patient log sheet date s m t w th f s · please return devices with completed log sheet on / at : ....

Time BG Meal (food/drink) Carbs Medication Dosage Activity Duration Other

S M

T W

TH

F S

|

d

ate

Name:

iPro2 serial number:

Meter brand:

Meter ID:Time BG Meal (food/drink) Carbs Medication Dosage Activity Duration Other

S M

T W

TH

F S

|

d

ate

Time BG Meal (food/drink) Carbs Medication Dosage Activity Duration Other

S M

T W

TH

F S

|

d

ate

Time BG Meal (food/drink) Carbs Medication Dosage Activity Duration Other

S M

T W

TH

F S

|

d

ate

First day: Take your first two blood glucose tests at

: and : , and at least

once more before midnight.

Throughout the study: Test your blood glucose at least four times a day, for example: before breakfast, lunch, dinner, and bedtime.

Last day: Test your blood glucose at least three times. Return date: Please return devices with completed log sheet on / at : .

Patient Log Sheet

Notes:

6025497-0U1_d

Time BG Meal (food/drink) Carbs Medication Dosage Activity Duration Other

S M

T W

TH

F S

|

d

ate

Time BG Meal (food/drink) Carbs Medication Dosage Activity Duration OtherS

M T

W T

H F

S

|

dat

e

Time BG Meal (food/drink) Carbs Medication Dosage Activity Duration Other

S M

T W

TH

F S

|

d

ate

Time BG Meal (food/drink) Carbs Medication Dosage Activity Duration Other

S M

T W

TH

F S

|

d

ate