You may use this information freely, but please reference Islets of Hope.

 

SYMPTOMS OF LOW BLOOD GLUCOSE
(Hypoglycemia)

Mild Hypoglycemia

Increased or sudden hunger
Feeling shaky, dizzy or nervous
Pounding heartbeat
Drowsiness, feeling tired
Sweating (cold and clammy)
Headache or stomach ache
Numbness/tingling around mouth

Moderate Hypoglycemia
Any mild symptoms above, plus:

Personality change
Irritability
Confusion and/or difficulty      concentrating
Slurred or slow speech
Poor coordination

Severe Hypoglycemia
***CALL 911 ASAP!***

Any of the above symptoms plus:

Loss of consciousness
Seizures and/or convulsions
Death

Severe hypoglycemia requires injection of glucagon to save my life!

 

Islets of Hope Form PO-101

I have diabetes.  If you find me unconscious or unable to swallow please call 911 ASAP!

If I seem confused or disoriented but am able to swallow, please give me something with pure sugar like sweetened soda, juice, milk, candy, or glucose tabs which may be in my car, briefcase, pocket, or purse.

My Name is:  ____________________________________

Address:  ______________________________

Emergency Contacts:

Name                                 Phone Number

______________________________________________

______________________________________________

______________________________________________

My Physician:
______________________________________________

Other Medical Information for Paramedics:

______________________________________________

______________________________________________

______________________________________________