Forms for Current Diabetes Center Patients
Blood Glucose and Medication Log (Web Form)
Blood Glucose and Medication Log (PDF)
Food Record (Web Form)
Food Record (PDF)
Blood Glucose Reporting Instructions
-Pregnant patients, please report your readings every Sunday and Wednesday.
-All other patients, please report your readings every Sunday.
Include your name, date of birth and return phone number.
Indicate the date you are beginning to report your test results: (*See example below.)
Report your test results for all days between report dates and add
any information you want the nurse to consider in the review, i.e. you
were sick, missed a dose of medication, gave wrong dose of insulin, etc.
If you didn’t test at a requested time, just report “no test” and
give reason if needed related to care, i.e. ran out of test strips.
If you had a low blood glucose that you treated, state how you
treated the low blood glucose and also subsequent BG readings you may
Please mark your book when you report your last reading so that
you begin the new report where you left off from the prior call.
If you need the nurse or dietician to call you back
(non-emergency), please let them know and your call will be returned as
soon as possible.
*Here is an example of a call: This is (your name) . I’m starting with the breakfast reading for Monday,
July 21. That reading was 108. My lunch reading was 120. I forgot to
take it before dinner. When I checked it before bedtime, it was 72,
and I drank some extra juice with my bedtime snack. On Tuesday, I took
it at 7:30 before breakfast and it was 130, at noon it was 200, and
before dinner it was 240. I’ve got a sore throat and I may have a
fever. I will be at work for the rest of the day, so call me back there
at (615) 000-0000.
IN CASE OF EMERGENCY, PLEASE CALL 911 OR GO TO YOUR NEAREST EMERGENCY ROOM.
ALL OTHER URGENT AND EMERGENT SITUATIONS:
Daytime: Please call the Diabetes Center at (615) 284-2800 to speak with a clinician.
After Hours: If you need to speak to a clinician
regarding an URGENT MATTER after office hours, please contact the
on-call Diabetes Nurse by calling (615) 284-2800, option 8. Ask the
operator to page the on-call Diabetes Nurse. Your call will be returned
within the hour. If your call is in relation to pain or medical
procedure, please contact your physician.