Hypoglycemia Questionnaire

Symptom
Crave Sweets
Irritable if meal missed
Tired or weak if meal
missed
Dizziness when
standing suddenly
Frequent headaches
Poor memory or
concentration
Tired an hour or so after
eating
Heart palpitations
Afternoon fatigue
Vision blues on occasion
Depression or mood
swings
Overweight
Frequently anxious or
nervous
Total

None
0
0
0

Mild
1
1
1

Moderate
2
2
2

Severe
3
3
3

0
0

1
1

2
2

3
3

0
0
0
0

1
1
1
1

2
2
2
2

3
3
3
3

0
0

1
1

2
2

3
3

Scoring:
<5 means hypoglycemia is not likely
6-15 means hypoglycemia may be a concern
>15 means hypoglycemia is very likely