Questionaire - Diabetes Center - Campbell County Memorial Hospital

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Do you currently test your blood sugar before meals?

Do you keep records of your blood sugars?

What do you think your blood sugar should be before meals?

Do you ever check your blood sugar two hours after you eat a meal?

What do you think your blood sugar should be two hours after a meal?

Do you know when your last hemoglobin A1c was performed?

Do you know how often to have a hemoglobin A1c?

Do you know the result of your last A1c?

Do you see an eye care specialist and have a dilated eye exam annually?

Do you send results of your dilated eye exam to your personal physician?

Do you check your feet daily for sores or pressure spots?

Does your health care provider check your feet with every appointment?

Do you get regular (every 6 month) dental exams?

Do you get the flu shot each fall?

Have you had a pneumonia vaccination in the last ten years?

Does your health care provider ever ask you for your blood glucose records?

Do you know the side effects of the medications that you take for diabetes?

How often do you have hypoglycemia?

Do you treat your hypoglycemia by yourself?

How many times have you needed medical assistance to treat hypoglycemia?

What county, state do you live in?

What type of diabetes do you have?

How many years have you had diabetes?

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Campbell County Memorial Hospital will not disclose any personal information provided in the questionnaire above to any third parties or outside sources.