Hypoglycemia Questionnaire
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HYPOGLYCEMIA QUESTIONNAIRE No = 0 Mild = 1 Moderate = 2 Severe = 3 Crave sweets 0 1 2 3 Irritable if a meal is missed 0 1 2 3 Feel tired or weak if a meal is missed 0 1 2 3 Dizziness when standing suddenly 0 1 2 3 Frequent headaches 0 1 2 3 Poor memory (forgetful) or concentration 0 1 2 3 Feel tired an hour or so after eating 0 1 2 3 Heart palpitations 0 1 2 3 Feel shaky at times 0 1 2 3 Afternoon fatigue 0 1 2 3 Vision blurs on occasion 0 1 2 3 Depression or mood swings 0 1 2 3 Overweight 0 1 2 3 Frequently anxious or nervous 0 1 2 3 TOTAL ________ Scoring: Less than 5 = hypoglycemia is not a likely factor 6 to 15 = hypoglycemia is a likely factor Greater than 15 = hypoglycemia is extremely likely 870 POST ROAD, DARIEN, CT 06820 203-655-4494
Transcript of Hypoglycemia Questionnaire
HYPOGLYCEMIA QUESTIONNAIRE
No = 0 Mild = 1 Moderate = 2 Severe = 3
Crave sweets 0 1 2 3
Irritable if a meal is missed 0 1 2 3
Feel tired or weak if a meal is missed 0 1 2 3
Dizziness when standing suddenly 0 1 2 3
Frequent headaches 0 1 2 3
Poor memory (forgetful) or concentration 0 1 2 3
Feel tired an hour or so after eating 0 1 2 3
Heart palpitations 0 1 2 3
Feel shaky at times 0 1 2 3
Afternoon fatigue 0 1 2 3
Vision blurs on occasion 0 1 2 3
Depression or mood swings 0 1 2 3
Overweight 0 1 2 3
Frequently anxious or nervous 0 1 2 3
TOTAL ________
Scoring: Less than 5 = hypoglycemia is not a likely factor 6 to 15 = hypoglycemia is a likely factor Greater than 15 = hypoglycemia is extremely likely
870 POST ROAD, DARIEN, CT 06820 203-655-4494
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