What should be included in a home monitoring chart for a diabetic patient to track blood sugar levels?

Home Blood Glucose Monitoring Chart for Diabetic Patients

A comprehensive home monitoring chart should include columns for date/time, blood glucose readings at specific testing times (fasting, pre-meals, 1-2 hours post-meals, bedtime), insulin doses, carbohydrate intake, physical activity, and symptoms of hypoglycemia or hyperglycemia. 1

Essential Components to Track

Blood Glucose Testing Times and Target Values

For patients on intensive insulin therapy (multiple daily injections or pump), the chart must accommodate 6-10 daily measurements at these critical times: 1

• Fasting/pre-breakfast: Target 80-130 mg/dL (4.4-7.2 mmol/L) 1
• Before each meal and snack: Target 80-130 mg/dL 1
• 1-2 hours after meals (postprandial): Target <180 mg/dL (10.0 mmol/L) 1
• Bedtime: Especially important to prevent nocturnal hypoglycemia 1
• Before, during, and after exercise: To prevent exercise-induced hypoglycemia 1
• When hypoglycemia suspected: Any reading <70 mg/dL (3.9 mmol/L) requires immediate treatment 1
• Before critical tasks (e.g., driving): Safety measure 1

For patients on basal insulin only, focus primarily on fasting glucose measurements to guide dose adjustments, though less frequent monitoring may suffice. 1

Insulin Documentation

The chart should include separate columns for: 2

• Basal insulin dose (type and units)
• Bolus/mealtime insulin dose (type and units)
• Time of administration relative to meals
• Any dose adjustments made and rationale

Carbohydrate and Meal Information

Document: 1

• Meal timing (consistency is critical for insulin-treated patients)
• Estimated carbohydrate content of meals and snacks
• Unusual foods or portions that may affect glucose levels

Physical Activity Log

Record: 1

• Type and duration of exercise
• Timing relative to insulin doses and meals
• Any pre-exercise carbohydrate intake or insulin dose reduction

Hypoglycemia Documentation

Critical safety component: Include a dedicated section for: 1

• Symptomatic hypoglycemia episodes (shakiness, sweating, confusion)
• Asymptomatic hypoglycemia detected on testing (<70 mg/dL)
• Severe hypoglycemia requiring assistance (<54 mg/dL or level 3)
• Treatment given (15-20g glucose, repeat testing at 15 minutes)
• Time to normalization

This is essential because 53% of hypoglycemic episodes may be clinically silent. 3

Additional Monitoring Elements

Include space for: 1

• Symptoms (polyuria, polydipsia, blurred vision, headache)
• Illness or stress (affects glucose levels)
• Medication changes (including non-diabetes medications)
• Menstrual cycle (for women, as hormones affect glucose)
• Notes section for patterns or questions for healthcare provider

Chart Format Recommendations

Use a structured weekly or monthly grid format with: 1

• Clear date and time columns
• Pre-printed target ranges for quick reference (80-130 mg/dL pre-meal, <180 mg/dL post-meal) 1
• Color-coding zones: green for target range, yellow for borderline (70-79 or 131-180 mg/dL), red for concerning values (<70 or >180 mg/dL)
• Space for healthcare provider review and comments

Critical Accuracy Considerations

Patients must understand: 1

• Meter accuracy standards: Only use FDA-approved meters meeting 95% accuracy within 15% for glucose ≥100 mg/dL 1
• Strip storage: Use only unopened, unexpired strips from licensed distributors 1
• Factors affecting readings: High-dose vitamin C, hypoxemia, hematocrit abnormalities, and certain medications can interfere 1, 4
• Plasma vs. whole blood calibration: Most modern meters report plasma-equivalent values (10-15% higher than whole blood) 1

Common Pitfalls to Avoid

Do not rely on urine glucose testing - it correlates poorly with blood glucose in 67% of patients and misses hypoglycemia entirely. 3

Avoid purchasing second-hand or resold test strips - these may give incorrect results and compromise safety. 1

Never ignore patterns of unexplained low readings - this may indicate hypoglycemia unawareness requiring immediate regimen reevaluation and raised glycemic targets. 1

Review and Action Plan

The chart should facilitate: 1

• Pattern recognition: Identify trends over 3-7 days rather than reacting to single values
• Treatment adjustments: Document what changes were made based on patterns
• Healthcare provider review: Bring completed charts to all appointments for collaborative decision-making
• Digital integration: Consider using apps or software that can generate ambulatory glucose profiles and trend reports 1

The monitoring frequency should be reassessed at each visit to ensure the burden of testing remains proportionate to the clinical benefit and treatment intensity. 1