Enter patient's name 121212124/2/22None Lantus NoneLantusHumalog1111 1

1

Name: Enter patient's name

MR: 12121212

DOB: 4/2/22

Date: June 30, 2017

Blood Glucose (mg/dl)	Breakfast Humalog	Lunch Humalog	Supper Humalog	Bedtime Humalog	If Not Eating at Mealtime Humalog
70 or below	Treat the low blood sugar. Recheck blood glucose in 15 mins. If sugar is more than 70, then take the number of units of insulin in the 71-90 row, if before a meal.
71-90	0	0	0	0	0
91-130 (Base Dose)	1	1	1	0	0
131-150	2	2	2	0	1
151-200	3	3	3	0	2
201-250	4	4	4	0	3
251-300	5	5	5	1	4
301-350	6	6	6	2	5
351-400	7	7	7	3	6
401-450	8	8	8	4	7
451 or above	9	9	9	5	8
Take None units of Lantus at breakfast
Take None units of Lantus in the evening

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