<span>29.12 Sick Day Record</span>

Summa Health System developed this record for patients with diabetes to use to log their blood glucose and urine ketones on days when they are sick. Care providers give it to patients during diabetes planned visits, and it is part of the Diabetes Planned Visit Notebook.

Sick Day Record

Name: _________________________________________________________________________

Chart#: ________________________________________________________________________

Date: __________________________________________________________________________

Sick day treatment plan (your doctor or nurse will mark the testing that is right for you)

Check blood glucose & urine ketones at the times marked in the shaded box.

Date	Glucose/Ketones	Before Breakfast	2 Hr After Breakfast	Before Lunch	2 Hr After Lunch	Before Supper	2 Hr After Supper
Date	Blood Glucose
	Urine Ketones
Date	Blood Glucose
	Urine Ketones
Date	Blood Glucose
	Urine Ketones
Date	Blood Glucose
	Urine Ketones
Date	Blood Glucose
	Urine Ketones

When to call your doctor

Call your doctor at (330) 375-3584 or 1-800-460-2332 if:

Your blood sugar is over 240.
Your blood sugar is less than 80.
Ketone results are MODERATE or LARGE.

Diabetes Planned Visit Notebook

29.12 Sick Day Record

Table of Contents

Sick Day Record

When to call your doctor