家居自我血糖記錄表

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Date BW/BMI/WC BP Smoking Na / K /Creat Urine protein HbA1c T.

Chol LDL/HDL TG Visual Acuity Cataract Fundi Tonometry Foot Pulse Neuropathy General Feet Self Monitor ( DM) Educational pamphlet/course Treatment for DM (Diet/Drug/Insulin) H'stix / FBS Hb (g/dl)/MVC(fL) ALT Framingham score Target LDL ECG / / / / / / / / / / / / / / / / /

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