Diabetes

[p.104]

Respondent rules for diabetes supplement

Record of return calls to complete supplement:

Name of interviewer ____

Code ____

[] Responded for self or Column number of respondent

[p.105]

In the interview you (your--, etc.) told me about your diabetes. This is a matter of continuing interest to the public health service and I have some additional questions about it.

1. About how old were you when a doctor first told you that you had diabetes?
Estimate is acceptable

2a. Before you were (age in question 1) ________ had you ever been told by a doctor that you might have or might be getting diabetes?

b. Have you ever had a glucose tolerance test?
A glucose tolerance test is a sweet drink followed by one or more blood tests taken the same day.

Hand respondent card NHS-HIS-1(c)
3a. Please look at that card and tell me which of those symptoms you had at the time you first found out that you had diabetes.
Note to interviewer: when the respondent mentions one or more symptoms, check the "Yes" box for each symptom mentioned and then ask "Any others?" continue to ask until an answer to "No" is given. Either the "yes" or "no" box must be checked for each symptom.
[Check "Yes" or "No" for each symptom listed under "At time of diagnosis"]

b. Please look at the card again. Did any of those symptoms bother you at any time during the past 30 days?

4a. Were you in the hospital at the time the doctor found out that you had diabetes?
As an inpatient

b. Were you there because you had symptoms of diabetes?

[p.106]

(Ask only if "No" in question 4a)

5. At the time your diabetes was first discovered, were you sent to the hospital for regulation of your diabetes? As an inpatient

b. About how many times?
Estimate acceptable.

c. Have you ever been hospitalized (ask all 4 parts).
Several reasons may be given for any single hospital stay.

7a. Have you ever had a nurse come to your home to help you in taking care of your diabetes?

b. About how many times has she visited you during the past 12 months?

c. Where do you usually go for care of your diabetes-- a clinic, a doctor's office, of some other place?

d. Does the doctor you go to for your diabetes specialize in the treatment of diabetes?

e. How long have you been going to him for your diabetes?

8a. How many brothers and sisters have you had -- either living or dead?

b. Did any of these brothers or sisters have diabetes?

c. Did your mother have diabetes?

d. Did your father have diabetes?

(if "ever married" ask)-
9a. How many children have you ever had?
Exclude stepchildren, adopted children and foster children

(if number entered in question 9a, ask)
b. How much did each of your children weigh at birth--starting with the oldest?
Accept estimate, enter answer in pounds and ounces. If pounds only are given, this is acceptable.

(if "1" or more in question 9a ask)-
c. Did any of your children have diabetes?

[p.107]

10a. Have you ever taken insulin injections?

b. How many years have you taken insulin injections?
Round to nearest whole year. Estimate acceptable.

c. Have you been taking insulin injections daily for most of the past 12 months?
If the respondent is not taking insulin at the present time ask: "How many years did you take it?"

d. Are you Now taking insulin injections?

Note to interviewer.
How was information for 11a and 11b obtained?
(check all that apply)

11a. What kinds of insulin are you now using?

b. What strength insulin are you now using?

c. Do you usually take your insulin injection before meals?

d. Which meals? (check all that apply and go to questions 11f)

e. When do you usually take your insulin?
(enter time of day and go to questions 11f)

f. If you delay taking your insulin for an hour or more does it make you feel sick?

g. When was the last time you delayed taking your insulin for an hour or more?

h. Do you inject the insulin yourself?

12. Who taught you how to inject the insulin? (check appropriate box and ask question 13a)

13a. During the past week, in what parts of the body have you been injecting the insulin? (check all that apply). Anywhere else?
The "past week" is the week ending last Sunday night.

b. How are your syringes and needles cleaned and sterilized? (check all that apply)

14. Do you usually carry candy or fruit or sugar or similar items with you?

[p.108]

15a. Do you know what an insulin reaction is?

b. Have you ever had an insulin reaction?
Sudden weakness, tremblings, shakiness, cold sweats.

c. How many insulin reactions have you had during the past 30 days?

d. About how many have you had during the past 12 months?

e. Have you ever used Glucagon?
Glucagon: A drug sometimes used by persons with diabetes to counteract insulin shock

16a. Can an insulin reaction be caused by too much food?

b. Can an insulin reaction be caused by too much exercise?

c. Is an insulin reaction the same as a diabetic coma?

