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Membership Lifestyle Survey
Demographics
1.
Q1 - What best describes your gender?
Male
Female
Other
2.
What is your age? Please specify
3.
Which of the following best describes you? (Choose one)
I have Type 1 diabetes
I have Type 2 diabetes
I am a parent/carer of someone with diabetes
I have Type 1.5 (LADA)
I have gestational diabetes
I am a health care professional
I don't have diabetes
Other (please specify)
4.
How long since you were diagnosed with diabetes? Choose one
10+ years
Five to 10 years
More than one year and less than five
Less than one year
I can't remember
N/A
5.
How are you managing your diabetes? Please choose one of the below options.
Diet & exercise
Diet, exercise & tablets
Diet, exercise & insulin injections
Insulin injections
Pump
Other (please specify)
