Pal Fitness Club

428/Soham Arcade,
Near Kratos Circle.
Pal, Adajan
www.palfitnessclub.in

Name: ____________________________________Total Score:

_______________________

Glucose Spike Checklist

Description Points
1. Gender
Male : 4 Points 4
Female : 0 Points
2. Age
44 and under : 0 Point 0
45 -54 : 4 Point
55-64 : 3 Points
65 and above : 0 Points

3. Diabetes to Parents/Sibling
Yes : 7 Points 7
No: 0 Points

4. BMI
BMI = Weight in Kg/ Height in m2 7

22.9 and Under : 0 Points

23- 25.9 : 3 Points
26 and above : 7 Points
5. Are you obese?
Male : Waist line over 90 cm (36 in)
Female : Waist line over 80 cm (32 in)
Yes : 3 Point
No : 0 Point
6. Blood Pressure
Yes : 7 Points
No: 0 Points

7. Cigarette Smoking
10 + Cigarette : 5 Points
Less than 10 + Cigarette : 2 Points

8. Exercise at least 3 times/Week (Subtract From Total Score)

Atleast 3 /Week
Positive Factor
Yes : 5 Points
No : 0 Points
Score Analysis and Conclusion:

9 or Less (Excellent Control) 10-19 Careful (Moderate) 20 + (High Risk)

Fall in love with taking care of your body

KARAN JOSHI,CSCS