Type 2 Diabetes 100% of survey complete. Question Title * 1. First name only Question Title * 2. Gender Female Male Question Title * 3. Age 20's 30's 40's 50 and over Question Title * 4. Do you take Lantus daily? Yes No Question Title * 5. If yes to question 4, how much Lantus do you take daily? 10-20 units 20-30 units 30-40 units 40-50 units 50+ units Question Title * 6. Are you taking a short acting insulin? Yes No I don't know Question Title * 7. Are you taking any other long acting insulin? Levemir Detemir Other Question Title * 8. Do you know your hemoglobin A1c (HbA1c or A1c)? Yes No Question Title * 9. If yes to A1c, please put in most recent value Question Title * 10. What medications are you taking for your diabetes? (mark all that apply) Glucophage/Metformin Glyburide/Micronase Glipizide/Glucotrol Liraglutide/Victoza Glimpiride/Amaryl Sitagliptin/Januvia Other None Question Title * 11. What city are you located in? Question Title * 12. Email(So we can contact you if you're a good fit) Question Title * 13. Cell Phone number(So we can contact you if you're a good fit) Done
