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Blood Glucose Monitoring ChartFor advice on the monitoring of blood glucose and insulin products, dosage & administration contact the Pharmacy Department.Patient’s name: RiO number: Ward/Team:Date of birth:NHS number:Responsible clinician: Meter / strips (ward or patients own): Start dateFrequency of testingTime in relation to meals, insulin or other instructionsIf you wish to alter the acceptable range of blood glucose levels please specify the range here:Stop date mmol/L to mmol/L mmol/L to mmol/L mmol/L to mmol/LBlood Glucose Monitoring RequirementsDate Date Time Time Blood glucose mmol/L20201919181817171616151514141313121211111010998877665544332211Blood Glucose (mmol/L)Was any Hypo Treatment Given? Y/NKetones present? How to use Blood Glucose Monitoring Chart 15.1mmol/L- higher – Refer to care plan. Contact doctor immediately if any signs of ketoacidosis. Doctor to review dose of insulin/oral antidiabetic medication10.1 – 15.0 mmol/L – refer to care plan, monitor more frequently. Doctor to review insulin/oral antidiabetic medication dose.4.0 – 10.0 mmol/L – acceptable range – no action required 0 – 3.9 mmol/L – Follow Trust guidelines for treatment of hypoglycaemia. (Appendix 3 – CNTW C 38 PPT PGN 06) ................
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