INTERVENTION GROUP MEALS LOG – Date and Time of First Meal: ___/____/_____ _____: _____ For the patient who is eating: Date Time Meal Percent of food eaten SQ Insulin Dose Given Nurse Initials B = Breakfast (circle one) (*give 20 mins L = No entry = none/nearly none start of meal dose – D = Dinner 30 = partial consumption determined by (circle one) 60 = all/nearly all GlucoStabilizer) consumption B L D 30 60 units No Entry B L D 30 60 units No Entry B L D 30 60 units No Entry B L D 30 60 units No Entry B L D 30 60 units No Entry B L D 30 60 units No Entry B L D 30 60 units No Entry B L D 30 60 units No B L D 30 60 No Entry B L D 30 60 units No Entry B L D 30 60 units No Entry B L D 30 60 units No B L D 30 60 units No Entry *Meal insulin is given 20 minutes after starting three daily meals (breakfast, lunch, and dinner) or bolus tube feedings, if subject still eating estimate final consumption and give meal insulin. *Meal insulin is rapid acting analog and dosing is determined by GlucoStabilizer If they ate none or nearly none. DO NOT make GlucoStabilizer and give NO insulin. Input for 30 grams partial consumption. Input for 60 grams all or nearly all consumption. *SQ Saline is ONLY to patients who are NPO Status or continuous tube feeds at 09:00 AM and 21:00 PM **Please remember to chart in Medical Record the amount of meal insulin given or amount of SQ saline given. **
INTERVENTION GROUP – MEALS LOG Date and Time of First Meal: ___/____/_____ _____: _____ For the patient who is eating: Date Time Meal B = Breakfast L = D = Dinner (circle one) Percent of food eaten (circle one) No entry = none/nearly none 30 = partial consumption 60 = all/nearly all consumption SQ Insulin Dose Given (*give 20 mins start of meal – dose determined by GlucoStabilizer) Nurse Initials B L D No Entry 30 60 units B L D No Entry 30 60 units B L D No Entry 30 60 units B L D No Entry 30 60 units B L D No Entry 30 60 units B L D No Entry 30 60 units B L D No Entry 30 60 units B L D No 30 60 units B L D No Entry 30 60 B L D No Entry 30 60 units B L D No Entry 30 60 units B L D No 30 60 units B L D No Entry 30 60 units *Meal insulin is given 20 minutes after starting three daily meals (breakfast, lunch, and dinner) or bolus tube feedings, if subject still eating estimate final consumption and give meal insulin. *Meal insulin is rapid acting analog and dosing is determined by GlucoStabilizer If they ate none or nearly none. DO NOT make GlucoStabilizer and give NO insulin. Input 30 grams for partial consumption. Input 60 grams for all or nearly all consumption. *SQ Saline is ONLY to patients who are NPO Status or continuous tube feeds at 09:00 AM and 21:00 PM **Please remember to chart in Medical Record the amount of meal insulin given or amount of SQ saline given. **
shine_-_intervention_group_meal_log.hmh.docx