Low Blood Sugar Level Record

Skip Navigation

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

Credits

Current as of: April 13, 2022

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




The Health Encyclopedia contains general health information. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider.