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Medicines for People with Diabetes Planning Forms
Instructions: Please print this page and return to Medicines for People With Diabetes. If you are unable to print this page, or if you would rather use a hard-copy booklet, please contact the National Diabetes Information Clearinghouse at ndic@info.niddk.nih.gov and request a copy of Medicines for People With Diabetes.
Questions to Ask About Your Diabetes Medicines
Ask these questions when your doctor prescribes a medicine. Write the answers in pencil so that you can make changes if your doctor changes your medicines.
- When do I take the medicine—before a meal, with a meal, or after a meal?
____________________________________________
- How often should I take the medicine?
____________________________________________
- Should I take the medicine at the same time every day?
____________________________________________
- What should I do if I forget to take
my medicine?
____________________________________________
- What side effects may happen?
____________________________________________
- What should I do if I get side effects?
____________________________________________
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My Diabetes Medicines
Fill in the names of your diabetes medicines, when you should take them, and how much you should take. Your doctor or diabetes teacher can help you fill in this record. Write this in pencil so you can make changes when your doctor makes changes in your diabetes medicines.
- Name of medicine: ______________________________
Time: __________ Meal: _________________________
How much: ____________________________________
- Name of medicine: ______________________________
Time: __________ Meal: _________________________
How much: ____________________________________
- Name of medicine: ______________________________
Time: __________ Meal: _________________________
How much: ____________________________________
- Name of medicine: ______________________________
Time: __________ Meal: _________________________
How much: ____________________________________
- Name of medicine: ______________________________
Time: __________ Meal: _________________________
How much: ____________________________________
- Name of medicine: ______________________________
Time: __________ Meal: _________________________
How much: ____________________________________
- Name of medicine: ______________________________
Time: __________ Meal: _________________________
How much: ____________________________________
- Name of medicine: ______________________________
Time: __________ Meal: _________________________
How much: ____________________________________
- Name of medicine: ______________________________
Time: __________ Meal: _________________________
How much: ____________________________________
- Name of medicine: ______________________________
Time: __________ Meal: _________________________
How much: ____________________________________
- I should call my doctor or diabetes teacher if I have these problems with my diabetes medicines:
___________________________________________________
___________________________________________________
- I should call my doctor or diabetes teacher if my blood glucose is too low or too high for several days.
Too low is _______ mg/dL for _______ days.
Too high is _______ mg/dL for _______ days.
- My blood glucose should be between _________ mg/dL and _________ mg/dL
before my first meal of the day.
- My blood glucose should be between _________ mg/dL and _________ mg/dL
1 to 2 hours after a meal.
- My blood glucose is too low at ___________________ mg/dL.
- My blood glucose is too high at ___________________ mg/dL.
- My A1C should be ___________________%.
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