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Low Blood Sugar Level Record

Overview

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

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Current as of: October 2, 2023

Author: Healthwise Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

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Low Blood Sugar Level Record

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