17. Can a person with diabetes exercise as much as other people?

18a. Have you ever taken diabetes pills?

b. How many years have you been taking them?
Round to the nearest whole year, estimate acceptable.

c. Have you taken them most of the past 12 months?
If respondent is not taking pills at present time ask: "How many years did you taken them?"

d. Are you now taking diabetes pills?

19a. How many pills do you take each day?

b. Do you usually take your pills before meals?

c. Which meals?

d. If you delay taking your pills for an hour or more does it make you feel sick?

e. When was the last time you delayed taking your pills for an hour or more?

20a. Do you test your urine for sugar?
Testing by person himself or close relative not a physician, pharmacist etc.

Note to interviewer
How was information for 20b obtained? (check all that apply)

b. What test do you use?

[p.109]

c. How many times did you test your urine last week? (if number is entered, go to question 20e)
"Last week" is the week ending last Sunday night.
(if number is entered, go to question 20e)

d. When was the last time you tested it?

e. Do you write down any of the results of these tests?

f. Do you show this to your doctor?
This means the record or notes of the results of the tests.

g. Did you test your urine for anything else besides sugar at any time during the past 12 months?

21. About how tall are you?

22a. About how much do you weigh?

b. What is the most you have weighed during the past 12 months?
Not counting pregnancies.

c. What is the least you have weighed during the past 12 months?

(Ask this questions if person is 25 years old or over (if under 25, go to question 24))
23a. When you were a youngster were you ever overweight?
Youngster is a person 0-25 years. Overweight is weighing more than the person himself or his doctor thinks that he should weigh.

b. What it the most you have weighed since you were 25 years old?
Not counting pregnancies.

c. What is the least you have weighed since you were 25 years old?

24. Were either of your parents overweight?

25a. Who prepares most of your meals?
(check one)

b. Do you or the person who fixes your meals use any special recipes prepared for persons with diabetes?

26a. Can you name some foods that can be substituted for meat?
(enter first two mentioned)

b. Can you name some drinks which have very few calories?
(enter first two mentioned) Drinks mean non-alcoholic drinks.

c. Can you name some vegetables which have very few calories?
(enter first two mentioned)

27a. During the past 30 days have you eaten any pastries?
Pastry made with sugar.

b. During the past 30 days have you eaten any candy made with sugar?

[p.110]

28. During the past week did you.....
The "past week" is the week ending last Sunday night.

29. How many calories a day are you allowed?

30a. Have you been given a diet for your diabetes?
Written, typed, or printed instructions about food.

b. Who taught you how to use this diet?

c. How long have you had this diet?

d. Do you follow this diet?
"Yes" means usually or most of the time.

e. Is the diet list used as a guide in the preparation of your meals?

f. When did you last look at your diet list?
"You" means respondent or person preparing the meals.

31a. Does you diet give the size of food portions?

b. Do you measure, weigh, or estimate the portions?
(check all that apply)

32. Do you have to follow your diet carefully in order to feel well?

33a. Do you ever eat away from home?

b. Do you have trouble following your diet when eating away from home?

34a. Does your diet include a list of food exchanges?
A food exchange list arranges foods in groups according to their food values permitting substitution within each group?

b. Without looking at the list can you tell me how many bread exchanges you are allowed each day?
(if "No" or "DK" go to question 35. If number is given, enter it and ask about the remaining food exchanges listed below)

c. Do you have any problems in using your exchange list?

[p.111]

35a. Here are the covers of three pamphlets. (shoe special diabetes pamphlets)
Have you ever had a copy of any of these pamphlets?

b. Which? (check all that apply)

36a. Were you taught how to take care of your feet to avoid infection?

b. How do you take care of your feet? (enter verbatim response)

c. During the past 12 months have you visited a foot doctor?
Podiatrist or chiropodist

37a. Have you been to a doctor to have your eyes examined during the past two years?

b. Do you see better in the morning or in the afternoon?

38a. If you had a bad cold, would you talk to your doctor?

b. If you had a skin infection, would you talk to your doctor?

c. If you had thrown-up, would you talk to your doctor?

39a. Have you ever attended classes to learn about diabetes?

b. Who gave the classes?

40a. Are you a member of a diabetes association or similar group?

b. what is the name of this group?

41. What are your most difficult problems in caring for your diabetes?