| * First Name |
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| * Last Name |
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| * Email Address |
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| * Gender |
Male
Female |
| * Do you or someone you know have Diabetes? |
Yes
No |
| * What is your relationship to the person with diabetes? |
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If you do not have diabetes yourself, but care about someone who does, answer with this person in mind.
* When were you diagnosed with diabetes? |
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| * What is the name of the blood glucose meter that you use most often to test your blood glucose levels? |
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| * How long have you had your meter? |
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| * How often do you test your blood sugar? |
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| * How many shots of insulin do you take a day? |
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| * How often, if ever, do you make adjustments to the amount of insulin you take? |
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