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Type 2 Diabetes Self Assessment
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1) Have you been diagnosed with type 2 diabetes?
*
Yes
No
2) Do you have these complications of diabetes?
*
Retinopathy
Stroke
Kidney Disease
Peripheral Neuropathy
Peripheral Vascular Disease
heart disease
I don't have any complications of diabetes
3) Are you interested in learning to use lifestyle to prevent and treat type 2 diabetes?
*
Yes
No
4) Are you taking medications that raise blood sugar level such as birth control pills, steroids, diuretics, beta blockers, caffeine, and over the counter decongestants?
*
Yes
No
I don't know
5) Are you taking medication to control your blood sugar?
*
Yes
No
6) Are you on a special diet for type 2 diabetes?
*
Yes
No
7) Do you take supplements for type 2 diabetes?
*
Yes
No
8) Are you overweight?
*
Yes
No
9) Do you exercise five days a week and are you fit?
*
Yes
No
10) Are you interested in lifestyle, dietary, and supplement recommendations to help your symptoms?
*
Yes
No
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