High and Low Blood Sugar Level Record for a Child

Activity before low blood sugar:

Time the medicine was last given, and the amount given:

Symptoms:

How long symptoms lasted:

Blood sugar levels during the problem:

Kind and amount of glucose or sucrose tablets or solution or other quick-sugar food that was taken:

Was glucagon given (only for children who take insulin)? ___ Yes ___ No

Was emergency care needed? ___ Yes ___ No

Did your child seem sick? If so, what were the symptoms?

What was he or she doing before the episode?

High blood sugar symptoms:

Blood sugar levels during the problem:

Was a dose of diabetes medicine missed? Did you give it after you remembered?

Was a dose of fast-acting insulin given? If so, what was the dose? ____ units

Was emergency care needed? __ Yes __ No