Nerve Health Symptom Tracker

Tracking symptoms helps you and your healthcare provider identify patterns, changes, and treatment effectiveness.

Use this tracker daily or weekly.

Instructions for Patients

✔ Check your feet and hands at the same time each day
✔ Note new or worsening symptoms
✔ Bring this tracker to appointments

Symptom Rating Scale

0 = No symptoms
1–3 = Mild
4–6 = Moderate
7–10 = Severe

Daily Symptom Log

Date	Tingling	Burning	Numbness	Sharp Pain	Balance Issues	Dizziness	Notes
	0–10	0–10	0–10	0–10	Yes / No	Yes / No
	0–10	0–10	0–10	0–10	Yes / No	Yes / No
	0–10	0–10	0–10	0–10	Yes / No	Yes / No

Weekly Reflection Questions

✔ Did symptoms improve, worsen, or stay the same?
✔ Are symptoms worse at night?
✔ Do symptoms increase after certain activities?
✔ Are blood sugar levels higher when symptoms are worse?

Patterns can help guide treatment decisions.

Urgent Symptom Checklist

Contact your provider if you notice:

☐ Sudden weakness
☐ Severe new pain
☐ Loss of balance
☐ New dizziness when standing
☐ Wounds you cannot feel

Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.

Medical Disclaimer

This resource is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Individuals should consult their physician, endocrinologist, certified diabetes educator, or qualified healthcare provider before making changes to medications, diet, or activity. Always follow individualized healthcare guidance and report any concerning symptoms promptly to your healthcare team. Call 911 if you are experiencing a medical emergency.

This handout is for educational purposes only and is not a substitute for professional medical advice. Always follow your healthcare provider’s instructions.

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.