Weight Your current: Your target: Ideal: BMI: BMI: BMI <25 Waist: _____ cm Waist: _____ cm Men waist cm ≤94 Women waist cm ≤80 Physical Activity Your current: Your target: At least 30 minutes of walking (or equivalent) on 5 or more days per week (Minimum of 150 minutes per week) Smoking Current status: Target: Complete cessation Avoidance of smoke Number per day: Alcohol Your current: Your target: Ideal: Number of standard standard drinks on standard drinks on ≤2 drinks on any day any day any day Biomedical Cholesterol / Lipids Your current: Your target: Cholesterol _____ Cholesterol _____ mmol/L mmol/L Triglycerides _____ Triglycerides _____ mmol/L mmol/L LDL-C _____ mmol/L LDL-C _____ mmol/L HDL-C _____ mmol/L HDL-C _____ mmol/L pressure Your current: < _____ Your target: < _____ Ideal: <130/80 mmHg For people with proteinuria >1g/day (with or without diabetes) <125/75 mmHg Blood Sugar Your current: Your target: ___BM (fasting) ___BM (fasting) ___ BM (random) ___ BM (random) Questions I want to ask my health professional at my next appointment and other relevant information:
Weight Your current: BMI: Waist: _____ cm Your target: BMI: Waist: _____ cm Ideal: BMI <25 Men waist ≤94 cm Women waist ≤80 cm Physical Activity Your current: Your target: At least 30 minutes of walking (or equivalent) on 5 or more days per week (Minimum of 150 minutes per week) Smoking Current status: Number per day: Target: Complete cessation Avoidance of smoke Alcohol Your current: Number of standard drinks on any day Your target: standard drinks on any day Ideal: ≤2 standard drinks on any day Biomedical Cholesterol / Lipids Your current: Cholesterol _____ mmol/L Triglycerides _____ mmol/L LDL-C _____ mmol/L HDL-C _____ mmol/L Your target: Cholesterol _____ mmol/L Triglycerides _____ mmol/L LDL-C _____ mmol/L HDL-C _____ mmol/L pressure Your current: < _____ Your target: < _____ Ideal: <130/80 mmHg For people with proteinuria >1g/day (with or without diabetes) <125/75 mmHg Blood Sugar Your current: ___BM (fasting) ___ BM (random) Your target: ___BM (fasting) ___ BM (random) Questions I want to ask my health professional at my next appointment and other relevant information:
2.4j%20My%20Diabetes%20Care%20plan%20v2_0.docx