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. 2017 Mar 17;11:587–595. doi: 10.2147/PPA.S124605

Table S1.

Questionnaire on possible difficulties at the time of switch from human insulin to insulin analogs (completed by the physician and the patient)

Any change in treatment may present potential challenges for patients. A switch from human insulins to insulin analogs may also pose such risk. Therefore, I am asking you to assess whether – and if so to what extent – this change in treatment makes a problem in the context of the following issues. Please, rate, whether each of the problems mentioned in the following questions caused: no problem, insignificant problem, moderate problem, major problem, or very significant problem.

You may find answering these questions easier if you look at the questionnaire together with me.

Potential problem No problem Insignificant problem Moderate problem Major problem Very significant problem
1. Does the change in treatment to a biphasic insulin analog and not needing to wait 30 min for a meal following insulin analog injection pose a problem for you? 0 1 2 3 4
2. Does the change of treatment to a biphasic insulin analog make it difficult for you to skip snacks between main meals? 0 1 2 3 4
3. Is it difficult to remember the additional, adjusted dose of biphasic insulin analog required in case of an extra meal/snack? 0 1 2 3 4
4. Does the change of treatment to a biphasic insulin analog make it difficult for you to identify hypoglycemic symptoms? 0 1 2 3 4
5. Does the change of treatment to a biphasic insulin analog make it difficult for you to comply with the therapy? 0 1 2 3 4

How frequently since your last visit did you happen to:

Never 1 to 5 times More than 5 times

Have a snack between the main meals?
Forget to modify the analog dose in case of eating a snack?
Inject insulin analog much earlier before a meal?
Experience hypoglycemia?
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