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To receive
a copy of any of these charts, please
contact us.
Pump log
A: available in excel format
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Date: |
Site Location________ |
Breakfast Ratio________ |
Lunch Ratio_______ |
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Supper Ratio |
Snack Ratio______ |
Site Change? |
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over 15 |
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10.1-15 |
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8.1-10 |
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6.1-8 |
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4.1-6 |
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2.1-4 |
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0-2.0mmoL |
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ReseviorFill? |
12am |
1am |
2am |
3am |
4am |
5am |
6am |
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8am |
9am |
10am |
11am |
noon |
1pm |
2pm |
3pm |
4pm |
5pm |
6pm |
7pm |
8pm |
9pm |
10pm |
11pm |
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BG Levels |
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Carbohydrates |
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Food Bolus |
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Correction Bolus |
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Basal |
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Temp Basal |
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Activity length: |
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Activity Type |
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Time |
Breakfast |
CHO |
Time |
Snack |
CHO |
Time |
Lunch |
CHO |
Time |
Snack |
CHO |
Time |
Supper |
CHO |
Totals |
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CHO__ |
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Bolus |
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Correct |
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Basal |
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7Day Basal |
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Total |
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Total |
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Total |
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Total |
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Total |
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Notes: |
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Cheque book Style Log Book:
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Date___________ |
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Correction Factor:_______ |
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Correct to:_______ |
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12am |
2 |
4 |
6am |
8 |
10 |
noon |
2 |
4 |
6pm |
8 |
10 |
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BS |
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Bolus |
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Correct |
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Basal |
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Activity |
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Notes: |
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Diabetes Pump Log Sheet: Available in Word
Name:
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Date:
February 2, 2004
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5:30am
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6:00am
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PreBrkfst
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PostBrkfst
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PreLunch
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PostLunch
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PreDin
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PostDin
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Bedtime
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Blood Glucose
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3.6 |
4.2 |
4.8 |
3.2* |
3.4 |
4.8 |
3.3 |
2.7 |
6.6 |
19.4at
10:30pm
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Carbs
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15g |
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50g |
15g |
72g |
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43g |
45g |
23g |
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Meal Bolus+Supl
Bolus |
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2.4 |
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3.05 |
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1.5 |
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.75 |
+1.25 |
Pump log B: Available in excel
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My Insulin:carb ratio for AM is
__________________ |
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My Insulin:carb ratio for lunch
is________________ |
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Date: |
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My Insulin:carb ratio for supper
is_______________ |
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My Insulin:carb ratio for snacks
is_______________ |
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My Correction Factor is _______________________ |
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I correct to a target of
_________________________ |
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7am |
8am |
9am |
10am |
11am |
noon |
1pm |
2pm |
3pm |
4pm |
5pm |
6pm |
7pm |
8pm |
9pm |
10pm |
11pm |
midn |
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Bg Reading |
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