HUMALOG/NOVOLOG AND LANTUS

OSF Pediatic Diabetes Resource Center

Fax: 309-682-8152
Name: ________________________________
DOB: ____

Meal insuline ______________

Correction insulin __________
(Total carb grams + _______ = dose) (Blood sugar - _________ ________

Time of Day:

M
N

1A

10

11

12

Blood
Sugar
Total
Carbs (gm)
Meal
Humalog/Novolog
Correction
Humalog/Novolog
Total dose
Humalog/Novolog
Lantus
Activity
Food
Amt

Breakfast

Time: ________

Morning Snack Time: ________

Food
Carb
Grams

Amt

Lunch

Time: ________

Afternoon Snack Time: ________

Carb
Grams

US
nter

ection insulin __________

Date:

od sugar - _________ ________ = dose)

10

11

Food
Amt

Dinner

Time: ________

Evening Snack Time: ________

Carb
Grams