Print out this
page and enter your choices with a pen or pencil. Total
each column, then multiply by the number at the top
of that column. Add all together (remember, all in the
0 column = 0). If your score is more than 50, you test
positive for blood-sugar stress.
Indicate each symptom according to the following:
0 = Never
1 = Mild and/or rare
2 = Moderate and/or up to twice a week
3 = Severe and/or more than twice a week
| |
0 |
1 |
2 |
3 |
| hungry between meals |
|
|
|
|
| eat candy, cake, soda |
|
|
|
|
| drink alcohol |
|
|
|
|
| drink more than three cups
coffee/cola |
|
|
|
|
| cravings for sweets or
coffee |
|
|
|
|
| irritable before meals |
|
|
|
|
| shakiness inside, especially
if hungry |
|
|
|
|
| faint if food is delayed |
|
|
|
|
| tired all of the time |
|
|
|
|
| depressed |
|
|
|
|
| can't fall asleep easily |
|
|
|
|
| wake up during the night |
|
|
|
|
| fearful |
|
|
|
|
| difficulty making decisions |
|
|
|
|
| difficulty with concentrating |
|
|
|
|
| poor memory |
|
|
|
|
| worried a lot |
|
|
|
|
| feel insecure |
|
|
|
|
| emotional |
|
|
|
|
| moody |
|
|
|
|
| feel like crying |
|
|
|
|
| outbursts of anger |
|
|
|
|
| make mountains out of molehills |
|
|
|
|
| feelings of hopelessness |
|
|
|
|
| bored |
|
|
|
|
| bad dreams |
|
|
|
|
| antisocial behavior |
|
|
|
|
| phobias |
|
|
|
|
| can't work under pressure |
|
|
|
|
| headaches |
|
|
|
|
| sleepy during the day |
|
|
|
|
| sleepy after food |
|
|
|
|
| slow starting in the morning |
|
|
|
|
| poor motivation |
|
|
|
|
| eat when nervous |
|
|
|
|
| fatigue relieved by food |
|
|
|
|
| excessive thirst |
|
|
|
|
| nervous stomach/cramps |
|
|
|
|
| allergies or sinus problems |
|
|
|
|
| can feel heart beat |
|
|
|
|
| gastritis, gastroesophageal
reflux |
|
|
|
|
| disorder, ulcers |
|
|
|
|
| abdominal bloating |
|
|
|
|
| cold hands and feet |
|
|
|
|
| shaking of the hands |
|
|
|
|
| blurring vision |
|
|
|
|
| lightheaded/dizzy |
|
|
|
|
| frequent urination |
|
|
|
|
| lack of coordination |
|
|
|
|
| excessive sweating |
|
|
|
|
|
