Hypoglycemia Questionnaire

Hypoglycemia Questionnaire

No = 0 Mild = 1 Moderate = 2 Severe = 3

Crave sweets

1

2

3

4

Irritable if a meal is missed

1

2

3

4

Feel tired or weak if a meal is missed

1

2

3

4

Dizziness when standing suddenly

1

2

3

4

Frequent headaches

1

2

3

4

Poor memory (forgetful) or concentration

1

2

3

4

Feel tired an hour or so after eating

1

2

3

4

Heart palpitations

1

2

3

4

Feel shaky at times

1

2

3

4

Afternoon fatigue

1

2

3

4

Vision blurs on occasion

1

2

3

4

Depression or mood swings

1

2

3

4

Overweight

1

2

3

4

Frequently anxious or nervous

1

2

3

4

Total

Scoring:

Less than 5 = hypoglycemia is not likely a factor

6-15 = hypoglycemia is a likely factor

Greater than 15 = hypoglycemia is extremely likely