Use this form to record a low blood sugar level problem. Fill out a record each time this happens. Take the completed form(s) with you when you visit your child's doctor. If your child is having low blood sugar problems, his or her medicine for diabetes may need to be adjusted or changed.
Date: ____________ Time: __________
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
High blood sugar level
Use this form to record a high blood sugar level problem. Fill out a record each time this happens. Take the completed form(s) with you when you visit your child's doctor. If your child is having high blood sugar problems, his or her medicine for diabetes may need to be adjusted or changed.
Date: ____________ Time: __________
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
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.
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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