Diabetes Numeracy Test: Last Revised: January 19, 2005 (Answers Revised 3/05, Format Revised 3/07)

Patient ID ____________ Date________
Interview _____________
Diabetes Numeracy Test
Last Revised: January 19, 2005 (Answers Revised 3/05,

format revised 3/07)
Time Started: ___________

Time Completed: ___________
Total Time: ___________
Copyright 2007 by Vanderbilt University. All rights reserved. Please contact authors for permission to use.
Patient ID ____________ Date________
Interview _____________
The Diabetic Numeracy Test

Description
The Diabetic Numeracy Test (DNT) is an assessment test designed to investigate the numeracy
skills in patients with diabetes. Numeracy can be defined as the ability to understand and use
numbers and math skills in daily life. Numeracy is particularly important to patients with
diabetes because these patients apply math skills to diabetes self-management activities such
as, glucose monitoring, carbohydrate counting, and adjustment of insulin. The questions in the
DNT were formulated from directions given by health care practitioners to patients with diabetes
during a routine clinic visit. In addition, question development was guided by reviewing
validated math and literacy tests. Arriving at the answers will require not only the ability to
perform a variety of math skills, such as addition, subtraction, and multiplication, but also the
application of those skills in the daily setting.
Funding
The development and validation of this scale was funded with support from the American
Diabetes Association (Novo Nordisk Clinical Research Award), the Pfizer Clear Health
Communication Initiative, the Vanderbilt Diabetes Research and Training Center (NIDDK
5P60DK020593) and a NIDDK Career Development Award (NIDDK 5K23DK065294).
Test Administration
The DNT can be written or orally administered. It consists of 43 questions in five domains:
nutrition, exercise, blood glucose monitoring, oral medications and insulin. In addition, the scale
consists of eight math problem types: addition, subtraction, multiplication, division, fractions,
multi-step mathematics, time, and numeration/counting/number hierarchy. The estimated time
for administration of the test is 30 minutes.
General Guidelines
• Introduce yourself to the respondent.
• If the respondent wears glasses, please ask him or her to put them on. If the respondent
wears contacts, remind him or her to wear them to the exam.
• Test the patients visual acuity using a Rosenbaum Pocket Vision Screener. Patients with
corrected visual Acuity >20/50 should be excluded from test.
• Explain the purpose and time frame of the test.
• Hand the respondent a pencil, paper and calculator before starting the exam.
• Ask the respondent to write any calculations on the scrap sheet.
• Ask the respondent to write his or her final answers on the numeracy test in the spaces
provided.
• Explain to the respondent that if he or she is to erase, erase completely without leaving
smears or markings.
• Do not look at the answer choices while administering the exam.
• Remind respondents who wear hearing aids to bring them to the test.
For oral administration, the test administrator is to follow these directions:

• Read the questions out loud to the respondent
• Allow the patient to examine any figures associated with the question.
• Repeat the question if asked
• Give the respondent time to answer the question
Patient ID ____________ Date________
Interview _____________
• Only read what’s printed in the question. Improvising or interpreting a question for a
respondent can invalidate the test results and decrease test efficiency.
• Allow time for the respondent to calculate and record his or her answers
• After the respondent has answered a question, immediately proceed to the next item
• There is no time limit on a particular item.
• Remind respondents who wear hearing aids to bring them to the test.
Patient ID ____________ Date________
Interview _____________
For respondents who are having difficulty:
• Repeat any question when asked by the respondent. However, do not repeat the
question more than three times.
• If the respondent is having difficulty, please encourage the respondent to continue.

