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Diab Man Profile

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This document provides a management profile template for people with diabetes to track their treatment plan, including their healthcare team, medications, physical activity, blood sugar targets, meal plan, and blood sugar testing schedule. The profile is meant to be filled out with a healthcare provider and used to easily review one's full diabetes management plan.

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Diabetes Management: Management Profile We've created this Management Profile to help you keep track of your diabetes management tools. The Profile will make it easy for you to review your entire, up- to-date management plan at any time. Work with your doctor, nurse, pharmacist or diabetes educator to fill in these sections. Use a pencil because this information will change from time to time. Name: Physician/Healthcare Team Name Telephone Number Frequency of visits Family Physician Specialists: Certified Diabetes Educator Endocrinologist Podiatrist Dietician Medicine Time Type Dose/Units Physical Activity Type Days Times Blood sugar target range: Between_______ mmol/L and ________mmol/L Meal plan My optimum daily caloric/CHO intake: _______________ Optimum eating times: Breakfast Snack Lunch Snack Dinner Snack Time: Blood sugar testing schedule Breakfast Lunch Dinner Bedtime Night Before After Before After Before After Monday Tuesday Wednesday Thursday Friday Saturday Sunday

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Diab Man Profile

  • 1. Diabetes Management: Management Profile We've created this Management Profile to help you keep track of your diabetes management tools. The Profile will make it easy for you to review your entire, up- to-date management plan at any time. Work with your doctor, nurse, pharmacist or diabetes educator to fill in these sections. Use a pencil because this information will change from time to time. Name: Physician/Healthcare Team Name Telephone Number Frequency of visits Family Physician Specialists: Certified Diabetes Educator Endocrinologist Podiatrist Dietician Medicine Time Type Dose/Units Physical Activity Type Days Times Blood sugar target range: Between_______ mmol/L and ________mmol/L Meal plan My optimum daily caloric/CHO intake: _______________ Optimum eating times: Breakfast Snack Lunch Snack Dinner Snack Time: Blood sugar testing schedule Breakfast Lunch Dinner Bedtime Night Before After Before After Before After Monday Tuesday Wednesday Thursday Friday Saturday Sunday