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MyChart
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: 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.
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. Healthwise is a URAC accredited health web site content provider. Privacy Policy. How this information was developed to help you make better health decisions.
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