Self Management Plan and Diary

human insulin (prb)30% soluble insulin 70% isophane insulinisophane human insulin (prb)Order detailsThis form is to be completed by theprescriber and should be used inconjunction with the prescription forHumulin I KwikPens or cartridges and givento the pharmacist, by the patient, to assistthem to dispense the correct insulin.Self ManagementPlan and Diaryfor Humulin IName ...................................................................................Date of Birth .....................................................................Address ............................................................................................................................................................................................................................................................................Tel ........................................................................................Further information is available from Customer CareEli Lilly and Company LimitedLilly HousePriestley RoadBasingstokeHampshire RG24 9NLTel: (01256) 315000www.lillydiabetes.co.uk/patientsThis diary has been developed, produced and printed by Lilly as aservice to patientsUKHML00089 January 2012This leaflet is intended only for those individuals who havebeen prescribed Humulin I. It is intended to be used in additionto the Patient Information Leaflet (PIL) which is included in yourmedicine and should also be read.

I have DiabetesName .........................................................................Address.....................................................................Details of prescribed productsProductPIP code.....................................................................................Tel ..............................................................................Diabetes Team Nurse.....................................................................................Humulin I 339-1836KwikPenDoctor.....................................................................................If I am unconscious or behaving abnormallyI may be experiencing hypoglycaemia / lowblood glucose levels associated with mydiabetes treatment.If I can swallow, give me sugar or a sweetdrink (diet drinks are not suitable).If I do not recover promptly, call anambulance.If I am unconscious or cannot swallow donot attempt to give me anything by mouth,but call an ambulance immediately.Humulin I 3mlCartridge 221-0896BD Micro-Fine 221-08964mm NeedlesBD Micro-Fine 351-28785mm NeedlesBD Micro-Fine 243-85548mm NeedlesBD Micro-Fine 239-34528mm NeedlesBD Micro-Fine 008-750212mm Needles

I have DiabetesName .........................................................................Address.....................................................................Details of prescribed productsProductPIP code.....................................................................................Tel ..............................................................................Diabetes Team Nurse.....................................................................................Humulin I 339-1836KwikPenDoctor.....................................................................................If I am unconscious or behaving abnormallyI may be experiencing hypoglycaemia / lowblood glucose levels associated with mydiabetes treatment.If I can swallow, give me sugar or a sweetdrink (diet drinks are not suitable).If I do not recover promptly, call anambulance.If I am unconscious or cannot swallow donot attempt to give me anything by mouth,but call an ambulance immediately.Humulin I 3mlCartridge 221-0896BD Micro-Fine 221-08964mm NeedlesBD Micro-Fine 351-28785mm NeedlesBD Micro-Fine 243-85548mm NeedlesBD Micro-Fine 239-34528mm NeedlesBD Micro-Fine 008-750212mm Needles

You have been prescribed aninsulin called Humulin I.To ensure that you have thecorrect medicine, it is importantthat the package of your medicinematches that shown below.It is important that you re suspend ( mix) your insulin priorto injection, to do this the pen should be rotated in thepalms of the hands ten times and inverted 180° ten timesimmediately before use to resuspend the insulin until itappears uniformly cloudy or milky. If not, repeat the aboveprocedure until contents are mixed. Cartridges contain asmall glass bead to assist mixing. Do not shake vigorouslyas this may cause frothing, which may interfere with thecorrect measurement of the dose. The cartridges should beexamined frequently and should not be used if clumps ofmaterial are present or if solid white particles stick to thebottom or wall of the cartridge, giving a frosted appearance.

AppointmentsDate Time To See......................... .......................... ........................................................................... .......................... ........................................................................... .......................... ........................................................................... .......................... ........................................................................... .......................... ........................................................................... .......................... ........................................................................... .......................... ..................................................Eye Screening......................... .......................... ..................................................Foot Screening......................... .......................... ..................................................Contact:...................................................................................................................................................................................................................................................................................................................................................When do I take my insulin?You may need to take Humulin I in themorning (before breakfast) and/or in theevening (either before your evening meal orbefore bed).Your healthcare professional will advise youhow often you need to take your insulin.

What to do if you are illIf you are vomiting or unable to eat your usual foods, youshould maintain your fluid intake with sugar free fluids toprevent dehydration and replace usual meals with fluidscontaining some carbohydrate.NEVER stop your insulin without discussing it withyour diabetes team.Check your blood glucose at least four times a day.Any illness is difficult to manage with diabetes. It isgood advice to contact your diabetes team for individualguidance.If you are vomiting or unable to eat your usual foods,you should maintain your fluid intake with sugar freefluids to prevent dehydration and replace usual mealswith fluids containing some carbohydrate.Always check urine or blood for ketones (they can makeyou sick).If you have moderate or high ketones and high bloodglucose levels this is a good indication you may needmore insulin.If high blood glucose and ketones lead to vomiting anddehydration, you may require hospital admission. Youmust contact your diabetes team.What should you do if you forgetto take your Insulin?Don’t panicIf you forget your insulin, you may notice,Your blood glucose levels will be higher,You may feel tired, thirsty, or pass more urine than usual.Forgetting your insulin is rarely an emergencysituation. Seek advice from your diabetes team. Theadvice will vary depending on when you have realisedyou have forgotten to take your insulin.

