Gestational Blood Sugar Log
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1GESTATIONAL BLOOD SUGAR LOG
GOAL:
Before breakfast:
60-95 mg/dl
1 hour after each meal:
Less than 130 mg/dl
Patient:______________________________________________________________________________
(Last)
(First)
(MI)
Date of Birth: _____ / _____ / _____
Expected Delivery Date: _____ / _____ / _____
Phone Number: (Home) __________________ (Work)__________________ (Cell) _________________
BLOOD SUGAR READINGS
Before
1hr after
1hr after
1hr after
DATE
COMMENTS
Breakfast
Breakfast
Lunch
Dinner
1
2
3
4
5
6
7
8
9
10
11
12
13
14
If you have 3 numbers greater than goal range, call _______________________. If your numbers are all within
th
goal range, please call us on the 14
day.
Information received by: _______________________________
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Parent category: Medical