Request edit access
Take the Prediabetes Risk Test
Sign in to Google to save your progress. Learn more
Having prediabetes means having a blood sugar (glucose) level higher than normal but not high enough to be type 2 diabetes. Many individuals do not know if they have prediabetes because they have never been given the blood test to determine it.

The Wellness Coalition is offering this lifestyle change program to help you prevent type 2 diabetes and other chronic conditions. The program is not for individuals who already have diabetes. However, it is for individuals who have prediabetes or a history of gestational diabetes.  It is also for individuals who score a 5 or more on the test below:
Do you have prediabetes?
Clear selection
Have you ever had gestational diabetes?
Clear selection
How old are you?
Clear selection
Are you a man or a woman?
Clear selection
If you are a woman, have you ever been diagnosed with gestational diabetes?
Clear selection
Do you have a mother, father, sister, or brother with diabetes?
Clear selection
Have you ever been diagnosed with high blood pressure?
Clear selection
Are you physically active?
Clear selection
Look at the chart below. Find your height, then your weight range. Then, move to the bottom of the chart to see your points.
How many points does this chart say for your height and weight?
Clear selection
If you scored 5 or higher: You may have prediabetes and you are at high risk of developing type 2 diabetes. Ask your doctor to give you a blood test.
Body Mass Index (BMI) is a measure of a person’s body weight relative to his or her height. Please use Table B below to find where your height and weight meet. That number is your BMI. Type your BMI in the space below the table.
Write your BMI number here:
Complete the form below, so we can follow up with you and help you change your lifestyle and change your life!
Name
Phone
Email
City
State
I am interested in:
This is a secured form and your information will not be shared without your permission.
Make sure you “submit” this form so we can receive it.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Black Women's Health Imperative. Report Abuse