for addressograph plate
Instructions: Record all the food and drink you consume and include time, place, thoughts, food preparation
and specific amounts. Use measuring cups or measuring spoons to determine the amount.
© 2009 American Diabetes Association Diabetes Education: Tool - I
Last Revision: 5/11/12
FOOD LOG
Food Log Example
Time Place
Thoughts and
Feelings
Foods and Beverages
(And how prepared)
Amount
8:15 am
Home
(kitchen, at table,
in front of TV)
Hungry, in a hurry
Egg, poached Orange
juice Toast
Margarine
1
1/2 cup
1 slice
1 tsp
10:00 am Work
Coffee 1 cup
12:30 pm Home Hungry, ate alone
Sandwich:
Bread
Roast beef
Mayonnaise
Lettuce, tomato
Sugar cookies
Low-fat (1%) milk
2 slices reg.
2 oz
1 tbsp lite
2
1 1/2 cups
6:00 pm
Restaurant
(fast food, take
out, sit down)
Enjoyed friends, got
too full
Fried chicken
Coleslaw
Mashed potatoes
Gravy
Apple pie
Lemonade
1 leg and thigh
1/2 cup
1 cup
1/4 cup
1 piece
1 1/2 cups
10:00 pm Movie
Tired, popcorn
smelled good
Buttered popcorn
Diet cola
2 cups
2 cups (16 oz)
for addressograph plate
Instructions: Record all the food and drink you consume and include time, place, thoughts, food preparation
and specific amounts. Use measuring cups or measuring spoons to determine the amount.
© 2009 American Diabetes Association Diabetes Education: Tool - I
Last Revision: 5/11/12
FOOD LOG
Food Log
Name
Day
Date
Time Place
Thoughts and
Feelings
Foods and Beverages
(And how prepared)
Amount
