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Maternal Fetal Medicine
Rita W. Driggers, MD, FACOG
Phone: 202-660-7180
Julia Timofeev, MD, FACOG
Fax: 202-660-7189
DIABETES GLUCOSE LOG SHEET
CURRENT MEDICATION REGIMEN:
Name of drug, dose, frequency (ex. glyburide 5mg twice a day)_________________________________________________________________________________
INSULIN
BREAKFAST
LUNCH
DINNER
BEDTIME
NPH
Regular/aspart/lispro
DATE
Before breakfast
FASTING
Time
Result
2 hours
AFTER BREAKFAST
Time
Result
*To print an extra copy of the log sheet, please go to www.sibley.org/MFM*
2 hours
AFTER LUNCH
Time
Result
2 hours
AFTER DINNER
Time
Result
NOTES
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