|
Diabetes Questionnaire
|
|
Check the box if your answer is Yes.
|
| Always tired |
|
Crave extra liquids
(More than 10 glasses/day) |
|
Frequent Urination
(Especially at night) |
|
Always hungry
(Especially after eating) |
|
| Unexplained weight loss |
|
| Blurred vision |
|
| Numbness and tingling of feet |
|
| Wounds that won't heal |
|
Infections
(Vaginal itching in females) |
|
Sexual dysfunction
(Difficulty with erection) |
|
|
Risks
|
| Family member has diabetes |
|
Overweight
(Waist measurement is more than 1/2 your height) |
|
| Smoking |
|
|
