The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

Hypoglycemia Questionnaire
Hypoglycemia, also known as low blood sugar or low blood glucose, is the condition in which blood glucose falls to below normal levels. This may result in a variety of symptoms including clumsiness, trouble talking, confusion, loss of consciousness, seizures, or death. A feeling of hunger, sweating, shakiness, and weakness may also be present. 

The Institute for Responsible Nutrition (www.responsiblefoods.org) and The Hypoglycemia Support Foundation, Inc. (www.hypoglycemia.org) are joining together to fight the preventable dietary causes of hypoglycemia and would like to reach as many sufferers of hypoglycemia as possible, whether they experience hypoglycemia in response to dietary, stress, or lifestyle factors or as a side-effect to diabetes medications.

Why? Due to the increase of questions and concerns about possible connections between hypoglycemia and diabetes (chronically high blood glucose), we want to find out if this association can be observed. Is hypoglycemia a prelude to type 2 diabetes? Further, the survey is designed to gather information on how and by whom hypoglycemia is diagnosed and what kinds of treatments are found to be beneficial, especially those related to diet.

With information obtained from the survey, we hope to

-- alert people experiencing symptoms of hypoglycemia to the seriousness of this condition
-- increase awareness and legitimacy of hypoglycemia within the medical community
-- improve diagnosis of hypoglycemia
-- identify a best practice for treating hypoglycemia without exacerbating it
-- suggest a dietary intervention that will not only prevent episodes of hypoglycemia but also prevent the development of type 2 diabetes.

This questionnaire should take five to 10 minutes to complete. Your responses will be anonymous. The (anonymized) data collected may be used to create educational, web-based content for those who experience hypoglycemia; to shape programs offered by the Institute for Responsible Nutrition or The Hypoglycemia Support Foundation, Inc.; or to present to clinicians or public health officials to inform clinical practices or programming. Results will be made available at hypoglycemia.org.

Are you taking this questionnaire on behalf of yourself or another person?
What is your age group (or the age group of the person for whom you are answering)?
Have you experienced hypoglycemia?
Was your hypoglycemia diagnosed by a physician?
Next
Never submit passwords through Google Forms.
This form was created inside of Institute for Responsible Nutrition. Report Abuse - Terms of Service - Additional Terms