Fillable De Montfort University Insulin Pump Users Dietand Exercise Survey2012 (De Montfort University Leicester)

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De Montfort University Insulin Pump Users Dietand Exercise Survey2012 (De Montfort University Leicester)

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Page 1
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
DearParticipant
OurresearchgroupintheSchoolofPharmacyatDeMontfortUniversityareworkingtoproduceamedicaldevicethat
mighthelppeoplewithdiabetesmaintaintherightlevelofglucoseintheirblood.
Oneofthewayswecaninvestigatethisistoexaminetheresponsetoordinaryexerciseinthediabetesperson.
WewouldthereforeliketoinviteyoutotakepartinthissurveybecauseyouhaveeitherType1orType2diabetes
anduseaninsulinpump.Itisanopportunityforyoutodiscussyourexperiencewithvariousaspectsofyourdiabetes
andyourattitudeswithexercise.Theinformationwegetfromthissurveywillbecombinedwithapracticalstudywe
willalsobeconductingwhichmayleadtorecommendationstoimprovethelifestyleofpeoplewithdiabetesinthe
future.Theinformationcouldalsohelpresearchtowardasuitableexerciseregimeforpeoplewithdiabetes.
Allinformationcollectedaboutyouduringthecourseofthesurveywillbestrictlyconfidentialandwewillnotaskfor
anypersonaldetails.
Ifyouhaveanyquestionsthenpleasecontactus.
Thankyouverymuchforyourtime.
Yourssincerely
MJTaylor
ProfessorofPharmaceutics
01162506317
mjt@dmu.ac.uk
MohamdAlblihed
PhDstudent
p06004947@myemail.dmu.ac.uk
THISSURVEYCANBEFILLEDINELECTRONICALLYBUTIFYOUPREFER,YOUCANPRINTTHESURVEY,
FILLITINMANUALLYANDTHEADDRESSLABELONTHEBACKPAGECANBEUSED
NOSTAMPNEEDEDIFMAILEDFROMTHEUK
1. Are you?
2. Are you?
De Montfort University Insulin Pump Users' Diet and Exercise Survey
Section A: Background information
1
Female
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2
Male
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1
Professional
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2
Skilled
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3
Semi
skilled
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4
Manuallabour
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5
Student
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6
Retired
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7
Other(pleasespecify)
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5
6
5
5
6
2
Page 2
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
3. How old are you?
4. How old were you when your diabetes was first diagnosed?
5. Please state your weight and height
6. What is your highest level of education?
7. What is your ethnic group?
8. Which country do you live in?
1
Height…………
(
cmorfeetandinches)
2
Weight………..(kgorstonesandpounds)
1
Between1
10years
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2
Between11
20years
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3
Between21
30years
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4
Between31
40years
nmlkj
5
Between41
50years
nmlkj
6
Between51
60years
nmlkj
7
Between61
80years
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8
Over80years
nmlkj
1
Between1
10years
nmlkj
2
Between11
20years
nmlkj
3
Between21
30years
nmlkj
4
Between31
40years
nmlkj
5
Between41
50years
nmlkj
6
Between51
60years
nmlkj
7
Between61
80years
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8
Over80years
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1
Iamstillinfulltimeeducation
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2
Iunderwentsomeformofeducationaltraining(e.g.
vocationalorcollege)
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3
Iaminorhavehadahighereducation(e.g.university)
nmlkj
nmlkj
nmlkj
6
Other(pleasespecify)
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1
WhiteBritish
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2
WhiteIrish
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3
AnyotherWhitebackground
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4
Mixed,WhiteandBlackCaribbean
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5
Mixed,WhiteandBlackAfrican
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6
Mixed,WhiteandAsian
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7
Anyothermixedbackground
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8
AsianorAsianBritish,Indian
nmlkj
9
AsianorAsianBritish,Pakistani
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10
AsianorAsianBritish,Bangladeshi
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11
AnyotherAsianbackground
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12
BlackorBlackBritish,Caribbean
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13
BlackorBlackBritish,African
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14
AnyotherBlackbackground
nmlkj
15
Chinese
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16
Other(pleasespecify)
nmlkj
7
3
Page 3
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
9. If you are from the UK, who provided your pump?
10. How was your diabetes first discovered?
11. What type of diabetes do you have
12. Is there a history of diabetes in your family?
Section B: Diabetes
1
MypumpwasprovidedfreethroughbytheNHS
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2
MypumpinfusionsetswereprovidedbytheNHS
nmlkj
3
Ipaidformypump.
