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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
DearParticipant
OurresearchgroupintheSchoolofPharmacyis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liketoinviteyoutotakepartinthissurveybecauseyouhaveeitherType1orType2diabetes.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
AhmedAlsabih
PhDstudent
p09053155@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
The De Montfort University Diabetes Type 1 & 2 Diet and Exercise Survey
Background information and personal data about you
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state
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14.
5.
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
3. How old are you?
4. How old were you when your diabetes was first diagnosed?
5. Please state your height and weight ?
6. What is your highest level of education?
7. What is your ethnic group?
1.Height(cmorfeetandinches)
2.Weight(kg,pounds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
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5.Between41
50years
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6.Between51
60years
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7.Between61
80years
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8.Over80years
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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
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5.Between41
50years
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6.Between51
60years
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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)
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4.Iamstillinfulltimeeducationasamaturestudent
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5.Ihavenothadanyfurthereducationafterleavingschool
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6.Other,pleasestate
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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
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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
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15.Chinese
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16.Anyotherethnicgroup,pleasespecify
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2.
2.
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
8. Which country do you live in?
9. How was your diabetes diagnosed?
10. What type of diabetes do you have?
11. Is there a history of diabetes in your immediate family?
12. What do you find most difficult about your diabetes?
13. Do you use insulin?
1.BymyGP(GeneralPractitioner)
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2.Byhospitalclinic
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3.Byfriend/family
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4.Byambulance/Accident&Emergency
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5.Bymyself
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6.Bymedicalcheck
up(e.gwork,insurance)
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7.Other,pleasestate
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1.Type1
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2.Type2
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3.Idon
tknow
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4.Other,pleasestate
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1.No
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2.Yes,pleasestatewho
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1.Healthydiet
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2.Exercising
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3.Testingbloodglucoselevels
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4.Other,pleasestate
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1.Yes
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2.No.PleasegotoQ19
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5.
2.
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
14. What type of insulin(s) do you use? Tick all that apply
15. How many insulin injections do you give yourself in a normal day?
16. How long have you been injecting this number of injections each day?
17. What was the total amount of insulin you used yesterday (over 24 hours)?
18. What is the typical total amount of insulin you use each day?
1.Humalog
®
(
Lispro)
gfedc
2.Novorapid
®
orNovolog
®
(
Aspart)
gfedc
3.Actrapid
®
(
regularorsolubleinsulin)
gfedc
4.HumulinS
®
(
regularorsolubleinsulin)
gfedc
5.HumulinI
®
(
Isophane)
gfedc
6.Insulatard
®
(
Isophane)
gfedc
7.Mixtard
®
gfedc
8.HumulinM3
®
gfedc
9.Levemir
®
(
detemir)
gfedc
10.Lantus
®
(
Glargine)
gfedc
11.Other(list)
gfedc
1
2
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2
4
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4ormore
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Iuseaninsulinpump
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EversinceIstartedtakinginsulin
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Lessthanoneyear
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1
lessthan2years
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2
lessthan5years
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longerthan5years
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1.Between20
39Units
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2.Between40
79Units
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3.Between80
100Units
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4.Other,pleasestate
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1.Between20
39Units
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2.Between40
79Units
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3.Between80
100Units
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4.Other,pleasestate
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2.
2.
2.
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
19. What was your HbA1c when you were diagnosed with diabetes? (if known)
20. How often is your HbA1c measured?
21. What is your recent measured HbA1c result?
22. Was your HbA1c taken in the last 3 months?
23. What do you think your HbA1c should be?
1.Don
tknow
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2.Below5%(31mmol/mol)
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3.Between5and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)
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7.Between9.1and10%(76and86mmol/mol)
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8.Over10%(86mmol/mol).Pleasestate
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1.Every3months
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2.Every6months
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3.Everyyear
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4.Other,pleasestate
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1.Don
tknow
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2.Below5%(31mmol/mol)
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3.Between5and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)
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7.Between9.1and10%(76and86mmol/mol)
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8.Over10%(86mmol/mol).Pleasestate
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1.Yes
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2.No,pleasestatewhen
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1.Don
tknow
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2.Below5%(31mmol/mol)
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3.Between5and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)
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7.Between9.1and10%(76and86mmol/mol)
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8.Over10%(86mmol/mol).Pleasestate
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5.
