U.S. Department of Health and Human Services

Your Diabetes Care Records

On this page:

Make copies of the charts in this section. These charts list important things you should discuss with your doctor at each visit.

Things to Discuss with Your Health Care Team at Each Visit

Date: _______________

Whom you visited: __________________________________

Your information

Things to remember

Check off what you covered, or write the result of your visit.
Your blood glucose levels
  • Share your blood glucose records. Your doctor will ask how you are checking your blood glucose levels to make sure you are doing it right.
  • Mention if you often have low or high blood glucose.

empty checkbox Shared blood glucose records?
empty checkbox Checked meter?
empty checkbox Practiced blood glucose reading?
empty checkbox Shared high or low blood glucose?
Your weight
  • Talk about how much you should weigh.
  • Talk about ways to reach your target weight that will work for you.

empty checkbox My weight now is _____________.
empty checkbox My target weight is _____________.
empty checkbox Steps to take:

Your blood pressure
  • Ask about ways to reach your target.
  • The target for most people with diabetes is below 140/80 unless your doctor helps you set a different target.

empty checkbox My blood pressure now is _________.
empty checkbox My target blood pressure is _________.
empty checkbox Steps to take:

Your medicines
  • Talk about any problems you have had with your medicines.
  • Ask if you should take a low-dose aspirin every day to lower your chance of getting heart disease.

empty checkbox Shared medicine problems?
empty checkbox Take aspirin?
empty checkbox Steps to take:

Your feet
  • Ask to have your feet checked for problems.
  • Talk about any problems you are having with your feet, such as numbness, tingling, or sores that heal slowly.

empty checkbox Checked feet?
empty checkbox Shared problems?
empty checkbox Steps to help with my feet:

Your physical activity plan
  • Talk about how often you are physically active, the type of physical activity you do, and any problems you have when being physically active.

empty checkbox Shared activities?
empty checkbox Steps to take:

Your healthy eating plan
  • Talk about what you eat, how much you eat, and when you eat.

empty checkbox Shared eating habits?
empty checkbox Steps to take:

Your feelings
  • If you feel stressed, ask about ways to cope
  • Talk about whether you are feeling sad.

empty checkbox Shared stress and problems?
empty checkbox Steps to take:

Your smoking
  • If you smoke, ask for help with quitting.

empty checkbox Shared smoking habits?
empty checkbox Steps to take:

PDF Version (PDF, 50 KB)


This chart lists important tests, exams, and vaccines to get at least once or twice a year.

Tests, Exams, and Vaccines to Get at Least Once or Twice a Year



Results or Dates
A1C test
  • Have this blood test at least twice a year. Your result will tell you what your average blood glucose level was for the past 2 to 3 months.

Date: __________

A1C: __________

Next test: __________

Blood lipid (fats) lab tests
  • Get a blood test to check your
    • total cholesterol—aim for below 200
    • LDL, or bad, cholesterol—aim for below 100
    • HDL, or good, cholesterol—men: aim for above 40; women: aim for above 50
    • triglyceridesaim for below 150

Date: __________

Total cholesterol: __________

LDL: __________

HDL: __________

Triglycerides: __________

Next test: __________

Kidney function tests
  • Once a year, get a urine test to check for protein.
  • At least once a year, get a blood test to check for creatinine.

Date: __________

Urine protein: __________

Creatinine: __________

Next test: __________

Dilated eye exam
  • See an eye doctor once a year for a complete eye exam that includes using drops in your eyes to dilate your pupils.
  • If you are pregnant, have a complete eye exam in your first 3 months of pregnancy. Have another complete eye exam 1 year after your baby is born.

Date: __________

Result: __________

Next test: __________

Dental exam
  • See your dentist twice a year for a cleaning and checkup.

Date: __________

Result: __________

Next test: __________

Pneumonia vaccine (recommended by the Centers for Disease Control and Prevention [CDC])
  • Get the vaccine if you are younger than 64.
  • If you’re older than 64 and your shot was more than 5 years ago, get another vaccine.
Date received: __________

Flu vaccine (recommended by the CDC)
  • Get a flu shot each year.

Date received: __________
Hepatitis B vaccine (recommended by the CDC)
  • Get this vaccine if you are age 19 to 59 and have not had this vaccine.
  • Consider getting this vaccine if you are 60 or older and have not had this vaccine.

Date of 1st dose: __________

Date of 2nd dose: __________

Date of 3rd dose: __________

PDF Version (PDF, 40 KB)


Daily Diabetes Record Page Week Starting ____________________

Medicine Lunch
Medicine Dinner
Medicine Bedtime
Medicine Other
Notes: (Special events, sick days, exercise)







PDF Version (PDF, 40 KB)


Go to Points to Remember

Return to Take Care of Your Diabetes during Special Times or Events

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Michael L. Parchman, M.D., M.P.H., F.A.A.F.P., MacColl Center for Health Care Innovation, Group Health Research Institute; Marion J. Franz, M.S., R.D., L.D., C.D.E., Minneapolis, Minnesota

This information is not copyrighted. The NIDDK encourages people to share this content freely.


February 2014