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4
Ipaidformypumpinfusionsets
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5
Otherpleasestate
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1
BymyGP
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2
Byhospitalclinic
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3
Byfriend/family
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4
Byambulance/A&E(AccidentandEmergency)
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5
Bymyself
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6
Bymedicalcheck
up(work,insurance)
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7
Other(pleasespecify)
nmlkj
1
Type1
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2
Type2
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3
Idon
’
tknow
nmlkj
4
Other(pleasespecify)
nmlkj
1
No
nmlkj
2
Ifyespleasestatewho
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8
Page 4
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
13. What was your HbA1c when you were diagnosed with diabetes? (if known)
14. What was your HbA1c average before using insulin pump therapy?
15. What is your average HbA1c now that you are using insulin pump therapy?
1
Don
’
tknow
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2
Below5%(31mmol/mol)
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3
Between5.1and6%(31and42mmol/mol)
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4
Between6.1and7%(43and53mmol/mol)
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5
Between7.1and8%(54and64mmol/mol)
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6
Between8.1and9%(65and75mmol/mol)
nmlkj
7
Between9.1and10%(76and86mmol/mol)
nmlkj
8
Over10.1%mmol/mol,pleasestate
nmlkj
1
Don
’
tknow
nmlkj
2
Below5%(31mmol/mol)
nmlkj
3
Between5.1and6%(31and42mmol/mol)
nmlkj
4
Between6.1and7%(43and53mmol/mol)
nmlkj
5
Between7.1and8%(54and64mmol/mol)
nmlkj
6
Between8.1and9%(65and75mmol/mol)
nmlkj
7
Between9.1and10%(76and86mmol/mol)
nmlkj
8
Over10.1%mmol/mol,pleasestate
nmlkj
1
Don
’
tknow
nmlkj
2
Below5%(31mmol/mol)
nmlkj
3
Between5.1and6%(31and42mmol/mol)
nmlkj
4
Between6.1and7%(43and53mmol/mol)
nmlkj
5
Between7.1and8%(54and64mmol/mol)
nmlkj
6
Between8.1and9%(65and75mmol/mol)
nmlkj
7
Between9.1and10%(76and86mmol/mol)
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8
Over10.1%mmol/mol,pleasestate
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7
2
4
7
Page 5
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
16. What do you think your HbA1c should be?
17. In the last 12 months, have you had any of the following tests?
18. For each question of the following please tick yes, no or Don't know
19. Please tell us what your cholesterol levels are, if known?
Yes
No
Don
’
tknow
1
Yourbloodpressuretakenbyadoctorornurse.
nmlkj nmlkj nmlkj
2
Acholesteroltestbyadoctorornurse.
nmlkj nmlkj nmlkj
3
Aneyetestwhereaphotographofthebackofyoureyeswastaken.
nmlkj nmlkj nmlkj
4
Yourbarefeetwereexamined.
nmlkj nmlkj nmlkj
5
Youhavehadyourweightcheckedbyadoctorornurse.
nmlkj nmlkj nmlkj
Yes
No
Don't
know
1
Hasyoureyesightsufferedasaconsequenceofyourdiabetes?
nmlkj nmlkj nmlkj
2
Doyouhavediabetickidneydisease?
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3
Doyourequiredialysis?
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4
Haveyouhadakidneytransplant?