Appropriate comments are “you’re doing fine.” However, do not establish a pattern,
such as saying “good” only after correct responses.
• If the respondent does not want to resume the test, please respond by saying, “I am not
trying to embarrass, humiliate, or put your down in anyway. We can stop now, but I
would like to pause to let you know that you are very important to this study, and the
information you are providing could be used to help patients with diabetes. May I
continue…”
• Record any information that you think is relevant or important about the respondent’s
behavior.
Domains
Domain Question number
Nutrition 1-9
Exercise 10-13
Blood Glucose Monitoring 14-17
Oral Medications 18-22
Insulin 23-43
Math Problem Type Question number
Addition 2,25
Subtraction 8
Multiplication 3,5,16,26,27
Division 11,21,28-31
Fractions/ Decimals 4,6,7,8
Multi-step mathematics 9,12,13,20,35-43
Time 10,17,22
Numeration/Counting/Hierarchy 1,14,15,18,19,23,24,32-34
Patient ID ____________ Date________
Interview _____________
Numeracy Survey Questions
For each question below, follow the directions and read the prompt. Please record your
responses on the blank provided for each question.
Nutrition
1. According to the nutrition label, how many grams of total carbohydrate are in
1/2 cup?
1. ANSWER _________ grams.
Patient ID ____________ Date________
Interview _____________
Questions 2-3
2. What is the total amount of carbohydrate eaten if 1 cup of pasta and 1 cup of
carrots are eaten together?
Pasta Carrots
2. ANSWER _________ total grams
3. If you ate the entire container of pasta, how many calories would you be eating?
3. ANSWER _________ calories
Patient ID ____________ Date________
Interview _____________
4. If you ate the entire bag of chips, how many total grams of carbohydrate would you
eat?
4. ANSWER _________ total grams
5. 1 gram of carbohydrate elevates your blood sugar level 3 points. How much will
20 grams of carbohydrate elevate your blood sugar?
5. ANSWER _________ points
6. 1/2 cup of potatoes counts as 1 carbohydrate choice. How many choices does 2
cups of potatoes count as?
6. ANSWER _________ choices
Patient ID ____________ Date________
Interview _____________
7. You ate 1 and 1/2 cups from the food labeled below. How many grams of
carbohydrate did you eat?
Nutrition Facts
Serving size: ¾ cup
Servings per container 10
Amount per Serving
Calories 150 Calories
Total Fat 7g
Total Carbohydrates 18 grams
Dietary Fiber 3g
Sugars 3g
Protein 3g
7. ANSWER _________ grams
8. Your dietitian recommends you eat 5 servings of fruits and vegetables each day.
You already ate ½ cup of canned pineapples, 1 orange and 1 cup of uncooked
vegetables. To have 5 servings of fruits and vegetables, how many cups of cooked
vegetables should you eat?
Fruits Vegetables
One serving equals: One serving equals:
1 orange, or 1 cup of uncooked vegetables, or
1 apple, or ½ cup of cooked vegetables, or
½ cup of canned pineapples ¾ cup of tomato juice
8. ANSWER _________ cups
Patient ID ____________ Date________
Interview _____________
9. You ate half the container of carrots. How many carbohydrates did you eat?
Carrots
9. ANSWER________ carbohydrates
Questions 10-11
10. When you lift weights, you need to eat 20 grams of carbohydrate within 15
minutes after you finish. If you finish weight training at 2:00 PM, by when should you
eat the carbohydrates?
10. ANSWER _________ PM
11. Each cracker has 2 grams of carbohydrate. How many crackers should you eat to
get 20 grams?
11. ANSWER _________ crackers
Patient ID ____________ Date________
Interview _____________
12. Before working in the yard you are to decrease your meal insulin by half, if the
meal and yard work are two hours or less apart. You usually take 8 units for lunch. If
you eat lunch at 12:30 and are going to cut the grass at 2:00 PM, how much insulin
should you take?
12. ANSWER _________ units
13. You have to eat 6 grams of carbohydrate for each 30 minutes you plan to walk.
You are planning to walk for one hour. You have a bag with 12 crackers. Each cracker
contains 10 grams of carbohydrate. How many crackers do you need to eat before
your walk?
13. ANSWER _________ Crackers
14. Your target blood sugar is between 60 and 120. Please circle the values below that
