Diabetes Hypoglycemic Event
Diabetes Hypoglycemia
Reported Term for the Clinical Event
Category for Clinical Event
Any hypoglycemic events experienced?	Yes  No
Sponsor Defined ID
Date of Event	01 Jan 2000
Time of Event	12:00
When did the hypoglycemic event occur?	Between Bedtime and Waking  Between Waking and Bedtime
In the opinion of the investigator, was this an adverse event?	Yes  No
Was a glucose measurement obtained at the time of the event?	Yes  No
Glucose Result
Glucose Units	mg/dL  mmol/L
Exposure Category
Date	01 Jan 2000
Time	12:00
Dose
Units
Diabetes Anit-Hyperglycemic Med
Category for Medication
Subcategory for Medication
Date	01 Jan 2000
Time	12:00
Dose
Units
Date	01 Jan 2000
Time	12:00
Diabetes Hypo Symptoms
Category for Clinical Event
Were signs/symptoms present? (If yes, complete the following)	Yes  No
Sweating	Yes  No
Tremors/Trembling	Yes  No
Dizziness	Yes  No
Cognitive Impairment	Yes  No
Loss of Consciousness	Yes  No
Convulsions/Seizure	Yes  No
Coma	Yes  No
Other (Specify)	Yes  No
Specify Other
Precipitating Factors
Category for Findings About
Findings About Object of the Observation
Were any precipitating factors reported?	Yes  No
Alcohol Consumption	Yes  No
Concurrent Illness	Yes  No
Deviation from Dosing Instructions	Yes  No
Missed, Delayed or Smaller Meal	Yes  No
Physical Activity	Yes  No
Other (Specify)	Yes  No
Specify Other
HYPO TREATMENT
Category for Medication
Was any treatment given for the hypoglycemic event? (If yes, complete the following)	Yes  No
Drink	Yes  No
Food	Yes  No
Glucose Tablets	Yes  No
Glucose Injection	Yes  No
Intravenous Glucose	Yes  No
If treatment given, indicate if assistance was needed	None - Subject Treated Self  Subject was Capable of Treating Self, but Received Assistance  Subject was Not Capable of Treating Self, and Required Assistance

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