Insulin Resistance Risk Assessment

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This assessment is based on the National Institutes of Health (N.I.H.) and the Centers for Disease Control and Prevention (C.D.C.) risk calculations and their future diabetes development figures, along with relative associated risk parameters from the National Institute of Diabetes and Digestive and Kidney Disease (N.IH.D.K.) , the American Association of Clinical Endocrinologists (A.A.C.E) and the American Diabetes Association

Full Name *

Phone Number *

Best Email *

YYYY

Time

Family, genetic, or lifestyle risk factors for Insulin resistance are below, please mark all that apply and keep track of your points you accumulate: *

Overweight or Obese (2 points)

Over 45 years old (1 point)

Immediate family with Type 2 Diabetes. (1 point)

All non-white ethnicities.(1 point)

Physical inactiveness.(1 point)

Health condition like: High blood pressure or cholesterol. (1 point)

History of gestational diabetes.(1 point)

Heart attack or stroke. (1 point)

Polycystic Ovarian Syndrome (P.C.O.S.) (2 points)

None Apply

Required

Have you tried to lose weight recently doing what you know works for you without success or feeling worse? *

Yes. (3 Points)

How many separate times have you tried dieting to lose weight in your adult life? *

Zero-2 times

3-6 times. (1 Point)

7-10 times. (2 Point)

More than 10 times. (3 Point)

Prednisone and corticosteroid history (synthetic cortisol): *

Daily. (2 pt)

As needed. (1 pt)

1 time

Multiple times over the years. (3 pt)

Taking it now

Last 2 years

Last 3-5

Last 5-10

What happens when you stop caffeine intake? (artificial adrenaline). Mark all that apply: *

No Change

I feel "Off"

Shakey (1 Point)

Headaches. (2 Point)

Irritability. (1 Point)

Disturbed sleep

Sugar cravings. (1 Point)

Menstrual discomfort. (1 Point)

Constipation

Down, bad mood. (1 Point)

Required

Metabolic Health Numbers: Please mark all that apply to you. If you don't know your exact numbers, please give your best estimate/guess. *

HDL (good cholesterol) is under 50 for women or 40 for men. (3 Point)

Fasting blood sugar over 100. (3 Point)

Fasting blood sugar is 87 to 100 (1 point)

Triglycerides over 150. (3 Point)

Triglycerides are 100 to 150 (1 point)

Have high blood pressure of 130/85 or higher. (1 Point)

Is your waist circumference greater than 35" as a woman or 40" as a man? (3 Point)

Waist circumference is 33.5 to 35 for women or 38 to 40 for men ( 1 point)

Required

Metabolic Risk Indicators: Please Indicate which applies to you: *

Vitamin D level below 40? (3 Point)

Is your A1c 5.7% or above? (3 Point)

Do you sweat when you eat or just after? (1 Point)

Do you get tired right after a big meal? (2 Point)

Do you have dark patches on your skin in the folds? (3 Point)

Have you been diagnosed with PCOS or Endometriosis? (3 Points each)

None Apply

Required

How do you feel if you go a half day without eating? Mark all that apply: *

No Change

I feel "Off"

Shakey. (2 Point)

Headaches. (2 Point)

Irritability. (1 Point)

Disturbed sleep

Sugar or junk food cravings. (2 Point)

Stomach aches.

Get dizzy. (3 Point)

Down, bad mood. (1 Point)

Feel faint. (3 Point)

Get "Hangry". (2 Point)

Required

Please indicate if you ever had any issues with addiction to any of the following: *

Alcohol. (1 Point)

Tobacco. (1 Point)

Prescriptions. (1 Point)

Drugs. (1 Point)

Porn. (1 Point)

Phone. (1 Point)

Gambling. (1 Point)

Sugar. (1 Point)

Bread. (1 Point)

Internet. (1 Point)

Currently

Before

Never an issue

Maybe

Which of the following is accurate about your regular sleep patterns: Mark all that apply. *

Wake up during the night, not related to bathroom visits. (1 point)

Toss and turns. (1 Point)

Hard to wake up and get moving. (1 Point)

Need coffee to wake up. (1 Point)

Drop in energy around 2-4 pm. (1 Point)

Sleep in a warm room or use warm bedding. (1 Point)

None Apply to me

Required

How many times per week do you......(1 - 7) *

0. (2 points)

1-2. (1 point)

3-4

5-7

Exercise for 30 minutes or more

Meditate

Take a nap

Go for walks

Drink more than 60 oz of water

Practice breathing exercises

You are almost done! Add up all the points assigned to your answers and you will find the score result interpretations below. This is a functional screening evaluation and is not a diagnosis or treatment for any medical conditions. The next question will show you how you can get more information on how the Insulin Friendly Lifestyle & Fasting Rotation can help you improve your metabolic health, along with an option to get started today. *

0-12 points: Low Risk for Insulin Resistance.

13-18 points: Moderate RIsk for Insulin Resistance

19-24 points: High Risk for and may indicate early stages of Insulin Resistance

25 or more points: Positive association for Insulin Resistance

Blood sugar over 100 Indicates Insulin Resistance independent of other scores

3 out of 5 Metabolic Syndrome Markers Indicates Insulin Resistance independent of other scores

A1c of 5.7 or higher Indicates Insulin Resistance independent of other scores

Vitamin D under 40 Indicates Insulin Resistance independent of other scores

Weight Loss Resistance Indicates Insulin Resistance independent of other scores

Required

Insulin Resistance robs quality of life. Insulin issues are part of the hormonal trifecta of Insulin, Adrenals, & Thyroid, & bully other hormones and lead to the develop: Pre & Type 2 Diabetes, Metabolic Syndrome, Cardiovascular Disease, Obesity, Weight Loss Resistance, Adrenal Fatigue, Autoimmune Conditions, Low T & Estrogen Imbalance, stops Ketosis & Autophagy, speeds aging & 90% of cancers. Dr. Don's Insulin Friendly Lifestyle & Fasting Rotation Program stops the Trifecta, & promotes healing. I'm offering a FREE 20 min call to discuss your metabolic health & see how I can help. CLICK YES! Then click the calendar link to schedule your call!

YES! I am booking my FREE Meet & Greet call now at https://link.scalelocal.com/widget/bookings/freecallwithdrdon

No thank you, I will continue on my own.

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