are in the target range (circle all that apply):
55
145
118
Patient ID ____________ Date________
Interview _____________
15. The hemoglobin A1c (HbA1c) test measures average blood sugar levels for the 2-3
month period before blood is drawn. A HbA1c of 6% is equal to an average blood
sugar of about 120. If your average blood sugar in the past 3 months is 240,
approximately what is your HbA1c?
15. _________%
16. You test your blood sugar 4 times a day. How many strips do you need to take
with you on a 2-week vacation?
16. ANSWER _________ strips
Patient ID ____________ Date________
Interview _____________
17. You test your blood sugar 3 times a day. You purchase a prescription of 50 strips
on March 5th. Of the dates below, by when will you need to buy new strips?
March 21st
April 21st
May 21st
June 21st
18. You have a prescription for repaglinide 1 mg pills. The label says, “Take 2 mg of
repaglinide with breakfast, 1 mg with lunch and 3 mg with supper.” How many pills
should you take with supper?
18. ANSWER _________ pills
19. You have a prescription for metformin extended release 500 mg tablets. The label
says, “Take 1 tablet with supper each night for the first week. Then, increase by 1
tablet each week for a total of 4 tablets daily with supper.”
How many tablets should you take with supper each night the second week?
19. ANSWER _________ tablets
20. You have only a few pills left in your pill bottle. Your doctor’s office needs 3 days
to process a new prescription and your pharmacy needs 2 days to fill it. You take 2 pills
a day. What is the least amount of pills that should be in your prescription bottle when
you call for a renewal?
20. ANSWER _________ pills
21. For your diabetes, you take 1 pill two times per day. When you get your refill, the
bottle has 60 pills. How many days supply do you have?
21. ANSWER _________ days
22. You fill your prescription on July 15th. You get a 90 day supply. You must mail in
a renewal 10 days before your supply runs out. When do you need to mail in a
renewal?
22. ANSWER _________
Patient ID ____________ Date________
Interview _____________
23. You take 46 units of insulin at bedtime. On the syringe below, circle the
line/marking that shows you have drawn 46 units.
10
15
20
25
30
35
40
45
50
U N IT S
Patient ID ____________ Date________
Interview _____________
24. Your insulin dose is increased to 54 units and you begin using a larger syringe that
holds 100 units. On the syringe below, circle the line/marking that shows you have
drawn 54 units.
10
20
30
40
50
60
70
80
90
100
U N IT S
Patient ID ____________ Date________
Interview _____________
25. You take 10 units of insulin lispro and 16 units of insulin glargine before breakfast.
What is the total number of units of insulin you take before breakfast?
25. ANSWER _________ total units
26. The doctor tells you to take 2 units of insulin for every 1 serving of carbohydrate you
eat. How many units of insulin do you take for 6 servings of carbohydrate?
27. 1 unit of insulin lowered your blood sugar by 30 points. How much does 4 units of
insulin lower your blood sugar?
27. ANSWER _________ points
Use the following information for questions 28, 29, 30.
Please round down to the nearest whole number.
You are given the following instructions: “Take 1 unit of insulin for every 7 grams of
carbohydrate you eat.” How much insulin do you take:
28. When you eat 49 grams at Breakfast?
49g
29. When you eat 60 grams at Lunch?
60g
30. When you eat 98 grams at Supper?
98g
Patient ID ____________ Date________
Interview _____________
31. You have been told to cut your insulin in half for a colon test.
Your usual dose is 41 units. What amount should you take for the colon test?
Use the following information for question 32, 33, 34;
You are told to follow the sliding scale shown here. The sliding scale indicates the amount of
insulin you take based upon your blood sugar levels.
If Blood sugar is: Units of Insulin
130-180 0
181-230 1
231-280 2
281-330 3
331-380 4
32. How much insulin would you take for a blood sugar of 191?
Patient ID ____________ Date________
Interview _____________
Use the following information for questions 35, 36 and 37

