This three-part assessment looks at the two sides of the pancreatic endocrine function (blood sugar regulation) and pancreatic exocrine digestive enzyme production.
Name & Surname
For each statement that applies to you, enter a ' X '.
Hypoglycemia
1.
Crave sweets?
2.
Anxious edge to personality, nervous?
3.
Sleepy shortly after a meal?
4.
Pulse races after eating sweets?
5.
Vision fades when standing up suddenly, dizziness?
6.
Eating starch or sweets relieves headache?
7.
Irritable, jittery, shaky, if meal is missed?
8.
Appetite increased, frequently hungry?
9.
Calmer after eating?
10.
High carbohydrate diet (vegetarian, low protein)?
11.
Forgetful, weak memory?
12.
Restless mind, poor concentration? enlarging?
13.
Hungry 1-3 hours after a meal?
14.
Falls asleep easily if activities stop during day?
15.
Fatigue is a chief complaint?
16.
History of low thyroid?
17.
High stress lifestyle for extended periods (worry a lot)?
18.
Wakes at night to eat?
19.
Desires sweets right after eating?
20.
Heart palpitations after eating sweets?
21.
Needs caffeine to get day underway?
For each statement that applies to you, enter a ' X '.
Hyperglycemia
1.
History of diabetes in ancestry?
2.
Night sweats?
3.
Deteriorating eyesight (rapid failing)?
4.
Craves sweets, but no relief after eating them?
5.
Increased thirst?
6.
Cuts and bruises heal slowly?
7.
Frequent infections, simple cuts easily infected?
8.
Weight gain, fat gain, over-weight?
9.
High carbohydrate, low protein diet?
10.
Passes sugar in the urine?
11.
Itchy skin, no apparent reason?
12.
Leg sores, boils, skin eruptions?
13.
Fatigue is an ongoing concern?
14.
Mental confusion?
15.
Better energy after exercise?
16.
Excessively frequent urination
For each statement that applies to you, enter a ' X '.
Pancreatic Digestive Enzyme Insufficiency
1.
History of pancreatitis?
2.
History of, or current, stomach ulcers?
3.
Trouble digesting protein foods (meat, nuts, seeds)?
4.
Oily, foul smelling bowel movements that float?
5.
Often have diarrhea?
6.
Abdominal pain, upper right quadrant?
7.
Iron deficiency, anemia?
8.
Raised, scaly rash on skin?
9.
Vitamin B12 deficiency?
10.
Trouble digesting fatty foods?
11.
Frequent abdominal pain?
12.
Are you too thin and unable to gain weight?
13.
Do you have persistent gas and abdominal bloating?