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5
Isyourbloodpressureusuallynormal?
nmlkj nmlkj nmlkj
6
Doyoutakeanymedicationtocontrolyourbloodpressure?
nmlkj nmlkj nmlkj
7
Areyouonlipidloweringmedication(forhighcholesterolortriglycerides)?
nmlkj nmlkj nmlkj
8
Haveyoueverhadaheartattack?
nmlkj nmlkj nmlkj
9
Doyoueverhavechestpainduetoangina?
nmlkj nmlkj nmlkj
10
Haveyoueverhadheartbypasssurgery(coronaryarterybypass)?
nmlkj nmlkj nmlkj
11
Haveyoueverhadaballoonangioplastyoracoronarystentplaced?
nmlkj nmlkj nmlkj
12
Haveyoueverhad,orsuspectedthatyouhadastroke?
nmlkj nmlkj nmlkj
1
Totalcholesterollevel
2
Low
densitylipoprotein(LDL)cholesterol(ifknown)
3
High
densitylipoprotin(HDL)cholesterol(ifknown)
Your insulin Pump
1
Don
’
tknow
nmlkj
2
Below5%(31mmol/mol)
nmlkj
3
Between5.1and6%(31and42mmol/mol)
nmlkj
4
Between6.1and7%(43and53mmol/mol)
nmlkj
5
Between7.1and8%(54and64mmol/mol)
nmlkj
6
Between8.1and9%(65and75mmol/mol)
nmlkj
7
Between9.1and10%(76and86mmol/mol)
nmlkj
8
Over10.1%mmol/mol,pleasestate
nmlkj
11
7
Page 6
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
20. What kind of insulin pump do you use?
21. How many years have you been using a pump?
22. What kind of insulin do you infuse into your pump?
23. Typically, what are your basal rates throughout a non
exercise day?
24. How do you bolus for meals on a non
exercise day?
25. What was the total amount of insulin you typically use on a non
exercise day?
1
MedtronicParadigm
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2
Roche
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3
Animas
nmlkj
4
SmithsMedical–Cozmo
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5
Accu
ChekSpirit
nmlkj
6
Other,pleasestate
nmlkj
1
Lessthan1year
nmlkj
2
Morethan1yearandlessthan3years
nmlkj
3
Between3and5years
nmlkj
4
Morethan5years
nmlkj
1
Humalog
®
(
Lispro)
nmlkj
2
Novorapid
®
orNovolog
®
(
Aspart)
nmlkj
3
Actrapid
®
(
regularorsolubleinsulin)
nmlkj
4
HumulinS
®
(
regularorsolubleinsulin)
nmlkj
5
Other,pleasestate
nmlkj
1
Lessthan0.5Unit/hr
nmlkj
2
Between0.5Unit/hrand1Unit/hr
nmlkj
3
Between1Unit/hrand2Unit/hr
nmlkj
4
Morethan2Unit/hr
nmlkj
1
Standardbolus(Spike)
nmlkj
2
Extendedbolus(Squarewave)
nmlkj
3
Combinationbolus(SpikeandSquarewave)
nmlkj
4
Superbolus(Increasedspike)
nmlkj
5
Other,pleasespecify
nmlkj
1
Lessthan20Units
nmlkj
2
Between21Unitsand30Units
nmlkj
3
Between31Unitsand40Units
nmlkj
nmlkj
nmlkj
6
Morethan61Units,pleasestate
nmlkj
Page 7
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
26. How many times do you test your blood glucose on a non
exercise day?
27. Typically, what are your basal rates throughout an exercise day?
28. How do you bolus for meals on an exercise day?
29. What is the total amount of insulin you typically use on an exercise day?
30. Do you use a pre
exercise bolus?
31. What is an acceptable blood glucose for you before exercise?
32. How does exercise change your blood glucose?
33. How many times do you test your blood glucose on an exercise day?
1
3times
nmlkj
4
6times
nmlkj
Morethan6times
nmlkj
1
Lessthan0.5Unit/hr
nmlkj
2
Between0.5Unit/hrand1Unit/hr
nmlkj
3
Between1Unit/hrand2Unit/hr
nmlkj
4
Morethan2Unit/hr
nmlkj
5
Anyadditioninformation
nmlkj
1
Standardbolus(Spike)
nmlkj
2
Extendedbolus(Squarewave)
nmlkj
3
Combinationbolus(SpikeandSquarewave)
nmlkj
4
Superbolus(Increasedspike)
nmlkj
5
Other,pleasespecify
nmlkj
1
Lessthan20Units
nmlkj
2
Between21Unitsand30Units
nmlkj
3
Between31Unitsand40Units
nmlkj
nmlkj
nmlkj
6
Morethan61Units,pleasestate
nmlkj
1
No
nmlkj
2
Yes,pleasestatehowmuch
nmlkj
1
Below4mmol/l(72mg/dl)
nmlkj
2
Between4
7mmol/l(72
126mg/dl)
nmlkj
3
Above7mmol/l(126mg/dl)
nmlkj
1
Increaseyourbloodglucose
nmlkj
2
Decreaseyourbloodglucose
nmlkj
3
Nochange
nmlkj
1
3times
nmlkj
4
6times
nmlkj
Morethan6times
nmlkj
2
6
2
Page 8
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
34. If your blood glucose was less than 4mmol/L (72 mg/dl) pre
exercises, what would
you do?