You check your blood sugar just before eating. You take 1 unit of insulin for every 10
grams of carbohydrates you eat. You are also given the sliding scale shown below.
The sliding scale indicates the amount of insulin you should add to your usual dose
based upon your blood sugar levels:
If your blood sugar is greater than 120 points at breakfast, lunch or supper, add 2 units of insulin.
Insulin Dose Schedule

1 unit of Insulin /10 grams carbohydrate at meals
If Blood sugar is: Breakfast Lunch Supper
> 120 +2 +2 +2
> 150 +4 +4 +4
> 180 +6 +6 +6
35. Your blood sugar is 284 and you ate 40 grams of carbohydrate at breakfast. How
much total insulin do you need to take?
284 mg/dl 40 grams
36. Your blood sugar is 140 and you will eat 50 grams of carbohydrate at lunch. How
140 mg/dl 50 grams
37. Your blood sugar is 380 and you will eat 60 grams of carbohydrate at supper. How
380 mg/dl 60 grams
Patient ID ____________ Date________
Interview _____________
Questions 38-42
You have been asked to start taking 32 units of NPH insulin tonight at bedtime.
This insulin will work during the night and will lower your blood sugar first thing in the
morning. You were given the following instructions:
• Your goal is to have the morning (fasting) blood sugar below 120.
• Check your blood sugar every morning before breakfast.
• Start with 32 units of NPH tonight. Increase the dose by 2 units every other
day until your blood sugar is at or below 120.
• Your fasting blood sugar must be above 120 for 2 mornings in a row in order for
you to increase the insulin dose by 2 units.
• Once your blood sugar is staying below 120, stop increasing the nighttime
insulin.
You begin with 32 units of NPH insulin last night. How much NPH insulin will you take
on each of the following nights?
38. Morning of day 1, your blood sugar is 164. How much insulin will you take that
night?
39. Morning of day 2, your blood sugar is 136. How much insulin will you take that night?
Patient ID ____________ Date________
Interview _____________
43. After seeing the Doctor, you are given the following instruction to lower a high
blood sugar level before a meal:
“ Starting with a blood sugar of 120, take 1 unit of insulin lispro for
each 50 points of blood sugar.”
How much insulin should you take for a blood sugar of 375?
Patient ID ____________ Date________
Interview _____________
Answer Key
Question # Answer
1 13 grams
2 41 grams
3 500 calories
4 63 grams
5 60 points
6 4 choices
7 36 grams
8 1 cup
9 12.5 grams
10 2:00 - 2:15pm
11 10 crackers
12 4 units
13 1-2 crackers
14 Circled 118 only
15 10
16 56
17 March 21
18 3 pills
19 2 tablets
20 10 pills
21 30 days
22 Accept Oct 3-6
23 See Question sheet
24 See Question sheet
25 26 units
26 12 units
27 120 points
28 7 units
29 8 units
30 14 units
31 20 or 20.5 units
Patient ID ____________ Date________
Interview _____________
32 1 unit
33 0 units
34 3 units
35 10 units
36 7 units
37 12 units
38 32 units
39 34 units
40 34 units
41 34 units
42 36 units
43 Accept 5-6 units

Diabetes Numeracy Test: Last Revised: January 19, 2005 (Answers Revised 3/05, Format Revised 3/07)

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Patient ID ____________ Date________

Diabetes Numeracy Test

Last Revised: January 19, 2005 (Answers Revised 3/05,

Time Started: ___________

The Diabetic Numeracy Test

For oral administration, the test administrator is to follow these directions:

For respondents who are having difficulty:

• If the respondent is having difficulty, please encourage the respondent to continue.

Blood Glucose Monitoring 14-17

Oral Medications 18-22

Math Problem Type Question number

Fractions/ Decimals 4,6,7,8

Multi-step mathematics 9,12,13,20,35-43

Numeracy Survey Questions

1. ANSWER _________ grams.

2. ANSWER _________ total grams

3. ANSWER _________ calories

4. ANSWER _________ total grams

5. ANSWER _________ points

6. ANSWER _________ choices

7. ANSWER _________ grams

8. ANSWER _________ cups

10. ANSWER _________ PM

11. ANSWER _________ crackers

12. ANSWER _________ units

13. ANSWER _________ Crackers

16. ANSWER _________ strips

18. ANSWER _________ pills

19. ANSWER _________ tablets

20. ANSWER _________ pills

21. ANSWER _________ days

22. ANSWER _________

25. ANSWER _________ total units

26. ANSWER _________ units

27. ANSWER _________ points

Use the following information for questions 28, 29, 30.

Please round down to the nearest whole number.

28. When you eat 49 grams at Breakfast?

29. When you eat 60 grams at Lunch?

30. When you eat 98 grams at Supper?

31. ANSWER _________ units

Use the following information for question 32, 33, 34;

32. ANSWER _________ units

33. ANSWER _________ units

34. ANSWER _________ units

Use the following information for questions 35, 36 and 37

Insulin Dose Schedule

284 mg/dl 40 grams

35. ANSWER _________ units

140 mg/dl 50 grams

36. ANSWER _________ units

380 mg/dl 60 grams

37. ANSWER _________ units

38. ANSWER _________ units

39. ANSWER _________ units

40. ANSWER _________ units

41. ANSWER _________ units

42. ANSWER _________ units

43. ANSWER _________ units

Patient ID ____ Date