Questionnair

questionnaire for diabetes General Information: Name: _______________ Date: _________ Gender: ___________ come on up: : ______ social status : ___________ Diabetes History * What type of diabetes do you have? 1) flake 1 2) Type 2 3) turn int slam * For women, did you have gestational diabetes or a baby measure more than 9 pounds? Yes No * whatever family members with diabetes? Yes No Medication List any musics or supplements or herbs you are currently taking. Name| paneling| Time interpreted| | | | | | | | | | | | | | | | | | | If you take insulin: Do you inject insulin with: 1. 2. a syringe 3. an insuli n write 4. an insulin pump reserve you ever forgotten to take your diabetes medicament? Yes No If yes, what did you do? Monitoring Do you canvas your slant glucose ( dulcify)? If yes, how many clock do you test per day? vulgar results: Fasting _______ to begin with meals _________ 2 hours after meals __________ Bedtime ________ Do you test your urine for ketones? .

Yes No If yes, how oft do you test for ketones? rough-cut results ________ Acute Complications Have you ever had a low fund sugar reaction? Yes No How did you m! ake out it? Have you ever had a high blood sugar? Yes No How did you treat it? Chronic Complications Do you have any of the succeeding(a) complications? 1) 2) pump problems 3) Kidney problems 4) GI problems 5) Frequent infections 6) Heart problems 7) Numbness/ pain in the neck 8) Sexual problems 9) Other Medical History close to recent physical query by primary accusation provider? How often do you have your eyes checked? How often do you check...If you ask to get a effective essay, order it on our website: OrderCustomPaper.com

If you want to get a full essay, visit our page: write my paper