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Blood Sugar Management Questionaire
* Indicates required question
Email
*
Record my email address with my response
What gender are you?
*
Male
Female
What is your age?
Your answer
How long has it been since you have been diagnosed with a blood sugar issue, diabetes or pre-diabetes?
Your answer
What type of blood sugar issue do you have?
Type 1 Diabetic
Type 2 Diabetic
Pre Diabetic
Hypoglycemic
Clear selection
What is your current method for monitoring your blood sugar levels?
Continuous Glucose Monitor (bluetooth device, worn daily)
Online Monitor (data tracked on a mobile device)
Offline Monitor (hand written data tracking)
Clear selection
What is your target blood sugar range and how often are you within that range? (mostly, sometimes, rarely, never)
Your answer
What medications, if any, are you using to manage your blood sugar?
Your answer
Do you follow a specific diet plan? If so, what is it?
Your answer
How days in a week do you engage in physical activity, on average?
Your answer
What are your biggest challenges in managing your blood sugar?
Your answer
What lifestyle changes have you attempted to help manage your blood sugar?
Your answer
What is your contact information? (Name, Email, Mobile Number)
Your answer
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