35. If you experienced hypoglycemia (low blood glucose) after exercise what action
would you take?
36. How important is participating in sport and exercise to you?
37. Have you always led an active exercise lifestyle?
38. Typically what is your blood glucose value pre
exercise?
Section C: Exercise
1
Missoutyourpre
exercisebolus
nmlkj
2
Reduceyourpre
exercisebolus
nmlkj
3
Leaveoutexercisetoday
nmlkj
nmlkj
nmlkj
7
Other,pleasestate
nmlkj
1
Re
checkyourbloodglucose
nmlkj
2
Eatordrinkcarbohydrate
nmlkj
3
Other(pleasespecify)
nmlkj
1
Important
nmlkj
2
Noview
nmlkj
3
Notimportant
nmlkj
1
Yes
gfedc
2
No
gfedc
3
Yes,butIhavestoppednow
gfedc
gfedc
gfedc
Pleaseexplainhow
1
Donotknow
nmlkj
2
Below5mmol/l(below90mg/dl)
nmlkj
3
Between5.1and6mmol/l(91
108mg/dl)
nmlkj
4
Between6.1and7mmol/l(109
126mg/dl)
nmlkj
5
Between7.1and8mmol/l(127
144mg/dl)
nmlkj
6
Between8.1and9mmol/l(144
162mg/dl)
nmlkj
7
Between9.1and10mmol/l(163
180mg/dl)
nmlkj
8
Over10mmol/l,(over180mg/dl)pleasestate
nmlkj
6
2
4
11
Page 9
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
39. Please tick (
✓✓✓✓
)
appropriate box
40. If you don
’
t switch your pump on during exercise, do any of the following apply?
41. How much exercise did you participate in before you started your pump therapy?
42. Has this changed since you have been on your pump?
43. What would you say the level of intensity is when you exercise?
Yes
No
1
Isyourpumpswitchedonduringexercise?
nmlkj nmlkj
2
Doyouhaveanypumpproblemsduringexercise?Ifyes,pleaseexplainbelow
nmlkj nmlkj
Explanation
1
Youarenotsureaboutthepumpsensitivityduringexercise
nmlkj
2
Youareworriedaboutdiscomfort
nmlkj
3
Youworrythatyourbloodglucosegoesuptoabnormallevel(hyperglycemia)
nmlkj
4
Youworrythatyourbloodglucosegoesdown(hypoglycemia)
nmlkj
5
Interfereswithexerciseprogram
nmlkj
6
Advisedbymedicalprofessionaltoswitchpumpoffduringexerecise
nmlkj
7
Other
nmlkj
1
None
nmlkj
2
Lessthan1houraweek
nmlkj
3
Between1
3hoursaweek
nmlkj
4
Morethan3hoursaweek
nmlkj
1
No
nmlkj
2
Yes,pleasestate
nmlkj
1
Light(Easy,doesnotinducesweatingunlessit'sahot,humidday,nonoticeablechangeinbreathingpatterns.)
nmlkj
2
Moderate(Somewhathard,sweatafterabout10minutesofexercise.Breathingbecomesdeeperandmorefrequent.)
nmlkj
3
Heavy(Hard,sweatafter3
5minutes.Breathingisdeepandrapid.)
nmlkj
4
Combinationbetweenlowandmoderate.
nmlkj
5
Combinationbetweenlowandhigh.
nmlkj
6
Combinationbetweenhighandmoderate.
nmlkj
Page 10
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
44. Typically, what type of exercise do you do?
45. Which of the following do you participate in (please select all that apply)
46. Are there any barriers preventing you from taking part in more sport?
47. Typically, how many days in the week do you undertake physical activity?
48. In a typical exercise session how long do you spend participating in sport or
exercise?
