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high blood sugar level record

overview

use this form to record a high 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 high blood sugar problems, the diabetes medicine dose may need to be adjusted or the medicine may need to be changed.

date: ____________

time of day that the emergency occurred: ___________________

symptoms: ____________________________________________

blood sugar levels during the emergency: _________________

was a dose of diabetes medicine missed? ___yes ____no

did you (or your child) take it when the medicine was remembered? ___yes ____no

was a dose of fast-acting insulin taken? ___yes ____no

if an insulin dose was taken, how much was taken? ____ units

was emergency care needed? ___yes ____no

credits

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.

this information does not replace the advice of a doctor. healthwise, incorporated, disclaims any warranty or liability for your use of this information. your use of this information means that you agree to the terms of use. learn how we develop our content.

this information does not replace the advice of a doctor. healthwise, incorporated, disclaims any warranty or liability for your use of this information. your use of this information means that you agree to the terms of use and privacy policy. to learn more about healthwise, visit healthwise.org. © 1995-2022 healthwise, incorporated. healthwise, healthwise for every health decision, and the healthwise logo are trademarks of healthwise, incorporated.

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