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* 1. Sex + Age:

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* 2. What Type of Diabetes do you have?

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* 3. On a typical day, how many times do you inject insulin?

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* 4. What device do you use to inject / deliver your insulin?

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* 5. Do you regularly inject insulin outside your home?

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* 6. How difficult is it to inject your insulin outside your home?

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* 7. Do you carry or have your insulin on your body or on your person and with you at all times throughout the day - such as - “I always have insulin in my pocket”?

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* 8. A new insulin injection device is in development to make it easier for insulin to be carried and with you at all times to make insulin injections “easier, safer, faster and more discrete”. The new device can be filled once with all of the insulin needed for the day and you will be able to have it with you with the plunger rod depressed and available for all of your injections. To inject you simply set the plunger to the desired dose and then inject! The new insulin device is the size of a 50u - 100u syringe and is very portable and easy to use (Like a mini-Insulin Pen). A user will be able to complete an injection in 10-15 seconds without people noticing. Given the description of this new product – how likely are you to use / try this new insulin syringe device?

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* 9. What one feature or aspect is MOST appealing about this new device?

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* 10. What one feature or aspect is THE LEAST appealing about this new device?

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