North Austin Maternal Fetal Medicine
12200 Renfert Way Ste.G3
Austin, TX 78758
512-821-2540
Name:___________________________DOB____________
Target blood sugar levels:
Fasting no higher than: 95
1 hour after eating no higher than: 140
2 hours after eating no higher than: 120
1-2 hours
1-2 hours
1-2 hours
Notes: If your blood sugar is out of range
Fasting
Date
after
after lunch
after
please write what you ate/drank for that
breakfast
dinner
meal.
Dr. DeStefano Dr. Adusumalli Dr. Haeri Dr. Singh
Please fax or email your blood sugar levels WEEKLY to: 877-493-3567 or
***Bring logs to every visit***