[MaryA410]

Survey for Diabetics

1. What type of diabetes do you have?

2. At what age were you diagnosed?

3. What type of treatment are you using?

4. Do you control it yourself (testing, insulin)? If not, who does?

5. How many times a day do you test yourself?

6. Does it affect your confidence level at all?

7. Are you more careful with your diabetes when you are out with your peers?

8. How many times a week do you exercise?

9. How many times a week does your blood glucose go low?

10. How many times a week does it go high?

11. Have you ever been to some time of camp or a support group for diabetes?