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[p. 182]

Section Q -- Diabetes

Section Q1 -- Diabetes Screening

Check Item 1
Refer to ages of all family members.

1a. Has any adult in this family, that is (read names of persons 18 and over) ever been told by a doctor that they had diabetes? Do not include pre, potential, or borderline diabetes.

b. Who is this?
Mark "Diabetes" box in appropriate person's column.

c. Has any other adult in this family been told they have diabetes? Do not include pre, potential, or borderline diabetes.

Section Q2 -- Diabetes Followup Questions

Check Item 2
Refer to 1b above.

Check Item 3
Status of diabetic.

(Earlier I was told you had diabetes.)
1. How old were you when you got diabetes? Do not include pre, potential, or borderline diabetes.

2. Are you now a diabetic?

3a. When you first learned that you might have diabetes, were you sick or feeling diabetic symptoms, or was the diabetes discovered by chance?

b. Were you at your doctor's office, a patient in the hospital, or somewhere else?

c. Was the diabetes discovered while getting a routine physical, a screening test for diabetes, or while being treated for something else?

4a. When your diabetes was first diagnosed, did you have a blood test, a urine test, or both?

b. Was the blood test an oral glucose tolerance test?

Ask if female; otherwise, go to 6.
5a. Were you pregnant when you were first told that you had diabetes?

b. Other than during pregnancy, did a doctor ever tell you that you had diabetes?

[p.183]

Section Q2 -- Diabetes Followup Questions -- Continued

6a. Are you now taking insulin?

b. For how long have you been taking insulin?

c. Currently, about how often do you use insulin?

d. On an average day, about how many units of insulin do you take?

Mark without asking if known.
e. Have you ever used an insulin pump?

f. Are you now taking diabetes pills to lower your blood sugar?
Read if necessary: These are sometimes called oral agents or oral hypoglycemic agents.

g. For how long have you been taking them?

h. About how often do you take them?

7a. Has a doctor or other health professional ever given you a diet or instructions on what foods you should eat as a diabetic?

b. In the past 12 months, have you tried to follow the diet or instructions?

Hand Card O1. Read categories if telephone interview.

Card O1

c. In the past 12 months, about how often have you been able to follow the diet or instructions?

[p. 184]

Section Q2 -- Diabetes Followup Questions -- Continued

8a. Is it difficult for you to stay on your diet --

b. Do you (also) find it difficult to stay on your diet --

9. How important do you think what you eat or drink is in controlling your diabetes? Is it very important, somewhat important, or not important?

[p. 185]

Section Q2 -- Diabetes Followup Questions -- Continued

10a. Is there one doctor you usually see for your diabetes?

b. How many times have you seen this doctor in the past 12 months?

c. Which of the following did you see in the past 12 months for any reason --

The next few questions are about glucose or sugar in your urine or blood.

11a. About how many times in the past 6 months has a health professional check your urine for glucose or sugar? Do not count times when an overnight patient in the hospital.

b. On your own, about how often do you check your urine for glucose or sugar? Include times when check by a family member or friend.

If "None" in 11a and "Never" in 11b, skip to 11d.
Hand Card Q1.

Card Q1

Read list if telephone interview.
c. Based on all your urine tests during the past 6 months, how often would you say you have had glucose or sugar in your urine?

d. Have you been tested for ketones in the past 6 months?

e. Were any of these tests positive?

12a. About how many times in the past 6 months has a health professional checked your blood for glucose or sugar? Do not count times when an overnight patient in a hospital.

b. On your own, about how often do you check your blood for glucose or sugar? Include times when checked by a family member or friend.

If "None" in 12a and "Never" in 12b, skip to 13..
Hand Card Q1.

Card Q1

Read list if telephone interview.
c. Based on all your blood sugar tests during the past 6 months, how often would you say your blood sugar level has been too high?

[p. 186]

Section Q2 -- Diabetes Followup Questions -- Continued

13a. Have you ever heard of glycosylated hemoglobin (gli-ko'sil-?ted he"mo-glo'bin) or hemoglobin "A one C"?

b. About how many times in the past 6 months has a doctor, nurse, or other health professional checked you for glycosylated hemoglobin or hemoglobin "A one C"?

14a. About how many times in the past 6 months has a health professional checked your feet for any sores or irritations?

b. About how often do you check your feet for sores or irritations?

15. During the past 6 months have you had any sores or irritations on your feet or ankles that did not heal normally?

16. When was the last time you had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to bright light.

17a. Have you had any kind of eye exam by a doctor within the past two years?

b. Have you had any kind of eye exam by a doctor within the past 12 months?

18a. Have you ever been told that diabetes has affected the back of your eyes, that is, the retina?

b. How old were you when the doctor first told you this?

19a. Have you ever had laser or photocoagulation treatment for this problem?

b. Did you receive this treatment within the past 12 months?

c. Was this the first time you had this treatment?

20. Have you ever had photographs taken of the retina or inside of your eyes?

21. Do you have serious trouble seeing with one or both eyes even when wearing glasses?

[p.187]

Section Q2 -- Diabetes Followup Questions -- Continued

22a. About how many times in the past 12 months has a doctor or other health professional checked your blood pressure? Do not count times when an overnight patient in a hospital.

b. Has a doctor ever told you that you had high blood pressure or hypertension?

c. Are you doing any of the following (for your/to prevent) high blood pressure --

d. The last time you had your blood pressure checked, were you told it was high, borderline, low, normal, or were you not told?