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
24. In the last 12 months, have you had any of the following tests?
25. For each question please tick yes or no
26. Please tell us what your cholesterol levels are, if known?
27. Have you ever had a low blood glucose (hypoglycaemia)?
Yes
No
Don'tknow
1.Yourbloodpressuretakenbyadoctorornurse
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2.Acholesteroltestbyadoctorornurse
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3.Aneyetestwhereaphotographofthebackofyoureyeswastaken
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4.Yourbarefeetwereexamined
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5.Youhavehadyourweightcheckedbyadoctorornurse.
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Yes
No
1.Hasyoureyesightsufferedasaconsequenceofyourdiabetes?
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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usualbloodpressurenormal?
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6.Doyoutakeanymedicationtocontrolyourbloodpressure?
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7.Areyouonlipidloweringmedication(forhighcholesterolortriglycerides)?
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8.Haveyoueverhadaheartattack?
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9.Doyoueverhavechestpainduetoangina?
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10.Haveyoueverhadheartbypasssurgery(coronaryarterybypass)?
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11.Haveyoueverhadaballoonangioplastyoracoronarystentplaced?
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12.Haveyoueverhad,orsuspectedthatyouhadastroke?
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Totalcholesterollevel
High
densitylipoprotein(HDL)
Low
densitylipoprotein(LDL)
Hypoglycemia
1.Yes
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2.No,pleasegotoQ37
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6.
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
28. What symptoms do you experience when you have a
hypoglycaemia
?
Tick all that
apply
29. How low does your blood glucose get before you feel these symptoms?
30. What time(s) of day do you have hypoglycaemia? Tick all that apply
31. Does hypoglycaemia affect your day
to
day activities?
32. Do you respond to a low blood glucose by taking a sugary food or drink
immediately?
33. Has problems with hypoglycaemia stopped you permanently from being able to
drive?
1.Paleness
gfedc
2.Trembling
gfedc
3.Sweating
gfedc
4.Afeelingofweakness/fatigue
gfedc
5.Rapidheartbeat
gfedc
6.Hunger
gfedc
7.Agitation/irritability
gfedc
8.Poorconcentration
gfedc
9.Blurredvision
gfedc
10.Lossofcoherence
gfedc
11.Blackout
gfedc
12.Convulsions/Fit
gfedc
13.Coma
gfedc
14.Other,pleasestate
gfedc
1.Don
tknow
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2.Between4and5mmol/L(72and90mg/dl)
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3.Between3.5and3.9mmol/L(63and70mg/dl)
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4.Between3and3.4mmol/L(54and61mg/dl)
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5.Below3mmol/L(54mg/dl),pleasegiveavalue
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1.Morning
gfedc
2.Afternoon
gfedc
3.Evening
gfedc
4.Duringnight
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Anyadditionalcomments
1.Agreatdeal
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2.Quitealot
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3.Alittle
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4.Notatall
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1.Yes
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2.No,pleasestatewhatyoudo
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1.Yes
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2.No
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8.
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
34. During the past 12 months have you had
severe
hypoglycaemia where you
passed out or had a seizure that
required help from others?
35. If yes, how many times has this occurred?
36. How many times have you had to go to hospital because of hypoglycaemia in the
past 12 months?
37. How many times per week is your measured fasting blood glucose 10 mmol/L (180
mg/dl) or above?
38. Has your blood sugar ever been above 20 mmol/L (360 mg/dl)?
39. Have you ever been in diabetic ketoacidosis (DKA)?
40. Do you know what caused your DKA?
41. Have you ever been in a coma because of
high
blood glucose?
Hyperglycemia
Diet
1.No,pleasegotoQ36
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2.Yes.Pleasestatewhathappened
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1
2
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3
5
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6ormore
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None
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1–2
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3–5
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Morethan5
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1.Once
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2.Twice
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3.Morethantwice
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4.Never
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1.Yes
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2.No
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1.Yes
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2.No,pleasegotoQ41
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1.Becauseyouwereunwell
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2.Missedtakinginsulin
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3.Becauseyouwerestressed
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4.Diet
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5.Other,pleasestate
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1.Yes
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2.No
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2.
6.
