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M1A
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 |
If you take pills for your diabetes, please indicate which of the following pills you are currently taking. (Circle one answer for each line.) Glucotrol (glipizide) |
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M1B
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Micronase, Glynase, or Diabeta (glyburide) |
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M1C
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Amaryl (glimepiride) |
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M1D
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Starlix (nateglinide) |
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M1E
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Diabinese (chlorpropamide) |
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M1F
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Glucophage (metformin) |
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M1G
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Precose (acarbose) |
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M1H
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Actos (pioglitazone) |
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M1J
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Prandin (repaglinide) |
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M1K
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Avandamet (metformin and rosiglitazone combination pill) |
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M1L
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Glucovance (glyburide and metformin combination pill) |
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M1M
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Metaglip (glipizide and metformin combination pill) |
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M1N
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Other (please specify): |
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M2A
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If you take pills for high cholesterol, please indicate which of the following pills you are currently taking. (Circle one answer for each line.) Mevacor or Altocor (lovastatin)rol (glipizide) |
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M2B
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Zocor (simvastatin) |
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M2C
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Lipitor (atorvastatin) |
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M2D
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Lescol (fluvastatin) |
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M2E
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Pravachol (pravastatin) |
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M2F
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Other (please specify): |
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M3
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Besides any medications you marked in the question above, please list by name all other prescription medications (i.e., prescribed by a doctor) that you are currently taking regularly or use as needed, including those for conditions other than diabetes. The names of prescription medications can be found on the containers. Please include medications placed in the eye or on the skin. |
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M4
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Do you currently take herbal medications for diabetes or any other health problem? |
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M5
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Please list all herbal medications: |