diabetes survey form

1. SCHOOL OF ARCHITECTURE, BUILDING & DESIGN
Foundation in Natural and Built Environments
MATHEMATICS [MTH30104]
This survey is to fulfill the purpose of our Mathematics’ project. Participation in voluntary and the
information gathered will be kept confidential.
DIABETES SURVEY QUESTIONAIRE
1. Your gender
☐ Male ☐ Female
2. Which ethnicity is at the highest risk for Diabetes?
☐ African ☐ European ☐ Asian
3. Which races is most affected by diabetes in Malaysia?
☐ Malay ☐ Chinese ☐ Indian
4. How many types of diabetes are there?
☐ 1 ☐ 2 ☐ 3 ☐ 4
5. What age is the highest risk for diabetes to happen?
☐ below 30 ☐ 31-59 ☐ 60 and above
6. What typesof diabetescanbe preventedthroughlifestyleschanges?
☐ Type 1 diabetes ☐ Type 2 diabetes ☐ All of above
7. High blood pressure is a risk factor for diabetes?
☐ True ☐ False
8. Which of the following can alter a person’s blood glucose levels?
☐ Exercise ☐ Climate ☐ Stress Level ☐ All of above
9. Which factor do you think is the main causes of this disease?
☐ Genetic ☐ Unhealthy lifestyle

2. 10. When is the suitable time to have a blood test?
☐ Before meal ☐ After meal
11. At which stages of diabetes can be cured?
☐ First stage ☐ Second stage ☐Third Stage ☐Forth Stage
☐ Fifth stage ☐ All stages
12. What are the symptoms for diabetes?
☐ Excessive thirst ☐ Increased hunger ☐ Tiredness ☐All of above
13. Which of the following are complications of diabetes?
☐ Delayed wound healing ☐ vision loss ☐ Kidney failure
☐ All of above
14. What gender is more likely to be diagnosed with diabetes?
☐ Male ☐ Female
15. What type of sugar is the best for diabetes patient?
☐ brown sugar ☐ artificial sweetener ☐ white sugar
16. What are the most effective ways to control diabetes?
☐ Exercise regularly ☐ Take medicine ☐ Reduce alcohol drinks
17. What is the sugar level of diagnosis of a diabetes patient?
☐ More than 6.0 mmol/l (108mg/dl) ☐ More than 6.9 mmol/l (126mg/dl)
18. Gestational Diabetes usually effect to what type of people?
☐ Female during pregnancy ☐ People who overweight
19. A feeling of itchiness on your skin is sometimes a symptom of diabetes.
☐ Yes ☐ No
20. Diabetes is a disease of blood sugar.
☐ Yes ☐ No