Hyopglycemia

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Hypoglycemia Questionnaire

Blood sugar imbalance may be related to many other secondary health concerns. Proper assessment and a treatment plan are important to optimize one’s health.

Hypoglycemia or Insulin Resistance Syndrome can be diagnosed accurately by the Glucose Tolerance Test (GTT) . Often one maybe subclinically hypoglycemic. This subjective questionnaire will give your health care practitioner a quick summary of symptoms or signs that may be related to your blood sugar regulation and if you have a high likelihood of having hypoglycemia or subclinical hypoglycemia.

It is not a substitute for professional medical advice from your health care provider.

In the space provided below please indicate if you experience any of these conditions using the following scale:
Not at all =0 Mildly=1 Moderately =2 Severely =3

Symptom

Your Score

Symptom

Your Score

My vision gets blurred or double

 

I eat sweet things or drink caffeinated coffee, tea or cola

 

My gums bleed

 

I have more than 3 cups of coffee, tea or cola a day

 

After I fall asleep I wake up and cannot return to sleep

 

I am very restless

 

My muscles feel painful or sore

 

I feel very sleepy during the day

 

I get headaches

 

I drink alcoholic beverages

 

I have allergies or asthma

 

I cannot work under pressure

 

I get cramps in my legs

 

I find it hard to make decisions

 

I have itching or crawling sensations on my skin

 

I crave sweet foods, candies or drinks

 

I sigh or yawn during the day

 

I feel depressed or overwhelmed

 

My stomach or intestines are upset

 

I constantly worry about things

 

If I miss a meal or it is delayed, I notice my heart beat faster

 

I get confused

 

I get angry for no apparent reason

 

I am on the go most of the time

 

I easily get bruised or black and blue marks

 

I do things quickly

 

I have nightmares or bad dreams

 

I feel anxious or nervous

 

I get faint, dizzy, weak spells or cold sweats

 

I get irritated easily

 

It’s hard for me to concentrate

 

I get impatient easily

 

I am sleepy after I eat

 

I get fearful

 

I nibble between meals when I am hungry

 

I am highly emotional

 

I get jittery or nervous when I am hungry

 

I cry easily

 

I get very tired or exhaused

 

I get drowsy especially when I sit down

 

I no longer feel tired after I eat

 

I smoke cigarettes

 

I get hungry or feel faint if I do not eat often

 

I am aware of breathing deeply

 

I feel better after my first snack or meal of the day

 

I feel like I am running on adrenaline

 

I drink coffee or tea in the morning to get started

 

My mind is continually active

 

I often forget things

 

I exercise vigorously more than 5 hours per week

 

 

 

I eat a lot yet my weight remains constant

 

 

 

I crave carbohydrates such as breads and pastas

 

Assessment of potential hypoglycemia:
• Between 50 - 60 is borderline or subclinical
• Between 60-70 is likely
• Above 70 is the most likely to indicate a metabolic disorder.

 If in doubt and to investigate the exact nature of one’s glucose intolerance it is advisable to have your individual assessment done.

It is recommended to consult with your health care professional team.

To book an appointment.