Diabetes Medical Management Plan
My Type of Diabetes is (Please Tick):
Type 1 diabetes
Type 2 diabetes
Impaired glucose tolerance
Please Tick What You Do:
I have blood glucose tests Yes
I take diabetes medication Yes
I have insulin injections Yes
Blood Glucose Level
My 'ideal' blood glucose levels are ___________
My low blood glucose level would be___________
My high blood glucose levels would be___________
I Look After Myself By (Please Tick):
Eating Healthy Food Yes
Exercising every day Yes
Doing Blood Glucose Tests Yes
Visiting my doctor, my podiatrist, my eye specialist, my dietitian and my
diabetes educator when I should Yes
f I need to talk about my diabetes I can talk to: _______________________________________
Signed by _________________________