In just five minutes find out how serious your diabetes really is and the likelihood of developing complications or even more severe complications in the future.

Circle the response for each question that best represents your current diabetes situation.

1. How long have you had type 2 diabetes?
A. 0-1 year B. 2-3 years C. 4-6 years D. 7 years or more

2. What is your average blood sugar reading, or most recent hemoglobin A1c?
A. 80-120 B. 121-150 C. 151-180 D. 180+
(HgbA1c 6.0 or less) (HgbA1c 6.0 – 7.0) (HgbA1c 7.0 – 8.0) (HgbA1c > 8.0)

3. How much do you weigh above your ideal weight?
A. 1-10 lbs B. 11-25 lbs C. 26-39 lbs D. 40+ lbs

4. How many oral medications are you taking for your diabetes?
A. None B. One C. Two D. Three or more

5. Over the past two years, what percentage increase in the amount (dosages) of medication are you taking?
A. None B. 25% C. 50% D. More than 75%

6. How many medications, for health problems other than diabetes, are you taking?
A. None B. 1-2 C. 3-4 D. 5 or more

7. If you are taking insulin, how many units a day are you injecting?
A. 20 or less B. 21-40 C. 41-60 D. 60 or more

8. How much weight have you gained in the past 12 months?
A. None B. 1-7 lbs. C. 8-15 lbs. D. 16+ lbs.

9. How much weight have you gained in the past five years?
A. 1-10 lbs. B. 11-19 lbs. C. 20-29 lbs. D. 30+ lbs.

10. How much physical exercise do you get each day?
A. 60 min. B. 30 min. C. Less than 30 min. D. No structured exercise

11. How many of the following health conditions are you experiencing in addition to your diabetes? (High blood pressure; heart disease; high cholesterol; high triglycerides)
A. None B. One C. Two D. Three or more

12. If you have pain and numbness in your feet how much worse has it become over the past 12 months?
A. Same B. 25% worse C. 50% worse D. 75% or more worse

Add up the number of responses for each letter that you circled and list that number below.
A._______ B._______ C. _______ D._______

Multiply each A response x 1 _____ = ______
Multiply each B response x 2 _____ = ______
Multiply each C response x 3 _____ = ______
Multiply each D response x 4 _____ = ______
Total ______

Your Score
 
12 - Ideal
13-16 - Your diabetes is likely under good control, better than the average person with diabetes.
17-27 - You are at increased risk for complications.
28-39 - Your diabetes is not under good control. Your risk of complications is greatly increased.
40-48 - Your diabetes is poorly controlled. Your risk of complications is severely increased.

Complications of diabetes include (but are not limited to) heart attack; stroke; kidney failure; blockage of arteries to the legs, intestines and other major sites; small blood vessel disease, which can cause poor wound healing, infection, blindness, and limb amputation; impotence; and nerve inflammation – causing pain, numbness, and other disorders.

(This assessment is intended as a general guide, and not a diagnostic tool. The questions, answers, and scores are based on generally accepted diabetes principles, but are not necessarily defined by specific scientific research studies)