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
42. How would you describe your diet approach?
43. Have you been given any dietary advice to help control your diabetes?
44. Do you follow a medically approved dietary programme to help control your
diabetes?
45. Do you count carbohydrates regularly in order to help you to control your diabetes?
46. How many calories do you think you eat and drink in a typical day?
47. Do you eat special diabetic food/drink?
48. Do you drink alcohol?
1.Youareeatinghealthily
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2.Youtoobusytofindhealthyfoodsormeals
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3.Youdon'tknowenoughaboutgoodnutritionorhowtoeat
healthily
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4.Sometimes,youtrytoeathealthyfood
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5.Youcan
tresistjunkfood
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6.Youreatinghabitsarepoor
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1.Yes
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2.No
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1.No
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2.Yes,pleasestate
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1.Yes
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2.No
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1.1500orfewer
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2.Over1500upto2000
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3.Over2000upto2500
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4.Over2500upto3000
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5.Over3000upto3500
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6.3500ormore
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7.Idon
tknow
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1.No
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2.Yes,pleaselistandstatewhy
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1.No
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2.Yes.Howmanyunitsperweek
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3.
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
49. Do you smoke?
50. How important is participating in sport and exercise to you?
51. Do you exercise regularly?
52. Are there any barriers preventing you from taking part in more exercise and sport?
(Please tick all that apply)
Your attitude to exercise
Yes
No
1.Healthreasons
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2.Lackofmotivation
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3.Embarrassmentabouthowyoulook.egoverweightorlackoffitness
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4.Youdoubtitwillleadtoweightcontrol
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5.Lackoftime
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6.Itdoesnotinterestme
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7.Itistooexpensive
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8.Lackoftransport
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9.Fearofinjury
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10.Don'tknow
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1.No
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2.Yes,pleasestatehowmanyperday
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1.Important
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2.Noview
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3.Notimportant
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1.Yes
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2.No,youdonotexerciseatall.Fortherestofthesurveyansweronlyquestions52,53and54.Thankyouforyourparticipationin
thissurvey
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11.Other,pleasestate
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
53. Which of the following factors influenced your decision to participate in exercise?
(Please tick all that apply)
54. What frustrates you MOST about exercise? Tick all that apply
55. What effect did exercise have on your life after you became diabetic?
56. How effective has exercise been on each of the following
Yes
No
1.Tokeepwellwithyourdiabetes
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2.Bettercontrolofyourbloodglucose
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3.BetterforHbA1cvalue
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4.Toimprovehealthandfitness
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5.Lossweight
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6.Familyparticipateinsport
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7.Becausefriendsdoit
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8.Becauseyouenjoyit
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9.Torelievestress
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Effective
Nochange
Detrimental
1.BettergeneralHealth
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2.LowHbA1c
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3.Poorbloodglucosecontrol
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4.FewerHypoglycaemiaevents
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5.FewerHyperglycaemiaevents
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1.Findingtimetoexerciseeveryday
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2.Havingtochangeyourdiet
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3.Motivatingyourself
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4.Painafterexercise
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5.Other,pleasestate
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1.Noeffectonyourdiabetes
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2.Positiveeffectonyourdiabetes
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3.Negativeeffectonyourdiabetes
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Anyadditionalcomments
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
57.
Where do you typically exercise?
58. Do you have a membership in any sports centre or physical activity group?
59. What type of exercise do you do? (Please tick all that apply)
60. Typically what is your blood glucose value pre
exercise?
Yes
No
1.Walking
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2.Cycling
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3.Weighttraining(resistanceexercise)
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4.Swimming
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5.Teamsportsbasketball/football
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6.Running
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1.Atschool/college/work/university
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2.Inasportsteam(e.gfootball,netball)
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3.Inaclassorclub(e.gaerobics,dance,etc)
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4.Atagym
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5.Onyourjourneyhome(e.gwalkingorcycling)
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6.Elsewere,pleasestate
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1.Yes
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2.No
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7.Other,pleasestate
1.Don'tknow
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2.Below5mmol/l(90mg/dl)
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3.Between5and6mmol/l(91and108mg/dl
)
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4.Between6.1and7mmol/l(109and126mg/dl)
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5.Between7.1and8mmol/l(127and144mg/dl)
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6.Between8.1and9mmol/l(145and162mg/dl)
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7.Between9.1and10mmol/l(163and180mg/dl)
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8.Over10mmol/l(180mg/dl).Pleasestate
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
61. At what level of intensity do you exercise?
62. Typically, how many days of the week do you undertake physical activity and
exercise?
