Get Diabetes Self-management Questionnaire - Kettering Health Network

Filling out the Diabetes Self-Management Questionnaire is an essential step for individuals managing their diabetes. This guide will provide clear instructions to help you complete the questionnaire online with confidence and ease.

Follow the steps to complete the questionnaire seamlessly.

1. Press the ‘Get Form’ button to access the Diabetes Self-Management Questionnaire and open it in your preferred viewer.
2. Begin by entering your personal information. This includes your name, date of birth, address, and phone numbers. Ensure all entries are accurate for proper identification.
3. Indicate your ethnic background and language preference. This information helps in understanding your cultural context for better management.
4. State your marital status and the number of individuals living in your household, along with their relationship to you.
5. Answer your employment status and occupation. This assists healthcare providers in understanding your lifestyle.
6. Rate your confidence in filling out medical forms independently; this helps gauge your comfort level.
7. Specify how you learn best, and indicate any difficulties you may encounter in hearing, seeing, reading, or speaking.
8. Fill in your educational background, using the last grade completed.
9. Document your diabetes history, including the year or age of diagnosis and type of diabetes.
10. List any diabetes-related relatives and previous diabetes management training.
11. Provide details on how you check your blood glucose, including frequency, target ranges, and use of glucose meters.
12. Discuss experiences of low blood glucose, including incidence and treatment methods.
13. Explain your meal planning for diabetes, usage frequency, and dietary restrictions.
14. Outline your typical meal schedule and routine, noting dietary habits.
15. Acknowledge your physical activity level, type of exercise, and frequency.
16. Indicate if you have received sick day guidelines, along with alcohol and tobacco usage.
17. Assess any additional medical concerns, including conditions or tests taken in the last year.
18. List diabetes medications taken, any missed doses, allergies, and other medications.
19. Conclude with any learning interests from educational sessions and finalize the clinical assessment summary.
20. Once completed, save changes to the document, and then you can download, print, or share the questionnaire as needed.

Complete your Diabetes Self-Management Questionnaire online today for better health management.