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(Please attach corresponding calorie meal plan from the documents)
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Calories
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2000 Calories
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2000 Calories
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1800 Calories
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1800 Calories
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1600 Calories
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1600 Calories
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1400 Calories
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1400 Calories
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(Doctor please attach document by tapping on "Free Draw" > "+" sign on bottom right > "History" and choose corresponding file)
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Patient is insulin dependent
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(Tap Here)
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To be used before each meal
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Less than 60 Insulin, take two (2) glucose tablets; recheck blood sugar
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Blood Sugar
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Units
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130 - 150
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(Leave Blank)
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151 - 200
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(Leave Blank)
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201 – 250
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(Leave Blank)
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251 - 300
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(Leave Blank)
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301 - 350
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(Leave Blank)
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351 - 400
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(Leave Blank)
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more than 400
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(Leave Blank)
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