Join Diabetes Research
Please answer all the questions to find out if you’re eligible. Your answers are kept confidential and will not be shared with anyone except the research team.
1. Your name
*
First Name
Last Name
2. Your Email
*
example@example.com
3. Your Age
*
Your age in years
4. Do you live near, or are you able to travel to, Vancouver or Kelowna?
*
Yes
No
5. Are you able to commit for the full 90-day trial? This includes being randomly allocated to either taking the ketone supplement or a placebo, wearing a continuous glucose monitor and providing a blood sample at the beginning and end of the study.
*
Yes
No
Maybe / I need more information first.
6. Have you been diagnosed with Type 2 Diabetes by a physician for more than a year?
*
Yes, I was diagnosed more than a year ago.
No, I was diagnosed more recently.
No, I am not diagnosed by a physician.
7. Are you actively trying to gain or lose weight right now (e.g. via a specific diet or exercise regimen)?
*
Yes
No
Not sure
7a. How much has your weight changed over the past 3 months?
in kilograms
8. Are you currently managing your diabetes type 2 with any of the below? You can discuss this during the phone call with the research team if you are not sure.
Insulin
SGLT2 inhibitors (e.g., diabetes drugs like Jardiance, Invokana, or Farxiga)
Ketone supplements
Ketogenic diet
Natural supplements designed to lower blood glucose
None of the above
Not sure
9. Are you taking any glucose lowering medication?
*
Yes
No
Not sure
9a. Have you been taking that glucose lowering medication regularly for at least 3 months?
Yes
No
Not sure
10. Do you have a history of mental illness, neurological disease or cardiovascular events in the last 2 years?
*
Yes
No
10a. Please specify
11. Are you a competitively trained endurance athlete?
*
Yes
No
Result
*
Pass
Fail
source
area
Phone appointment
Thank you for completing the questionnaire. You appear to pass all study criteria. As a last step, the research team would like to speak with you on the phone. You will get the opportunity to learn more about the study and ask questions before deciding to join.
Appointment
Phone Number
*
-
Area Code
Phone Number
Wayturn contact email
Continue
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