1. Do you have a family history of diabetes or cardiovascular problems (high blood pressure, heart attack, stroke)? Yes   No

2. Do you now have diabetes or cardiovascular problems? Yes   No

3. Do you have any of these symptoms:

  • Aching, cramping or pain in the legs when you walk or exercise, which disappears after rest? Yes   No
  • Occasional tingling, numbness or coldness in your hands or feet? Yes   No
  • Loss of hair on your feet or toes? Yes   No
  • Irregular growth of fingernails or toenails? Yes   No

4. Do you experience impotence (men)? Yes   No

5. Do you currently smoke? Yes   No

6. If not, have you ever smoked? Yes   No

7. Are you more than 25 lbs overweight? Yes   No

8. Do you live a sedentary lifestyle (NOT exercise regularly)? Yes   No

9. Do you eat fried or fatty foods three times a week or more? Yes   No

   Total Score:

Publication Review By: the Editorial Staff at HealthCommunities.com

Published: 01 Jan 2000

Last Modified: 12 Feb 2015