49. How many times do you exercise per day?
1
Aerobicexercise(e.g.walking,cycling,joggingandswimming)
nmlkj
2
Anaerobicexercise(e.g.resistancetrainingandweightlifting)
nmlkj
3
Amixtureofaerobicandanaerobic
nmlkj
4
Otherpleasestate
nmlkj
1
Walking
gfedc
2
Cycling
gfedc
3
Weighttraining(resistanceexercise)
gfedc
4
Swimming
gfedc
5
Teamsportsbasketball/football
gfedc
6
Running
gfedc
7
Otherpleasestate
gfedc
1
Healthreasons
gfedc
2
Lackofmotivation
gfedc
3
EmbarrassmentabouthowIlookegoverweightorfitness
lack
gfedc
4
Youdoubtitwillleadtoweightcontrol
gfedc
5
Lackoftime
gfedc
gfedc
gfedc
gfedc
gfedc
gfedc
11
Other(pleasespecify)
gfedc
Everyday
nmlkj
1
2days
nmlkj
3
5days
nmlkj
6days
nmlkj
1
Lessthan30minutes.
nmlkj
2
From30to1hour.
nmlkj
3
From1to2hours.
nmlkj
4
From2to3hours.
nmlkj
5
From3to4hours.
nmlkj
6
Morethan4hours.
nmlkj
Once
nmlkj
Twice
nmlkj
Threetimes.
nmlkj
Morethan3times.
nmlkj
Page 11
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
50. How effective has exercise been on each of the following?
51. Where do you typically exercise?
52. Are you a member of any sport centre or physical activity group?
53. Which of the following factors influenced your decision to participate in sport?
Please tick all that apply
54. How often do you climb the stairs at home? (Average over the last 3 months):
please tick one
55. Typically when do you do your exercises? Tick all that apply
Effective
Nochange
Detrimental
Comments
1
Bettergeneralhealth
nmlkj nmlkj nmlkj nmlkj
2
LowHBA1c
nmlkj nmlkj nmlkj nmlkj
3
Betterbloodglucosecontrol
nmlkj nmlkj nmlkj nmlkj
4
Fewerhypoglycemiaevents
nmlkj nmlkj nmlkj nmlkj
5
Fewerhyperglycemiaevents
nmlkj nmlkj nmlkj nmlkj
1
Atschool/college/work/university
nmlkj
2
Inasportsteam(e.g.football,netball)
nmlkj
3
Inaclassorclub(e.g.aerobics,dance,etc)
nmlkj
4
Gym
nmlkj
5
Onyourwayhomeorschool.
nmlkj
6
Don
’
tknow
nmlkj
7
Elsewhere,pleasestate
nmlkj
1.Yes
nmlkj
2.No
nmlkj
1
Tokeepwellwithyourdiabetes
gfedc
2
Bettercontrolofyourbloodglucose
gfedc
3
BetterforHbA1cvalue
gfedc
4
Toimprovehealthandfitness
gfedc
5
Weightloss
gfedc
gfedc
gfedc
gfedc
gfedc
None
nmlkj
1to5timesaday
nmlkj
6to10timesaday
nmlkj
11to15timesaday
nmlkj
16to20timesaday
nmlkj
Morethan20timesaday
nmlkj
1
Morning.
gfedc
2
Afternoon.
gfedc
3
Evening
gfedc
gfedc
gfedc
Page 12
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
56. How often do you suffer with hypoglycaemia during a week?
57. Has exercise increased or decreased the hypoglycaemia you have?
58. Do you experience hypoglycaemia while exercising?
59. How many times per week is your measured fasting blood glucose 10 mmol/L (180
mg/dl) or above?
