To save time filling the “Diabetes History Form,” have the following information handy before filling the forms. We understand that you may not have all the information; however, the more the information provided, the more comprehensive our report will be.

Height, weight, all current medications including insulin, with doses, medication allergies

Glucometer readings if available for 1 week- (readings before meals and 2 hours after meals, especially if on insulin)

Lab results are optional, but we strongly recommend getting these results by calling your doctor’s office. The lab tests are listed below. This information helps our medical panel give more specific information. If not available or if not done, leave them blank.

• HbA1c
• BUN
• Creatinine
• Total cholesterol
• Triglycerides
• HDL cholesterol
• LDL cholesterol
• AST or SGPT
• ALT or SGOT
• Urine test for Microalbumin/creatinine ratio