HbA1c - what is it?HbA1c is a measure of the amount of glucose attached tothe red blood cells. When glucose enters the blood streamit sticks to the haemoglobin, this is known as haemoglobinA1c, or HbA1c. HbA1c is measured as a % or as mmol/mol.The more glucose that is present in the blood, the higher thehaemoglobin A1c or HbA1c.Red blood cells live for about 8-12 weeks before they arereplaced by new red blood cells. Measuring the HbA1c cantell you what your blood glucose level has been on averageover the last 8-12 weeks. In a person without diabetes theHbA1c is around 4-6% or 20-42 mmol/mol. In diabetesthe aim is to get the HbA1c to between 6.5-7% or48-53mmol/mol (your personal target based on yourindividual needs will be discussed with you by yourdiabetes team).This is not the same as the blood glucose results that youcheck yourself.The advice is:my Target HbA1c is ............................... by (date)........................Discussed by ............................................ date ................................Your current HbA1cDate

Self adjustment guidelinesWhen testing your blood glucose, if you have consistentlyhigh readings for more than three days at any testing point,then you will need to adjust your insulin.Your healthcare professional will explain to you how toadjust your insulin and will complete the following table foryour needs.Night-time Humulin INight-time Humulin I onlyFasting(before breakfast) mmol/Labovebelow..........................Adjust units of insulinMorningHumulin IMorning Humulin I onlyFasting (beforebreakfast) mmol/LabovebelowBefore eveningmeal mmol/Labovebelow....................................................Adjust unitsof insulinTwice dailyHumulin ITwice daily Humulin IFasting (beforebreakfast) mmol/LabovebelowBefore eveningmeal mmol/LabovebelowAdjust unitsof insulin..........................adjust evening dose..........................adjust morningdoseDose reduction is recommended if any results areconsistently less than 4 mmol/L (hypo) at any time.

Instructions on how to use thismonitoring diaryDate you started this diary .............................................................This Diary has been designed to help you keep a day-to-dayrecord of the amount of glucose in your blood.This information will help you determine how you arebalancing your diet and exercise with your insulin regimen.It will also help your Diabetes team to establish the bestinsulin regimen to manage your diabetes.Discuss with your Diabetes team about the frequency andbest times to test your blood glucose levels as this mayvary.Please follow the step by step instructions below on how tocomplete the Monitor Diary.1. Record date2. Record doses of insulin3. Record results of blood glucose tests4. Record any important comments about illness orchanges in diet or exercise patterns which mayaffect your test results5. Record ‘hypos’6. This diary also contains your diabetes reviewresults to enable you and your diabetes team toidentify the actions that need to be taken to achieveyour targetsThe information contained in this diary should be usedas a supplement to the Humulin I Patient Informationleaflet. Please consult your Nurse/Doctor if you have anyquestions or concerns.

Diary section

For Guidance on Self titration please refer topage 7.Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?Example table:DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMeal11th July12th July13th July15th July32323238EXAM38384040469.18.98.79.67.79.0

Start filling out your Diaryon the following pages...BeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?RemarksPLE11.39.911.314.010.1 10.6 Meal outwith family

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipA ‘hypo’ is when your bloodglucose is lower than 4 mmol/LBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipBuild more activity into yournormal day – try walking or cyclinga couple of times a weekBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipSwap food that is high sugar for lowsugar or sugar free alternativesBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipMake time for three regularmeals and try and eat at thetable at least once a dayBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipThe smaller your plate, thesmaller your portion. Eat yourmeals at home on a smaller plateBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipUse a new needle each timeyou inject. This helps to reduceproblems at the injection siteBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipUp your activity – why not join awalking group. They are normallyfree and a great way to meet peopleBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipTake the stairs instead of the lift –over a week that is a lot more exerciseBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipBe sensible. Enjoy the foodsyou eat, just don’t overdo itBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipWhen trying to increase your exercisechoose activities you enjoy & you’ll bemore likely to stick with themBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipBe active - walk the dog, don’tjust watch the dog walkBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipAlways remove the needle after eachinjection. This keeps out air bubblesand prevents leakage of your insulinBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipOrder your latte or cappucinowith fat-free skimmed milkBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?RemarksCarbohydrate awareness guide

Breakfast Lunch Dinner35 grams carbohydrate 60 grams carbohydrate 30 grams carbohydrate50 grams carbohydrate No carbohydrate 50 grams carbohydrate40 grams carbohydrate 50 grams carbohydrate 80 grams carbohydrateDAFNE copyright ©: Images reproduced with the permission of the DAFNE Programme.

