Diabetes-Related Questions

Diabetes-related questions

1. How many times, during the preceding year, have you visited a doctor? (please circle the most appropriate alternative)

Due to diabetes0 1-2 3-4 5-6 7-8 More than 8 times

Due to other reasons0 1-2 3-4 5-6 7-8 More than 8 times

please specify ?______

2. How many times, during the preceding year, have you visited a nurse (please circle the most appropriate alternative)

Due to diabetes0 1-2 3-4 5-6 7-8 More than 8 times

Due to other reasons0 1-2 3-4 5-6 7-8 More than 8 times

please specify ?______

3. How much does diabetes per se and/or its treatment disturb your normal life? (please circle one)

1Not at all

2Slightly

3Moderately

4Quite a lot

5Very much

4. How much do the potential diabetes related complications disturb your normal life? (please circle one)

0I do not have any complications

1Not at all

2Slightly

3Moderately

4Quite a lot

5Very much

5. What is your last measured HbA1c value? ______%

6. What does this above-mentioned value tell about an average daily glycaemic control during the preceding 6-8 weeks? (please circle one)

1That it is at a good level

2That it is at a satisfactory level

3That it is at a high level

7. Are you satisfied with your current HbA1c level?

1Yes

2No

8. Are you satisfied with your current insulin regimen?

1Yes

2No

9. How often have you experienced perceptions oflow blood glucose levels (perceptions of hypoglycaemia) during the past 4 weeks? (please circle one)

00 times

11-2 times

23-4 times

35-6 times

47-8 times

5More than 8 times

10. How often, during the past 4 weeks, have you measured blood glucose values below 3 mmol/l without having felt that you have low blood glucose levels (e.g., asymptomatic low)? (please circle one)

00 times

11-2 times

23-4 times

35-6 times

47-8 times

5More than 8 times

11. Are you afraid of hypoglycaemias?

1Yes

2No

12. Besides diabetes, do you suffer from any other chronic diseases?

1.No

2. Yes, which? ______