60. What do you do if your blood sugar is over 10mmol/L (180mg/dl)?
61. Have you ever experienced diabetic ketoacidosis since you started to exercise?
62. How many calories do you think you eat and drink in a typical day?
63. Do you count carbohydrates regularly in order to help you to control your diabetes?
Section D: Diet
1
None
nmlkj
2
One
nmlkj
3
Twoor3
nmlkj
4
Morethan3
nmlkj
1
Increase
nmlkj
2
Decrease
nmlkj
3
Noeffect
nmlkj
1
Always
nmlkj
2
Frequently
nmlkj
3
Rarely
nmlkj
4
Never
nmlkj
1
Once
nmlkj
2
Twice
nmlkj
3
Morethantwice
nmlkj
4
Never
nmlkj
1
Reducetheinsulinrate
nmlkj
2
Increasetheinsulinbolus
nmlkj
3
Waitforthebloodglucosetoreduce
nmlkj
nmlkj
nmlkj
1
Yes
nmlkj
2
No
nmlkj
3
Don
’
tknow
nmlkj
1
1500orless
nmlkj
2
Over1500upto2000
nmlkj
3
Over2000upto2500
nmlkj
4
Over2500upto3000
nmlkj
5
Over3000upto3500
nmlkj
6
3500ormore
nmlkj
7
Idon
’
tknow
nmlkj
1
Yes
nmlkj
2
No
nmlkj
Page 13
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
64. Do you eat special diabetic food/ drink?
65. Which of these are important to you?
66. Do you see a dietician?
67. Do you follow a medically approved dietary programme?
68. How would you describe your diet approach?
69. What other factors affect your eating habits?
1
No
nmlkj
2
Yes,pleaselistandstatewhy
nmlkj
1
Reducingfatindiet
nmlkj
2
Reducingbodyweight
nmlkj
3
Stayingmotivated
nmlkj
nmlkj
nmlkj
6
Others,pleasestate
nmlkj
1
Frequently
nmlkj
2
Regularly
nmlkj
3
Never
nmlkj
1
No
nmlkj
2
Yes(pleasespecify)
nmlkj
1
Youreatinghabitsarehealthy
nmlkj
2
Youaretoobusytofindhealthyfoodsormeals
nmlkj
3
Youdon'tknowenoughaboutgoodnutritionorhowtoeathealthily
nmlkj
4
Sometimes,youtrytoeathealthyfood
nmlkj
5
Youcan
’
tresistjunkfood
nmlkj
6
Youreatinghabitsarepoor
nmlkj
1
Yourparentsand/orfamilydon
’
teathealthily.
nmlkj
2
Yourschool/workdon
’
tofferhealthychoicesatlunchormealtimes
nmlkj
3
Youandyourfriendsarealwaysgoingouttoeatandsocializingoverfoodandyouendupeatinglotsofjunkfood.
nmlkj
4
Youreallydon
’
tfeellikeit
’
sworthitorhavethemotivationtotrytochangeyourhabits.
nmlkj
5
Youeatahealthydiet
nmlkj
6
Otherpleasestate
nmlkj
Page 14
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
70. Do you drink alcohol?
71. Do you smoke on your exercise days?
72. How often are you ever too unwell or stressed to exercise?
73. Have you experienced any of the following symptoms after exercise?
74. Please write any comments you would like to add
5
5
6
6
1
Yes
nmlkj
2
No
nmlkj
3
Yes,butnotonanexerciseday
nmlkj
1
Donotsmoke
nmlkj
2
Yes,pleasestatehowmanyperday
nmlkj
1
Frequently
nmlkj
2
Sometimes
nmlkj
nmlkj
4
Other(pleasespecify)
nmlkj
1
Bleeding
nmlkj
2
Chafing
nmlkj
3
Flushing
nmlkj
4
Hives
nmlkj
5
Hyperthermia
nmlkj
6
Musclecramps
nmlkj
7
Redface
nmlkj
8
Shortnessofbreath
nmlkj
9
Urinary(colour,blood,pain)
nmlkj
10
None
nmlkj
11
Other
nmlkj
Page 15
De Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise SurveyDe Montfort University Insulin Pump Users' Diet and Exercise Survey
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De Montfort University Insulin Pump Users Dietand Exercise Survey2012 (De Montfort University Leicester)

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