the results of these tests.

Note: You may require other tests that are not listed.

Basic Guidelines for diabetes care
Discuss these issues with your diabetes care provider and keep track of your results.

Print this page to use for tracking, or contact the Texas Diabetes Council at (512) 458-7490 for a wallet-size copy of this Diabetes Health Record.

Review blood sugar records (every visit) Target (pre-meals): ______	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Blood Pressure (every visit) Target: ______	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Weight (every visit) Target: ______	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Foot Exam (every visit)	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Dental Inspection (every visit)	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
HbA1c – Blood test to measure past 3 mos. Blood sugar level (every 3-6 months) Target:______	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Microalbuminuria Urine kidney test (every year) Target: _______	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Dilated Eye Exam (eye exam)	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Blood tests to measure fats important to heart disease (Annually if at target, otherwise every 3-6 months)
Cholesterol (every year) Target:________	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Triglycerides (every year) Target:_________	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
HDL/LDL (every year) Target:_________	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Flu Shots (every year)	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Pneumonia Vaccine (usually once in a lifetime)	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Medical Nutrition Therapy (initial & at clinician’s discretion)	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Physical Activity Counseling (initial & at clinicians’s discretion)	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:
Review of Management Plan (every 6 months)	Date:	Date:	Date:	Date:
	Value:	Value:	Value:	Value:

The Texas Diabetes Council has partnered with the Coalition for Safe Community Needle Disposal to protect the public from the potential hazards that unsafe disposal practices present. More information on the Coalition is available at http://www.safeneedledisposal.org/. To download new recommendations from the Environmental Protection Agency that explain disposal options, click here (PDF, 1.2 mb, viewing information).

Last Updated July 29, 2005