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150 153rd Ave, Suite 300
Madeira Beach, FL 33708  
Diabetes can be life threatening! But with early detection it is manageable. This test is designed to allow you to answer questions that may indicate that a diabetic or pre-diabetic condition exists. It is not intended to replace or be a substitute for a clinical exam, which should be completed in an appropriate setting, such as your doctor's office.
 
It is now estimated that 24 million Americans (266 million people worldwide) have diabetes and one third of them don't know it! 57 million are pre-diabetic. Please take a moment to answer the test questions.

Instructions:
(1) Complete each question by indicating the degree of incidence. (2) Your "Total Number of Points" is automatically calculated as you answer the questions and is displayed in the box below the test. "Points" are scored this way:

 
High incidence=10 points / Medium incidence=5 points / Low incidence=0 points
 
Updated 2010

1. I go to the bathroom (urinate) often (every 2 to 3 hours):
 High
 Medium
 Low
2. I am always thirsty and/or hungry:
 High
 Medium
 Low
3. I am suddenly losing a lot of weight:
 High
 Medium
 Low
4. I am always fatigued (weak, tired) and/or drowsy:
 High
 Medium
 Low
5. I am irritable and have mood changes:
 High
 Medium
 Low
6. I am nauseous and/or vomit often:
 High
 Medium
 Low
7. I have blurred vision:
 High
 Medium
 Low
8. I have a tingling or numbness in my legs, feet or fingers:
 High
 Medium
 Low
9. I have frequent or recurring skin, gum and/or urinary tract infections:
 High
 Medium
 Low
10. I have frequent itching of my skin and/or genitals:
 High
 Medium
 Low
11. I have slow healing of cuts and bruises:
 High
 Medium
 Low
12. My family history shows diabetes:
 Don't Know
 Yes
 No
13. My Age is:
 Over 65
 45 to 65
 Under 45
14. I am:
 Obese (over 20% overweight)
 Overweight
 Not Overweight
15. For women, if you have a history of gestational diabetes (the type that occurs during pregnancy) or have delivered a baby over 9 pounds.
 Yes
 No
16. If you are Asian, Black, Hispanic/Latino, Pacific Islander or Native American, medical data shows that within these ethnic groups there are extremely high diabetic populations.
 I am Asian, Black, Hispanic/Latino, Pacific Islander or Native American.
 I am Caucasian
17. Indications of Acanthosis Nigricans (AN), a skin condition characterized by darkened, velvety and/or thickened skin patches.
 Yes
 No
18. Necrobiosis Lipoidica Diabeticorum (NLD), slightly raised shiny red-brown patches on my lower legs, mostly in women.
 Yes
 No

 
 
 
 
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