I Can Take Control of My Diabetes I understand that I have Diabetes Mellitus and that this is a life

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I Can Take Control of My DiabetesI understand
that I have Diabetes Mellitus and that this is a
lifelong serious conditions. If I control my
blood sugar I will reduce my risk for heart
attack, blindness, kidney damage and circulation
problems.As your health care provider we will
guide you and offer support as you manage your
own Diabetes. The following goals will help you
gain and maintain diabetes control and improve
your health.
The hemoglobin A1c measures how well your sugar
level is controlled. Hb SUGAR A1C
LEVEL The ideal Hb
A1c is 6.5 My current Hb A1c is_________ My
HbA1c goal level for better control is
__________ Patients signature_______________
_______ Providers signature____________________

• I will work hard to lower my Hb A1c
• __/__/__
• I will walk 30 minutes _____ days a week.
• __/__/__
• I will follow my diabetic and low fat diet.
• ___/__/__
• I will pay close attention to my medications.
• __/__/__
• I will try to obtain my ideal body weight.
• __/__/__
• I will test my blood sugar as instructed. __/__/
  __
• I will take an aspirin every day. __/__/__
• I will stop smoking.
• __/__/__
• I will check my feet daily.
• __/__/__
• I will keep my dental and eye appointments.
• __/__/__