63. How many times do you exercise per day?
64. When do you do your exercise? Tick all that apply
65. In a typical exercise day how long do you spend participating in sport or exercise?
66. How many times do you test your blood glucose in normal day (24 hr)?
67. Does this change on an exercise day?
68. Do you change the number of insulin injections on exercise day?
1.Low(Easy,doesnotinducesweatingunlessit'sahot,humidday,nonoticeablechangeinbreathingpatterns)
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2.Moderate(Somewhathard,sweatafterabout10minutesofexercise,breathingbecomesdeeperandmorefrequent)
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3.High(Hard,sweatafter3
5minutes,breathingisdeepandrapid)
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4.Combinationbetweenlowandmoderate
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5.Combinationbetweenlowandhigh
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6.Combinationbetweenhighandmoderate
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Everyday
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1
2days
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3
5days
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6days
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1.Once
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2.Twice
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3.Threetimes
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4.Morethan3times
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1.Morning
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2.Afternoon
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3.Evening
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4.Afterameal
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5.Beforeameal
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1.Lessthan30minutes
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2.From30minutestolessthan1hour
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3.From1tolessthan2hours
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4.From2tolessthan3hours
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5.From3tolessthan4hours
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6.Morethan4hours
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1.Once
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2.Twofourtimes
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3.Morethan4times
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1.Testmore
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2.Testless
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3.Nochange
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1.More
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2.Fewer
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3.Nochange
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
69. Does your insulin dose change in exercise day?
70. Do you inject insulin pre
exercise?
71. During an exercise day, for each question please tick all that
apply
72. If your blood sugar was less than 4mmol/L (72mg/dl) pre
exercises, what would you
do?
73. Do you experience hypoglycaemia while exercising?
74. How many times in the last month has your blood glucose been below 4mmol/L
(72mg/dl) after exercise?
1.More,howmuch
2.Less,howmuch
3.Nochange
4.Dependentontypeofexercise.Pleasestate
A.Beforeexercise
B.Duringexercise
C.Afterexercise
1.Whendoyoutestyourbloodglucose?
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2.Whendoyoutakeyourinsulindose?
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3.Whendoyoutakecarbohydrate?
gfedc gfedc gfedc
1.No
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2.Yes(pleasestatehowmuch)
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1.Missoutyourpre
exercisebolus
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2.Reduceyourpre
exercisebolus
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3.Leaveoutexercisetoday
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4.Takesomecarbohydratethenexercise
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5.Nothing
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6.Other,pleasestate
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1.Always
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2.Frequently
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3.Rarely
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4.Never
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1.Once
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2.Between1
3times
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3.Morethan3times
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4.None,gotoQ77
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
75. If you experience a hypoglycaemia after exercise what action do you take?
76. If you have hypoglycaemia associated after exercise, when would be your major
risk period?
77. How many times in the last month has your blood sugar been above 10mmol/L
(180mg/dl) after exercises?
78. If you experienced hyperglycaemia (high blood glucose) after exercise what action
do you take?
79. Have you experienced any of the following symptoms during or after exercise?
(Please tick all that apply)
1.Re
checkyourbloodglucose
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2.Eatordrinkcarbohydrate
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3.Other,pleasestate
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0
1hour
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1
2hours
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3
6hours
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Morethan6hours
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1.Once
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2.Between1
3times
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3.Morethan3times
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4.None,gotoQ79
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1.Injectinsulindose
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2.Re
checkyourbloodglucose
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3.Drinkwateroranydrinkwithnocalories
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4.Seekmedicalhelp
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5.Eatsomething(eg.carbohydrate)
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1.Bleeding
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2.Chafing
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3.Flushing
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4.Hives
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5.Hyperthermia
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6.Musclecramps
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7.Redface
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8.Shortnessofbreath
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9.Urinary(colour,blood,pain)
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10.Other
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11.None
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The De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and ExerciseThe De Montfort University Diabetes Type 1 and 2 Diet and Exercise
80.
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