Risk for high blood sugar

Blood Sugar

In each box below enter the number that corresponds with your choice. (0 = Never, 1 = Occasionally, 2 = Often, 3 = Regularly).

Crave sweets during the day

Irritable if meals are missed

Eating relieves fatigue

Agitated, easily upset, nervous

Fatigue after meals

Must have sweets after meals

Forgetful; poor memory

Feel better or calmer after eating

Prone to infections and colds

History of diabetes in your family (N=0, Y=4)

Sugar (glucose) detected in urine test? (N=0, Y=4)

Hair loss under your socks? (N=0, Y=10)

BLOOD SUGAR TOTAL__________

Risk for high blood sugar:

Low = 0-10, Medium = 11-24, High = 25-45