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 ‘Prediabetes’ Program Intake Form What was your most recent A1c* test result (%)? Please select.<5.05.05.15.25.35.45.55.65.75.85.96.06.16.26.36.46.56.66.76.86.97.07.17.27.37.47.5*A1c 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 85Select your weight in pounds or kilos Pounds (lbs) Kilograms (kg) Select your current weight (kg)Under 555555155.255.355.455.555.655.755.855.95656.156.256.356.456.556.656.756.856.95757.157.257.357.457.557.657.757.857.95858.158.258.358.458.558.658.758.858.95959.159.259.359.459.559.659.759.859.96060.160.260.360.460.560.660.760.860.96161.161.261.361.461.561.661.761.861.96262.162.262.362.462.562.662.762.862.96363.163.263.363.463.563.663.763.863.96464.164.264.364.464.564.664.764.864.96565.165.265.365.465.565.665.765.865.96666.166.266.366.466.566.666.766.866.96767.167.26767.467.567.667.767.867.96767.167.267.367.467.567.667.767.867.96868.168.268.368.468.568.668.768.868.96969.169.269.369.469.569.669.769.869.97070.170.270.370.470.570.670.770.870.97171.171.271.371.471.571.671.771.871.97272.172.272.372.47272.672.772.872.97272.172.272.372.472.572.672.772.872.97373.173.273.373.473.573.673.773.873.97474.174.274.374.474.574.674.774.874.97575.175.275.375.475.575.675.775.875.97676.176.276.376.476.576.676.776.876.97777.177.277.377.477.577.677.777.877.97878.178.278.378.478.578.678.778.878.97979.179.279.379.479.579.679.779.879.98080.180.280.380.480.580.680.780.880.98181.181.281.381.481.581.681.781.881.98282.182.282.382.482.582.682.782.882.98383.183.283.383.483.583.683.783.883.98484.184.284.384.484.584.684.784.884.98585.185.285.385.485.585.685.785.885.98686.186.286.386.486.586.686.786.886.98787.187.287.387.487.587.687.787.887.98888.188.288.388.488.588.688.788.888.98989.189.289.389.489.589.689.789.889.99090.190.290.390.490.590.690.790.890.99191.191.291.391.491.591.691.791.891.99292.192.292.392.492.592.692.792.892.99393.193.293.393.493.593.693.793.893.99494.194.294.394.494.594.694.794.894.99595.195.295.395.495.595.695.795.895.99696.196.296.396.496.596.696.796.896.99797.197.297.397.497.597.697.797.897.99898.198.298.398.498.598.698.798.898.99999.199.299.399.499.599.699.799.899.9100100.1100.2100.3100.4100.5100.6100.7100.8100.9101101.1101.2101.3101.4101.5101.6101.7101.8101.9102102.1102.2102.3102.4102.5102.6102.7102.8102.9103103.1103.2103.3103.4103.5103.6103.7103.8103.9104104.1104.2104.3104.4104.5104.6104.7104.8104.9105105.1105.2105.3105.4105.5105.6105.7105.8105.9106106.1106.2106.3106.4106.5106.6106.7106.8106.9107107.1107.2107.3107.4107.5107.6107.7107.8107.9108108.1108.2108.3108.4108.5108.6108.7108.8108.9109109.1109.2109.3109.4109.5109.6109.7109.8109.9110110.1110.2110.3110.4110.5110.6110.7110.8110.9111111.1111.2111.3111.4111.5111.6111.7111.8111.9112112.1112.2112.3112.4112.5112.6112.7112.8112.9113113.1113.2113.3113.4113.5113.6113.7113.8113.9114114.1114.2114.3114.4114.5114.6114.7114.8114.9115115.1115.2115.3115.4115.6115.7115.8115.9116116.1116.2116.3116.4116.5116.6116.7116.8116.9117117.1117.2117.3117.4117.5117.6117.7117.8117.9118118.1118.2118.3118.4118.5118.6118.7118.8118.9119119.1119.2119.3119.4119.5119.6119.7119.8119.9120120.1120.2120.3120.4120.5120.6120.7120.8120.9121121.1121.2121.3121.4121.5121.6121.7121.8121.9122122.1122.2122.3122.4122.5122.6122.7122.8122.9123123.1123.2123.3123.4123.5123.6123.7123.8123.9124124.1124.2124.3124.4124.5124.6124.7124.8124.9125125.1125.2125.2125.4125.5125.6125.7125.8125.9126126.1126.2126.3126.4126.5126.6126.7126.8126.9127127.1127.2127.3127.4127.5127.6127.7127.8127.9128128.1128.2128.3128.4128.5128.6128.7128.8128.9129129.1129.2129.3129.4129.5129.6129.7129.8129.9130130.1130.2130.3130.4130.5130.6130.8130.9131131.1131.2131.3131.4131.5131.6131.7131.8131.9132132.1132.2132.3132.4132.5132.6132.7132.8132.9133133.1133.2133.3133.4133.5133.6133.7133.8133.9134134.1134.2134.3134.4134.5134.6134.7134.8134.9135135.1135.2.4135135.4135.5135.6135.7135.8135.9136136.1136.2136.3136.4136.5136.6136.7136.8136.9137137.1137.2137.3137.4137.5137.6137.7137.8137.9138138.1138.2138.3138.4138.5138.6138.7138.8138.9139139.1139.2139.3139.4139.5139.6139.7139.8139.9140140.1140.2140.3140.4140.5140.6140.7140.8140.9141141.1141.2141.3141.4141.5141.6141.7141.8141.9142142.1142.2142.3142.4142.5142.6142.7142.8142.9143143.1143.2143.3143.4143.5143.6143.7143.8143.9144144.1144.2144.3144.4144.5144.6144.7144.8144.9145145.1145.2145.3145.4145.5145.6145.7145.8145.9146146.1146.2146.3146.4146.5146.6146.7146.8146.9147147.1147.2147.3147.4147.5147.6147.7147.8147.9148148.1148.2148.3148.4148.5148.6148.7148.8148.9149149.1149.2149.3149.4149.5149.6149.7149.8149.9150150.1150.2150.3150.4150.5150.6150.7150.8150.9151151.1151.2151.3151.4151.5151.6151.7151.8151.9152152.1152.2152.3152.4152.5152.6152.7152.8152.9153153.1153.2153.3153.4153.5153.6153.7153.8153.9154154.1154.2154.3154.4154.5154.6154.7154.8154.9155155.1155.2155.3155.4155.5155.6155.7155.8155.9156156.1156.2156.3156.4156.5156.6156.7156.8156.9157157.1157.2157.3157.4157.5157.6157.7157.8157.9158158.1158.2158.3158.4158.5158.6158.7158.8158.9159159.1159.2159.3159.4159.5159.6159.7159.8159.9160160.1160.2160.3160.4160.5160.6160.7160.8160.9161161.1161.2161.3161.4161.5161.6161.7161.8161.9162162.1162.2162.3162.3162.4162.5162.6162.7162.8162.9163163.1163.2163.3163.4163.5163.6163.7163.8163.9164164.1164.2164.3164.4164.5164.6164.7164.8164.9165165.1165.2165.3165.4165.5165.6165.7165.8165.9166166.1166.2166.3166.4166.5166.6166.7166.8166.9167167.1167.2167.3167.4167.5167.6167.7167.8168.9168168.1168.2168.3168.4168.5168.6168.7168.8169.9169169.1169.2169.3169.4169.5169.6169.7169.8169.9170170.1170.2170.3170.4170.5170.6170.7170.8170.9171171.1171.2171.3171.4171.5171.6171.7171.8171.9172172.1172.2172.3172.4172.5172.6172.7172.8172.9173173.1173.2173.3173.4173.5173.6173.7173.8173.9174174.1174.2174.3174.4174.5174.6174.7174.8174.9175.1175.2175.3175.4175.5175.6175.7175.8175.9176176.1176.2176.3176.4176.5176.6176.7176.8176.9177177.1177.2177.3177.4177.5177.6177.7177.8177.9178178.1178.2178.3178.4178.5178.6178.7178..8178..9179179.1179.2179.3179.4179.5179.6179.7179.8179.9180180.1180.2180.3180.4180.5180.6180.7180.8180.9181181.1181.2181.3181.4181.5181.6181.7181.8181.9182182.1182.2182.3182.4182.5182.6182.7182.8182.9183183.1183.2183.3183.4183.5183.6183.7183.8183.9184184.1184.2184.3184.4184.5184.6184.7184.8184.9185185.1185.2185.3185.4185.5185.6185.7185.8185.9186186.1186.2186.3186.4186.5186.6186.7186.8186.9187187.1187.2187.3187.4187.5187.6187.7187.8187.9188188.1188.2188.3188.4188.5188.6188.7188.8188.9189189.1189.2189.3189.4189.5189.6189.7189.8189.9190190.1190.2190.3190.4190.5190.6190.7190.8190.9191191.1191.2191.3191.4191.5191.6191.7191.8191.9192192.1192.2192.3192.4192.5192.6192.7192.8192.9193193.1193.2193.3193.4193.5193.6193.7193.8193.9194194.1194.2194.3194.4194.5194.6194.7194.8194.9195195.1195.2195.3195.4195.5195.6195.7195.8195.9196196.1196.2196.3196.4196.5196.6196.7196.8196.9197197.1197.2197.3197.4197.5197.6197.7197.8197.9198198.1198.2198.3198.4198.5198.6198.7198.8198.9199199.1199.2199.3199.4199.5199.6199.7199.8199.9200Above 200Select your current weight (lbs)110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263264265266267268269270271272273274275276277278279280281282283284285286287288289290291292293294295296297298299300301302304305306307308309310311312314315316317318319320321322323324325326327328329330331332333334335336337338339340341342343344345346347348349350351352353354355356357358359360361362363364365366367368369370371372373374375376377378379380381382383384385386387388389390391392393394395396397398399400Above 400Are you currently taking anti-glycemic* medications? Yes No *Medications to help lower blood sugarSelect Medication Type* Metformin GLP-1 agonist Other *If you're unsure, click the options to view medication brands/names.Select your current Metformin dosage: mg per day25050075010001500175020002550What 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? Please explain your medications I prefer to go straight to the program