PAID (Problem Areas In Diabetes)

Please tell us your name or NHI number. (This will only be used to link your answers to your DAFNE ID)

Which of the following diabetes issues are currently a problem for you? Circle the number that gives the best answer for you. Please provide an answer for each question.

	Not a problem	Minor problem	Moderate problem	Somewhat serious problem	Serious problem
Not having clear and concrete goals for your diabetes care?

Feeling discouraged with your diabetes treatment plan?

Feeling scared when you think about living with diabetes?

Uncomfortable social situations related to your diabetes care (eg people telling you what to eat)?

Feelings of deprivation regarding food and meals?

Feeling depressed when you think about living with diabetes?

Not knowing if your mood or feelings are related to your diabetes?

Feeling overwhelmed by your diabetes?

Worrying about low blood sugar reactions?

Feeling angry when you think about living with diabetes?

	Not a problem	Minor problem	Moderate problem	Somewhat serious problem	Serious problem
Feeling constantly concerned about food and eating?

Worrying abut the future and the possibility of serious complications?

Feelings of guilt or anxiety when you get off track with your diabetes management?

Not 'accepting' your diabetes?

Feeling unsatisfied with your diabetes physician?

Feeling that diabetes is taking up too much of your mental and physical energy energy day?

Feeling alone with your diabetes?

Feeling that your friends and family are not supportive of your diabetes management efforts?

Coping with complications of diabetes?

Feeling 'burned out' by the constant effort needed to manage diabetes?

Approximately how many units of quick-acting insulin are you giving each day (Humalog/NovoRapid/Apidra)?

Approximately how many units of background insulin are you giving per day? (Lantus/Protaphane/Humulin NPH)?

Do you inject your background insulin:

Once per day

Twice per day

Since completing your DAFNE course, have you had a hypo you were unable to treat yourself ie had someone to help you? If so, how many? How many required paramedic assistance?

Do your symptoms of hypoglycemia USUALLY occur at a blood glucose level of: