T2Diet Program Before we get you started in the program, please support Dr Jedha’s ongoing research by completing the form below. We’ll check in with you again at the end of the program for an update on your progress and results. Thank you! T2Diet Program Intake Form Select the option that suits your situationI'm newly diagnosed type 2 diabetes (less than 1 year)I've had type 2 diabetes 1-6 yearsI've had type 2 diabetes 7-15 yearsI've had type 2 diabetes 15+ yearsWhat was your most recent A1c test result (%)? Please select.5.05.15.25.35.45.55.65.75.85.96.06.16.26.36.46.56.66.76.86.97.07.17.27.37.47.57.67.77.87.98.08.18.28.48.58.68.78.88.99.09.19.29.39.49.59.69.79.89.910.010.110.210.310.410.510.610.710.810.911.011.111.211.311.411.511.611.811.912.012.112.212.312.412.512.612.712.812.913.013.113.213.313.413.513.613.713.813.914.014.114.214.314.414.514.614.714.814.915.0>15.0A1c is a test done by your doctor via a pathology lab, it is not a daily self-monitoring test at home. It is normally a percentage, eg: 7.7%.Select your age1819202122232425262728293031323334353637383940414243444546474849505152535455565758596061626364656667686970717273747576777879808182838485over 85Please select your ageSelect your weight in pounds or kilos Pounds (lbs) Kilograms (kg) Select your current weight (kg)Under 454545.145.245.345.445.545.645.745.845.94646.146.246.346.446.546.646.746.846.94747.147.247.347.447.547.647.747.847.94848.148.248.348.448.548.648.748.848.94949.149.249.349.449.549.649.749.849.95050.150.250.350.450.550.650.750.85151.151.251.351.451.551.651.751.851.95252.152.252.352.452.552.652.752.852.95353.153.253.353.453.553.653.753.853.95454.154.254.354.454.554.654.754.854.95555.155.255.355.455.555.655.755.855.95656.156.256.356.456.556.656.756.856.95757.157.257.357.457.557.657.757.857.95858.158.258.358.458.558.658.758.858.95959.159.259.359.459.559.659.759.859.96060.160.260.360.460.560.660.760.860.96161.161.261.361.461.561.661.761.861.96262.162.262.362.462.562.662.762.862.96363.163.263.363.463.563.663.763.863.96464.164.264.364.464.564.664.764.864.96565.165.265.365.465.565.665.765.865.96666.166.266.366.466.566.666.766.866.96767.167.26767.467.567.667.767.867.96767.167.267.367.467.567.667.767.867.96868.168.268.368.468.568.668.768.868.96969.169.269.369.469.569.669.769.869.97070.170.270.370.470.570.670.770.870.97171.171.271.371.471.571.671.771.871.97272.172.272.372.47272.672.772.872.97272.172.272.372.472.572.672.772.872.97373.173.273.373.473.573.673.773.873.97474.174.274.374.474.574.674.774.874.97575.175.275.375.475.575.675.775.875.97676.176.276.376.476.576.676.776.876.97777.177.277.377.477.577.677.777.877.97878.178.278.378.478.578.678.778.878.97979.179.279.379.479.579.679.779.879.98080.180.280.380.480.580.680.780.880.98181.181.281.381.481.581.681.781.881.98282.182.282.382.482.582.682.782.882.98383.183.283.383.483.583.683.783.883.98484.184.284.384.484.584.684.784.884.98585.185.285.385.485.585.685.785.885.98686.186.286.386.486.586.686.786.886.98787.187.287.387.487.587.687.787.887.98888.188.288.388.488.588.688.788.888.98989.189.289.389.489.589.689.789.889.99090.190.290.390.490.590.690.790.890.99191.191.291.391.491.591.691.791.891.99292.192.292.392.492.592.692.792.892.99393.193.293.393.493.593.693.793.893.99494.194.294.394.494.594.694.794.894.99595.195.295.395.495.595.695.795.895.99696.196.296.396.496.596.696.796.896.99797.197.297.397.497.597.697.797.897.99898.198.298.398.498.598.698.798.898.99999.199.299.399.499.599.699.799.899.9100100.1100.2100.3100.4100.5100.6100.7100.8100.9101101.1101.2101.3101.4101.5101.6101.7101.8101.9102102.1102.2102.3102.4102.5102.6102.7102.8102.9103103.1103.2103.3103.4103.5103.6103.7103.8103.9104104.1104.2104.3104.4104.5104.6104.7104.8104.9105105.1105.2105.3105.4105.5105.6105.7105.8105.9106106.1106.2106.3106.4106.5106.6106.7106.8106.9107107.1107.2107.3107.4107.5107.6107.7107.8107.9108108.1108.2108.3108.4108.5108.6108.7108.8108.9109109.1109.2109.3109.4109.5109.6109.7109.8109.9110110.1110.2110.3110.4110.5110.6110.7110.8110.9111111.1111.2111.3111.4111.5111.6111.7111.8111.9112112.1112.2112.3112.4112.5112.6112.7112.8112.9113113.1113.2113.3113.4113.5113.6113.7113.8113.9114114.1114.2114.3114.4114.5114.6114.7114.8114.9115115.1115.2115.3115.4115.6115.7115.8115.9116116.1116.2116.3116.4116.5116.6116.7116.8116.9117117.1117.2117.3117.4117.5117.6117.7117.8117.9118118.1118.2118.3118.4118.5118.6118.7118.8118.9119119.1119.2119.3119.4119.5119.6119.7119.8119.9120120.1120.2120.3120.4120.5120.6120.7120.8120.9121121.1121.2121.3121.4121.5121.6121.7121.8121.9122122.1122.2122.3122.4122.5122.6122.7122.8122.9123123.1123.2123.3123.4123.5123.6123.7123.8123.9124124.1124.2124.3124.4124.5124.6124.7124.8124.9125125.1125.2125.2125.4125.5125.6125.7125.8125.9126126.1126.2126.3126.4126.5126.6126.7126.8126.9127127.1127.2127.3127.4127.5127.6127.7127.8127.9128128.1128.2128.3128.4128.5128.6128.7128.8128.9129129.1129.2129.3129.4129.5129.6129.7129.8129.9130130.1130.2130.3130.4130.5130.6130.8130.9131131.1131.2131.3131.4131.5131.6131.7131.8131.9132132.1132.2132.3132.4132.5132.6132.7132.8132.9133133.1133.2133.3133.4133.5133.6133.7133.8133.9134134.1134.2134.3134.4134.5134.6134.7134.8134.9135135.1135.2.4135135.4135.5135.6135.7135.8135.9136136.1136.2136.3136.4136.5136.6136.7136.8136.9137137.1137.2137.3137.4137.5137.6137.7137.8137.9138138.1138.2138.3138.4138.5138.6138.7138.8138.9139139.1139.2139.3139.4139.5139.6139.7139.8139.9140140.1140.2140.3140.4140.5140.6140.7140.8140.9141141.1141.2141.3141.4141.5141.6141.7141.8141.9142142.1142.2142.3142.4142.5142.6142.7142.8142.9143143.1143.2143.3143.4143.5143.6143.7143.8143.9144144.1144.2144.3144.4144.5144.6144.7144.8144.9145145.1145.2145.3145.4145.5145.6145.7145.8145.9146146.1146.2146.3146.4146.5146.6146.7146.8146.9147147.1147.2147.3147.4147.5147.6147.7147.8147.9148148.1148.2148.3148.4148.5148.6148.7148.8148.9149149.1149.2149.3149.4149.5149.6149.7149.8149.9150150.1150.2150.3150.4150.5150.6150.7150.8150.9151151.1151.2151.3151.4151.5151.6151.7151.8151.9152152.1152.2152.3152.4152.5152.6152.7152.8152.9153153.1153.2153.3153.4153.5153.6153.7153.8153.9154154.1154.2154.3154.4154.5154.6154.7154.8154.9155155.1155.2155.3155.4155.5155.6155.7155.8155.9156156.1156.2156.3156.4156.5156.6156.7156.8156.9157157.1157.2157.3157.4157.5157.6157.7157.8157.9158158.1158.2158.3158.4158.5158.6158.7158.8158.9159159.1159.2159.3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200Please select the closest numberSelect your current weight (lbs)<9090919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263264265266267268269270271272273274275276277278279280281282283284285286287288289290291292293294295296297298299300301302304305306307308309310311312314315316317318319320321322323324325326327328329330331332333334335336337338339340341342343344345346347348349350351352353354355356357358359360361362363364365366367368369370371372373374375376377378379380381382383384385386387388389390391392393394395396397398399400Above 400Please select the closest numberAre you currently taking anti-glycemic medications? Yes No *Medications to help lower blood sugarSelect Medication Type Metformin SGLT-2 inhibitor DDP-4 inhibitor GLP-1 agonist Sulfonylureas Insulin Other *If you’re unsure, click the options to view medication brands/names.Select your current Metformin dosage: mg per day25050075010001500175020002550What type/brand of SGLT-2 inhibitor do you take? dapagliflozin (Farxiga) empagliflozin (Jardiance) ertugliflozin (Steglatro) canagliflozin (Invokana) What's your daily dosage (mg per day)?*eg: 25What type/brand of DDP-4 inhibitor are you taking? sitagliptin (Januvia) saxagliptin (Onglyza) linagliptin (Tradjenta) vildagliptin (Galvus) alogliptin (Nesina) Other: please explain Medication brand may vary dependent on location. Please choose the type if your brand is not listed. What's your daily dosage (mg per day)?*eg: 100What type/brand of GLP-1 agonist do you take? semaglutide (Ozempic) dulaglitide (Trulicity) exenatide extended release (Bydureon bcise) exenatide (Byetta) liraglutide (Victoza, Saxenda) lixisenatide (Adlyxin) semaglutide (Rybelsus) Medication brand may vary dependent on location. Please choose the type if your brand is not listed. Select your Trulicity dosage: mg per week0.50.751.53.04.5Select your Ozempic dosage: mg per week0.250.50.7511.52What's your weekly dosage?What's your daily dosage?What type/brand of sulfonylurea do you take? gliclazide (Diamicron, Glyade, Ardix, Oziclide, Nidem) glimepiride (Amaryl, Dimirel, Aylide, Diapride) glipizide (Glucotrol, Melizide, Minidiab) glibenclamide (Glimel, Daonil) glyburide (Micronase, Diabeta, Glynase PresTab, Glynase, Glycron) Other: please explain Medication brand may vary dependent on location. Please choose the type if your brand is not listed. What's your daily dosage (mg per day)?*eg: 60Please explain your medicationsWhat's your current insulin dosage? I prefer to go straight to the program