1.
How many meals and snacks do you eat daily?
Irregular meals and / or less than three
Three meals including snacks
Three meals as well as snacks in-between meals
2.
How many of your meals/snacks contain starches (e.g. cereal, bread, crackers, potato)?
One or less
Two
Three or more
3.
Is the rice, pasta, bread, cereal you eat mainly:
White or refined e.g. cornflakes, white bread and white rice
Whole-wheat or brown e.g. All-Bran, whole-wheat bread and brown rice
4.
How many pieces of fruit do you eat daily (excluding fruit juice)?
Often nothing
One to two
Three or more
5.
Are you aware of the use of the glycaemic index in the eating plan of a diabetic?
No or unsure
Yes
6.
How many alcoholic drinks do you consume?
Daily consumption or more than two drinks
No more than one or two drinks approximately three times a week
Seldom or never
7.
When do you consume alcohol?
One or more hours before or after a meal
Always with a meal or rarely consume alcohol
8.
Do you have a snack or meal both before and after exercise?
No
Yes
9.
How often do you eat sweets, chocolates, cakes, puddings or sweet biscuits?
Three or more times a week
One to two times a week
Seldom or never
10.
If you do eat sweets, chocolates etc., do you eat them with a meal or as a snack in-between meals?
Usually in-between meals
Usually with a meal or seldom eat these foods
11.
Would you consider diabetic chocolate or biscuits a healthy substitute?
Yes or unsure
No
12.
How many different types of vegetables do you eat daily?
Not daily
One to two
Three or more
13.
Do you know how to read food labels to ensure a low fat, low sugar intake?
No or unsure
Yes
14.
Do you cut all visible fat and skin off meat and chicken before cooking it?
No
Sometimes
Always
15.
How often do you eat processed meats (e.g. sausage, salami), pastries or fried foods?
Four or more times a week
Not more than three times a week
Seldom or never
16.
Which dairy products (milk, cheese, yoghurt) do you use most often?
Full cream
Reduced fat or low fat
Mostly fat free
17.
Is your usual weight considered normal?
No - I am more than 10 kg overweight
No - I am 5-10 kg overweight or underweight or unsure
I am within 5 kg of a normal, healthy weight
18.
How often does your blood glucose level fall outside the normal range (fasting: 4,4-6,1 mmol/L; non-fasting: 4,4-8 mmol/L) when you test it?
Almost every time or I hardly ever test it
In normal range more than 50% of the time
Almost always in the normal range
19.
Does your HbA1c level fall within the normal range when your doctor tests it?
No, or never have it tested, or unsure
Yes
20.
Do you use artificial sweeteners in place of sugar?
No
Sometimes
Always
21.
How many artificial sweeteners do you use in a day?
More than eight
Six to eight
Less than six
