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    What type of diabetes do you have?
    Type 1
    Type 2
    Which, if any, of the following do you currently take to treat your diabetes? (Check ALL that apply)
    Oral Medications (a pill)
    Insulin
    ByettaŽ
    Other
    What was the result of your last A1C test (This blood test is usually done 2 or more times a year at your doctor's office)?
    Less than 7.0
    7.0 to 9.0
    Greater than 9.0
    I don't know

    IMPORTANT SAFETY INFORMATION FOR INSULIN
    Possible side effects may include blood sugar levels that are too low, injection site reactions, and allergic
    reactions, including itching and rash. Tell your doctor about all other medicines and supplements you are
    taking because they could change the way insulin works. Glucose monitoring is recommended for all
    patients with diabetes.

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    professional is the single best source of information regarding your health. Please consult your healthcare
    professional if you have any questions about your health or treatment.

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