If you suspect you might have diabetes, this survey can help!

Instructions: Check the answer that most accurately describes your condition. Click the submit button at the end of the form to tally your score.

If your total is over 60, you may be at risk for diabetes and should see your doctor as soon as possible. If your score is below 60 and you are concerned about any of these symptoms you should see your doctor for peace of mind.

1. Are you overweight?
   
   No
   10 Pounds
   20 Pounds
   30 Pounds
   
   
2. Have you experienced recent unexplained weight loss?
   
   Yes
   No
   
   
3. Do you have relatives with diabetes?
   
   No
   Yes
   
   
4. Do you experience frequent urination?
   
   Yes
   No
   
   
5. Do you have blurred eyesight when you miss or are late for meals or when you overeat sweet foods?
   
   Yes
   No
   
   
6. Do you regularly have cold hands and feet?
   
   Yes
   No
   
   
7. Do you get the shakes when you miss or are late for meals or when you overeat sweet foods?
   
   Yes
   No
   
   
8. Do you experience fatigue, weakness and easy tiring?
   
   Yes
   No
   
   
9. Are you always thirsty?
   
   Yes
   No
   
   
10. Are you always hungry?
    
    Yes
    No