Diabetes Treatment Center

Take the Self-Risk Assessment

Diabetes is a disease that could lead to many serious complications if left untreated. Learn and know the symptoms: excessive thirst, frequent urination, extreme fatigue, unexplained weight loss and blurred vision. Take a moment to take our test and find out if you’re at risk.*

1.

 I have been experiencing one or more of the following symptoms on a regular basis:
Excessive thirst Yes No
Frequent urination Yes No
Extreme fatigue Yes No
Unexplained weight loss Yes No
Blurry vision from time to time Yes No
   
2. I am over 30 years old Yes No
   
3. I am 10 pounds overweight Yes No
   
4. I am a woman who has had a baby weighing more than nine pounds at birth ** Yes No
   
5. I am of Native American (American Indian) descent Yes No
   
6. I am of Hispanic or African American descent Yes No
   
7. I have a parent with diabetes Yes No
   
8. I have a brother or sister with diabetes Yes No

Scoring:
If you answered yes to five or more questions, you may be at a high risk for diabetes. Please contact the North Mississippi Medical Center Diabetes Treatment Center at (662) 377-2500 or 1-800-843-3375 for further information.

*This test is meant to educate and make you aware of the serious risks of diabetes. Only a physician can determine if you have diabetes.

**The American Diabetes Association urges all pregnant women to be tested for diabetes between the 24th and 28th week of pregnancy.

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Phone Number:________________________________________________________________________________

Mailing address:
Diabetes Treatment Center
North Mississippi Medical Center
830 South Gloster
Tupelo, MS 38801
FAX:(662)377-2069

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