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HTML Preview Diabetic Record page number 1.

1

XXX Hospital NHS Trust

ADULT DIABETES RECORD

Current values as of (date): …………

Height: ……… cm

Weight: ……… kg

BMI: ……… kg m

–2

HbA1c: ……… %

Creatinine: ……… mM (mmol l

–1

)

Year diagnosed: …………

Pre-admission diabetes therapy:

SURNAME Hospital Number

First name(s) Date of birth Sex

Consultant Ward

Capillary blood glucose reading (mM)

Please record across the page

DATE READINGS

COMMENTS

(e.g. fasting, surgery,

steroid use)

Time

Glucose

Time

Glucose

Time

Glucose

Time

Glucose

Time

Glucose

Time

Glucose

Time

Glucose

Time

Glucose

Time

Glucose

Time

Glucose

Time

Glucose

Time

Glucose

Time

Glucose

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