10 grams of carbohydrates =Fruit1 slice pineapple* 140g1 small apple* 90g1 medium orange* 150g2-3 apricots* 110g1/2 banana* 70g1 small pear* 90g7 tbls blueberries 140g8 tbls blackberries 140g10 strawberries 160g1 satsuma 80g8 tbls raspberries 150g7 tbls elderberries 140g7 tbls redcurrants 140gcherries*90g1 large kiwi* 110gkumquat*70glychee*90g2 mandarin oranges* 150gmango*110gmelon*100g1/2 grapefruit* 170g1 peach* 120g4 plums* 90g7 tbls cranberries 140g6 tbls gooseberries 120gwater chestnut* 100gwatermelon*270g12 grapes 70g* with stone/peelFresh fruit should be counted the same as driedfruit. Approximately 100ml of fruit juice (withoutadded substances, 100% juice) contains 10 grams ofcarbohydrate.Adapted from: Food portion sizes: A photographic atlas:Food Standards Agency publication England, Nelson M,Atkins M, Meyer J (1997)10 grams of carbohydrates =Milk and dairy products1 glass milk 200ml1 glass yoghurt 200mlBread and bakery products1/2 bread roll 20g1/2 croissant 30g1-2 slices* crisp bread 15-25g*1 small slice wholemeal bread 25g1/2 slice thick sliced bread 20g1/2 slice mixed grain bread 20g2 rusks 15g2 crackers 15g* depending on type, check labelFlours, pastas2 (tbls) cornflakes 15g1 tbls barley 15g1 tbls pearl barley 15g1 tbls oatmeal 15g1 tbls porridge 15g1 tbls cornflour 15g1 tbls breadcrumbs 15g1 tbls rice, uncooked 15g2 tbls rice, cooked 45g1 tbls rye grains 15g1 tbls pasta, uncooked 15g1 tbls pasta, cooked 45g1 tbls wheat grains 15g1 tbls wheat flour 15g1 tbls semolina 15gPotatoes, potato-products and vegetables1 potato (egg sized) 60gcrisps25g1 tbls mashed potato powder 15g2 tbls mashed potato, made-up 75g2 croquettes 35g3 tbls sweetcorn 65gcorn-on-the-cob 100gchips35g

Top TipIf you have 3 or 4 hypos in a shortperiod of time seek help fromyour healthcare teamBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipFind out more to help you manageyour diabetes - ask your nurse aboutlocal education opportunitiesor support groupsBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipRotate where you inject each timeyou give your insulin. Ask your nursefor more information if you areunsure where you can injectBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipEat 5 a day: try fruit as ahealthy snack or add tastyvegetables to a sauceBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipReduce your waist circumference,being “apple shaped” increasesinsulin resistanceBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipCheck your feet every day - if youspot any cuts, sores, corns, calluses,blisters, ingrown toenails or ulcers,contact your diabetes teamBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipIf you are travelling abroad, plan ahead. Checkwhat insulin will be available in the countryyou’re visiting - the names and strengths canvary. You will need a note from your doctor tocarry the insulin pen/needle on boardBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipHave your eyes checked atleast once a yearBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipWhen flying make sure that your insulin doesnot go into the hold. Insulin can freeze in thehold which will damage its effectivenessBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipMonitor your blood glucose morefrequently if you are ill and never stoptaking your insulin or tabletsBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipAlways carry some form of quick actingcarbohydrate so that you are able to treat a hypo.Follow up with a longer acting carbohydrate(e.g. slice of bread or a plain biscuit)BeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipHow long have you had your bloodglucose monitor? If you have had itlonger than 3 years please check if itneeds to be replaced?BeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Are my results in my target range?Is there a pattern to the results?Do I need to make any changes to mytreatment based on these results?DateBeforeBreakfastHumulin IDoseBeforeEveningMeal /BedtimeHumulin IDoseBeforeBreakfast(Fasting)AfterBreakfastBeforeMiddayMealAfterMiddayMealComments:

Top TipStore unopened insulin in the fridge. Once inuse, insulin can be stored at room temperatureas long as it is kept under 30 degreescentigrade and for no longer than 28 daysBeforeEveningMealAfterEveningMealBefore BedDuringNightHave youhad anyHypos?Remarks

Self Management PlanReview ResultsYourtargetResults& dateResults& dateResults& dateBlood glucoseprofilesHbA1cTotalCholesterolHDLLDLTriglyceridesWeight/BMIBlood PressureOtherHow confident do you feel achieving your goals?Goal 1.......... 1 2 3 4 5 6 7 8 9 10Goal 2.......... 1 2 3 4 5 6 7 8 9 10Goal 3.......... 1 2 3 4 5 6 7 8 9 10

DateCare plan/Self Care goalsAim1)2)3)1 = Not confident10 = Very confident(If you score

Self Management PlanReview ResultsYourtargetResults& dateResults& dateResults& dateBlood glucoseprofilesHbA1cTotalCholesterolHDLLDLTriglyceridesWeight/BMIBlood PressureOtherHow confident do you feel achieving your goals?Goal 1.......... 1 2 3 4 5 6 7 8 9 10Goal 2.......... 1 2 3 4 5 6 7 8 9 10Goal 3.......... 1 2 3 4 5 6 7 8 9 10

DateCare plan/Self Care goalsAim1)2)3)1 = Not confident10 = Very confident(If you score

Medicines List............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

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