High Blood Sugar Level Record
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…
In this article
Current as of: April 16, 2019
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
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.
High Blood Sugar Level Record
Topic 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
Current as of: April 16, 2019
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
Topic Contents
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.