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In this survey, we will be asking about your out-of-pocket costs.
Out-of-pocket costs are the amount you pay from your own funds, including any taxes, fees, or other charges. We will ask for these costs in US dollars. Please convert costs from your local currency to USD.
Here is a tool to help you
Conversion Tool Who in your family has type 1 diabetes?
(Choose all that apply)
I have type 1 diabetes
My child has type 1 diabetes
My spouse/partner/significant other has type 1 diabetes
Other
If you check 'my child or spouse has type 1', please read you/your as 'your child/spouse'
What country do you live in?
Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cabo Verde Central African Republic Chad Chili China Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Costa Rica Cote d'lvoire Croatia Cuba Curacao Cyprus Czechia Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia, The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela Vietnam Yemen Zambia Zimbabwe
Do you have health coverage that covers the cost of your diabetes medication and supplies?
(Choose the answer the best describes your situation)
No, there is no coverage for any of my costs
Yes, there is health care coverage for some of my costs
Yes, there is health care coverage for all of my costs (so I do not pay anything out of pocket)
Prefer not to answer
In addition to any health coverage you have, do you receive any help to pay for your insulin, diabetes supplies, or care?
(Choose all that apply)
If other, please describe
What do you mainly use to administer insulin?
(Choose all that apply)
Please select all insulins you currently use.
(Choose all that apply)
How many vials or pens of short acting insulin (e.g. Humalog, Novalog/Novorapid, Apidra, Humulin, Novolin/Regular or Fiasp) do you typically use per month?
1
2
3
4
5
6
7
8+
Prefer not to answer
In US dollars, how much do you pay out of pocket for a 1 month supply of short acting insulin (e.g. Humalog, Novalog/Novorapid, Apidra, Humulin, Novolin/Regular or Fiasp)?
Conversion Tool
Number only
How many vials or pens of long acting insulin (e.g. Lantus/Toujeo, Levemir, Tresiba, Basaglar or NPH) do you typically use per month?
1
2
3
4
5
6
7
8+
Prefer not to answer
In US dollars, how much do you pay out of pocket for a 1 month supply of long acting insulin (e.g. Lantus/Toujeo, Levemir, Tresiba, Basaglar or NPH)?
Conversion Tool
Number only
How many vials or pens of mixed insulin (e.g. Humulin 70/30, Humulin 50/50, Humalog 75.25, Novolin 70/30 or Novolog 70/30) do you typically use per month?
1
2
3
4
5
6
7
8+
Prefer not to answer
In US dollars, how much do you pay out of pocket for a 1 month supply of mixed insulin (e.g. Humulin 70/30, Humulin 50/50, Humalog 75.25, Novolin 70/30 or Novolog 70/30)?
Conversion Tool
Number only
How many vials or pens of other insulin type do you typically use per month?
1
2
3
4
5
6
7
8+
Prefer not to answer
In US dollars, how much do you pay out of pocket for a 1 month supply of other insulin type)?
Conversion Tool
Number only
What type of insulin pump do you use?
Animas
Accu-Check
Asante
Medtronic
Sooil
Tandem t:slim
Omnipod
Other
Prefer not to answer
In US dollars, how much do you pay out of pocket for a 1 month supply of insulin pump supplies?
Conversion Tool
Number only
What brand of blood testing strips do you use?
None
One touch
Accu-check
Abbott Freestyle
Ascensia (Bayer)
Precision
True track
True test
Sanofi BG star
Subscription based services (e.g. One Drop or Good Glucose)
Other
Prefer not to answer
How many test strips do you use per month?
Number only
In US dollars, how much do you pay out of pocket for a 1 month supply of blood glucose testing strips?
Conversion Tool
Number only
How often do you have to ration or NOT give yourself insulin due to cost?
Never
At least once per year
At least once per month
At least once per week
Every day
Prefer not to answer
How often do you NOT test your blood sugar due to lack of strips or CGM supplies?
Never
At least once per year
At least once per month
At least once per week
Every day
Prefer not to answer
Do you use or keep a glucagon emergency injection with you?
Yes
No
Prefer not to answer
You answered that you do not use or keep a glucagon with you. Why not?
(Choose all that apply)
In US dollars, how much do you pay out of pocket for a glucagon emergency shot?
Conversion Tool
Number only
Do you use or keep urine ketone strips with you?
Yes
No
Prefer not to answer
You answered that you do not use or keep urine ketone strips with you. Why not?
(Choose all that apply)
If other, please describe
In US dollars, how much do you pay out of pocket for one container of ketone test strips?
Conversion Tool
Number only
Do you use a continuous glucose monitor/Flash Glucose Monitoring devices (CGM)?
No
Yes, Dexcom
Yes, Medtronic
Yes, Freestyle Libre
Yes, other
Prefer not to answer
In US dollars, how much do you pay out of pocket for a 1 month supply of CGM/Flash Glucose Monitoring supplies?
Conversion Tool
Number only
In US dollars, how much money do you think you spend on average in total on insulin and diabetes supplies each month?
Conversion Tool
Number only