By Debra A. Sokol-McKay, MS, CVRT, CLVT, CDE, OTR/L

Being in control of your diabetes is hard work, especially when you have a vision loss. But it can be done - and you don't have to do it alone. Since you're the one living with diabetes, it's up to you to know about available services and products. It's also important to realize that there are people you can turn to for support and information - eyecare and medical professionals, vision rehabilitation therapists, certified diabetes educators and, in many cases, family and friends. It may take more time and effort, but you can achieve the independence you want and learn to manage diabetes your way.

Eye Examinations Are Key

Diabetes affects vision, so it's very important to have regular eye examinations by an ophthalmologist and to report any changes in your vision as quickly as possible. When you have a vision loss, an eye exam by an ophthalmologist or optometrist who specializes in low vision care can be an important next step. A low vision exam focuses on the vision you have and, in most cases, optical and/or electronic magnification devices can be prescribed to help you use your remaining vision to perform many diabetes-related and other daily tasks. These may include reading medication and nutrition labels, expiration dates on insulin bottles or blood glucose test strips, and numbers on a syringe. Learning to use these devices successfully and confidently takes some practice, but if it's important to you to carry out these tasks on your own, it is worth the effort.

Managing Diabetes-related Tasks

Let's look at three specific tasks:

Blood Glucose Monitoring: Many blood glucose monitors on the market have large displays and bold numbers, making it possible for people with vision loss to continue to test on their own. For those who cannot rely on vision, "talking" blood glucose monitors are available, including one encased in a "voice" unit and others with "voice" attachments that connect to the monitor by a data cable. The voice unit reads aloud the information shown on the monitor display. Your diabetes care professional can provide information about the various monitors with speech capability, such as the Accu-ChekTM VoicemateTM System, an integrated talking system; or the OneTouch® Basic® and OneTouch® SureStep® - each of which can be used with a voice attachment.

"Talking" monitors are reimbursable by many insurance companies, including Medicare, as long as your physician writes a detailed prescription and your eye report indicates that you are legally blind (the corrected vision in your better eye is 20/200 or worse).

Being able to insert the test strip into the monitor's port and apply your blood sample to the site on the test strip are essential day-to-day tasks that need to be accomplished visually or by touch. Coding the monitor to the test strips and checking that the monitor is working correctly are also important for proper use and maintenance of your blood glucose monitor.

While it takes patience and motivation to learn the steps involved, many people without vision do test their glucose levels independently. But you'll need a good teacher. A certified diabetes educator (CDE) and/or a vision rehabilitation specialist can help you manage these doable tasks and evaluate which glucose monitor is easiest for you to use.

Insulin Management: There are several insulin measurement devices on the market, and a number of techniques you can learn to draw up insulin accurately and safely. It's important to work with a vision rehabilitation professional along with a CDE or physician to receive proper instruction in the use of these devices, as well as to verify that you are using proper techniques.

If you take the same dose of insulin every day, you may be able to use a device that is initially preset by a sighted person and can be used independently thereafter. If your dose varies, you can use a device that measures the insulin by counting and feeling clicks or by counting the number of turns. There are also non-visual techniques to remove air bubbles and to know when your insulin vial is empty.

Insulin pens are another alternative for measuring insulin. Your physician or CDE will be able to advise you if the kind of insulin or dose you take is available in this form. Similar to other insulin measurement devices, you can "dial up" your dose with pens by feeling and listening for clicks.

Another benefit and safety feature of many insulin pens is that they stop dialing when they're empty. Many are on the market by such manufacturers as Novo Nordisk, Aventis and Eli Lilly & Co., and require prescriptions. With the exception of one insulin pen specifically designed for users with low vision, all pens have a disclaimer that states a person who is sighted should supervise their use. However, CDEs working with people with vision impairment have long advocated independent insulin pen use following proper instruction.

Nutrition Management: Healthy eating - what you eat and how much - is very important to managing diabetes. It's a good idea to work with a dietician who specializes in diabetes or a CDE to create a meal plan designed for you, and to update it every five years.

And you'll want to be able to organize and identify foods in your cupboard or refrigerator. Here is where a vision rehabilitation professional can help by teaching you methods of organizing your kitchen; identifying foods by using sound, smell and touch; and helping to develop a labeling system that works for you. Many tools are available to obtain proper food portions, including color contrasting/nested measuring cups; portion-controlled serving utensils; and large-display, tactile and talking food scales.

Some Helpful Tips

You can also apply a number of important vision rehabilitation principles - organization, contrast, lighting and glare control - to help perform many diabetes-related tasks. For example:

  • When you test your blood glucose or draw up insulin, place your supplies on a solid contrasting surface, or on a tray with a rim or edge. The rim will keep items from getting away from you or accidentally falling on the floor.
  • Choose a tray color that contrasts with items such as your pills, lancets and blood glucose meter. For example, a dark color tray will make light color items more visible and easier to use.
  • If you're measuring insulin, place the syringe against a white surface such as a wall or refrigerator, so that the black plunger tip and syringe markings stand out better.
  • Consider a flexible-armed desk lamp for your diabetes tasks area. Overhead lighting is usually not sufficient. Position your lamp so that your hand or shoulder does not cast a shadow on your work area.
  • Avoid glare by covering any shiny surfaces when using diabetes supplies. If glare is a problem when reading the display on a blood glucose monitor, try repositioning the monitor or the lamp.
  • Consider putting your blood glucose records, food label and other nutrition information in an accessible format - in large print, on a cassette tape or on your computer.

It's in Your Hands

Managing your diabetes can feel overwhelming at first. There are many different areas to learn about and a variety of products that can help you on a day-to-day basis. But you're not alone. While you're the one to decide what level of independence you're comfortable with, there are professionals specialized in diabetes care and vision rehabilitation who can guide you. Partner with them, make educated decisions - and stay in charge of your life!

Debra A. Sokol-McKay, MS, CVRT, CLVT, CDE, OTR/L, is an Adjunct Faculty at the Pennsylvania College of Optometry's Graduate Program in Low Vision. She is also Chair of the Disabilities/ Visually Impaired Specialty Group of the American Association of Diabetes Educators.

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