Insulin Administration and Blood Glucose Log

Per-resident log for recording fingerstick blood glucose readings, insulin administration, sliding scale coverage, and hypoglycemia events in a nursing home setting.

Resident and Log Details

• Resident Identifier
  Use the resident's internal identifier or chart number. Do not enter SSN.
• Resident Name
  Optional if your facility uses an internal identifier for minimum necessary documentation.
• Date of Entry
• Time of Entry
• Shift
• Entered By
  Staff member completing the log entry.

Blood Glucose Reading

• Time of Fingerstick
• Blood Glucose Reading (mg/dL)
• Reading Context
• Symptoms Present?
• Symptoms Description
  Show only if symptoms are present.

Insulin Administration

• Was Insulin Administered?
• Insulin Type
• Insulin Name
  Optional brand or formulation name if needed for the medication record.
• Dose Given (units)
• Sliding Scale Coverage Used?
• Sliding Scale Reference
  Enter the scale or order reference used for dose calculation.
• Route

Hypoglycemia Event and Follow-Up

• Hypoglycemia Event Occurred?
• Lowest Blood Glucose During Event (mg/dL)
• Intervention Provided
• Follow-Up Notes
  Document response to treatment, repeat glucose results, and any escalation.
• Provider Notified?

Attestation and Submission

• I confirm this entry is accurate and complete to the best of my knowledge.
• Additional Notes
  Use only for relevant clinical notes. Do not include unnecessary PII.