HTML Preview Diabetic Record page number 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