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1Blood Glucose Testing Chart for Pregnant Women
Name: _______________________________________________________
Use copies of this form to keep track of your blood glucose numbers, your urine or blood ketone test results, and your insulin levels. Print a copy for each week of your
pregnancy and do not forget to carry along these records when visiting your doctor.
My Daily Blood Glucose Record
Week
Starting: Fasting
Urine or
Breakfast
Other
Lunch
Other
Dinner
Other
Bedtime
Other
Blood
Blood
Insulin
Blood
Insulin
Blood
Insulin
Blood
Insulin
Blood
Insulin
Blood
Insulin
Blood
Insulin
Blood
Insulin
Blood
Notes
Glucose
Ketones
Glucose
Glucose
Glucose
Glucose
Glucose
Glucose
Glucose
Glucose
Sun
Mon
Tue
Wed
Thu
Fri
Sat
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Parent category: Medical