Use this form to record a low blood sugar level problem. Fill out a record each time this happens. Take the completed form(s) to the doctor. If you (or your child with diabetes) is having low blood sugar problems, the diabetes medicine dose may need to be adjusted or the medicine may need to be changed.
Date: ____________ Time: __________
Time that the last dose of medicine was given and the amount:
Symptoms, if any:
How long symptoms lasted:
Blood sugar levels during the problem:
Activity before low blood sugar:
Kind and amount of glucose or sucrose tablets or solution or other quick-sugar food that was taken:
Was glucagon given? __ Yes __ No
Was emergency care needed? __ Yes __ No
Current as of: August 31, 2020
Author: Healthwise Staff Medical Review: E. Gregory Thompson MD - Internal Medicine Adam Husney MD - Family Medicine Kathleen Romito MD - Family Medicine Rhonda O'Brien MS, RD, CDE - Certified Diabetes Educator
Medical Review:E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Kathleen Romito MD - Family Medicine & Rhonda O'Brien MS, RD, CDE - Certified Diabetes Educator
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