1)

Were you given written information about how your diabetes would be affected by the operation?

If YES to Q1, who gave you this information?

2)

3)

Were you given written information about how your diabetes would be managed during your stay in hospital?

4)

If YES to Q3 who gave you that information?

5)

Was it VERBALLY explained to you how your diabetes would be managed during your stay in hospital?

6)

If YES to Q5, who explained?

7)

Were you told of the effect that the anaesthetic may have on your diabetes?

8)

Do you feel that you were given adequate information about the effect your operation may have on your diabetes control?

9)

Please tell us any comments you may have about your inpatient stay in relation to your diabetes:

10)

Whilst in hospital, do you feel that your personal ability to manage your diabetes was respected?

11)

If NO to Q11, please tell us about your experience:

12)

Please indicate what type of procedure you underwent:

13)

Was this

14)

Date of procedure

15)

How long following surgery was your normal diabetic control achieved?

16)

Are you still have problems controlling your diabetes?

17)

Please use this space to elaborate on any answers or make general comments

18)

Date you completed this form?