23. Has a doctor ever told you that you had --

24. Has a doctor ever told you that you had --


25. About how many different times in the past 12 months have you had a bladder or urinary tract infection?

00[] None
Times ____
99[] DK

26. Have you ever had symptoms of a bladder infection that lasted more than 3 months, such as frequent urination and pain in your bladder?

[p.188]

Section Q2 -- Diabetes Followup Questions -- Continued

27. When you had these symptoms, were you told that you had painful bladder syndrome or interstitial cystitis (in'ter-stish'al sis-ti'tis)?

28. How old were you when you were first told that you had painful bladder syndrome or interstitial cystitis? (in'ter-stish'al sis-ti'tis)

29. When you urinate --

a. Do you usually have trouble starting?

b. Do you usually feel like you have not completely emptied your bladder?

30a. Do you usually have to get up at night to go to the bathroom to urinate? Exclude nights when you drink a lot of liquids.

b. About how many times each night do you have to get up?

31. Have you ever had an amputation of your toe, foot, leg, or part of a leg?
If "Yes," ask: Which?
Mark all that apply.

32. During the past three months have you had --

a. Numbness or loss of feeling in your hands or feet other than from your hands or feet falling asleep?

b. A painful sensation or tingling in your hands or feet? Do not include normal foot aches from standing or walking for long periods.

c. Decreased ability to feel hot or cold in things you touch?

33a. Do you now smoke cigarettes?

b. About how many cigarettes do you smoke per day?

34a. Have you tried to lose weight in the past year?

b. Is your weight now more, less, or about the same as a year ago?

c. In the past year, about how much weight have you (gained/lost)?

Ask if 26 or older; otherwise go to 36.
35a. About how much did you weigh when you were 25 years old?
Read if female: Except when you were pregnant when you were 25, tell me your weight just before you became pregnant.

b. What is the most you have ever weighed?
Read if female: Except when you were pregnant.

c. About how old were you when you first weighed that much?

[p.189]

Section Q2 -- Diabetes Followup Questions -- Continued

Hand card Q2. Read categories if telephone interview.

Card Q2

36a. Where have you obtained information about diabetes?
Mark all mentioned. Do not probe.

If three sources or less in 36a, mark boxes without asking and skip to 37.
b. Which three of these sources have provided you with the most useful information about diabetes?
Mark up to 3.

37a. Have you ever taken a course or class in how to manage your diabetes yourself?

b. About how many hours of instructions did you receive on how to manage your diabetes?

c. Did this course include any of the following subjects --

38. Have you ever attended any (other) education program or class about your diabetes?

39. Were either of your parents ever told that they had diabetes? Do not include pre, potential, or borderline diabetes. Also, do not include step, adoptive, or foster parents.
If "Yes," ask: Which?

40. How many children have you had, including any that may have died? Do not include step, adoptive, or foster children.
Read if female: Do not include stillbirths or miscarriages?

[p.198]

Section T -- Diabetes Risk Factor Questions (SP)

Check Item 1
Refer to letter indicator on sample selection label.

Check Item 2
Refer to section Q1, item 1b on page 32

1. Has a doctor ever told you that you had--

2. Not counting times while an overnight patient in a hospital, about how many times in the past 12 months has a doctor or other health professional --


3. About how many different times in the past 12 months have you had a bladder or urinary tract infection?

00[] None
Times ____
99[] DK

4. Have you ever had symptoms of a bladder infection that lasted more than 3 months, such as frequent urination and pain in your bladder?

5a. When you had these symptoms, were you told that you had painful bladder syndrome or interstitial cystitis? (in'ter-stish'al sis-ti'tis)

b. How old were you when you were first told that you had painful bladder syndrome or interstitial cystitis? (in'ter-stish'al sis-ti'tis)

6. When you urinate --

7a. Do you usually have to get up at night to go to the bathroom to urinate? Exclude nights when you drink a lot of liquids.

1[] Yes
2[] No (8)
9[] DK (8)

b. About how many times each night do you have to get up?

8. During the past 6 months have you had any sores or irritations on your feet or ankles that did not heal normally?

[p.199]

9. Have you ever had an amputation of your toe, foot, leg, or part of leg?
If "Yes," ask: Which?
Mark all that apply.

10. During the past 3 months have you had --

a. Numbness or loss of feeling in your hands or feet other than from your hands or feet falling asleep?

b. A painful sensation of tingling in your hands or feet? Do not include normal foot aches from standing or walking for long periods.

c. Decreased ability to feel hot or cold in things you touch?

11a. Do you now smoke cigarettes?

b. About how many cigarettes do you smoke per day?

12a. Have you tried to lose weight in the past year?

b. Is your weight now more, less, or about the same as a year ago?

c. In the past year, about how much weight have you (gained/lost)?

Ask if 26 or older; otherwise, go to 14.
13a. About how much did you weigh when you were 25 years old?
For females: If you were pregnant when you were 25, tell me your weight just before you became pregnant.

b. What is the most you have ever weighed?
For females: Except when you were pregnant?

c. About how old were you when you first weighed that much?

14. Do you have serious trouble seeing with one or both eyes even when wearing glasses?

15. Were either of your parents ever told that they had diabetes? Do not include pre, potential, or borderline diabetes.
If "Yes," ask: Which?

16. How many children have you had, including any that may have died?
For females: Do not include stillbirths or miscarriages.