February 2017 Issue  Volume 18  Number 2

Access to Diabetes Management Technology

Diabetes Management Devices and Technology for People with Visual Impairments

For most of my 53 years on this planet, I have had very little reason to visit a doctor for anything other than the occasional required checkup that generally consisted of a cursory examination by my physician, a few minutes of filling out information on a form, and my happily going on my way. Even though I was born totally blind, my condition could not be aided by medical intervention, and I had no problems with my eyes that required treatment. When my mother and sister were both diagnosed with diabetes several years ago, I didn't take a lot of time to contemplate whether I should be more diligent in having my own medical condition thoroughly evaluated. My wife had a glucose meter--a device used to measure blood sugar levels--around because of some medical issues she was dealing with, and I thought about asking her to check my blood sugar, but I always found excuses to put it off for another time.

The first signal from my brain to my body indicating that there might be trouble was a chronic, nagging thirst that was especially evident when I drank sweet beverages. I reduced the amount of sweets, drank a bit more water, and felt better, so I figured all was well. When the nagging thirst became almost intolerable, and wasn't even quench by drinking water, I began to Google my symptoms. No matter how many searches I conducted, and no matter how much I read, I came back to the same conclusion. One evening when I was feeling lethargic, achy, and, of course, thirsty, I asked my wife to check my blood sugar. Although several readings yielded different results, they were all high enough that, at her insistence, I took a trip to the emergency room. I was evaluated, my glucose level was brought down to a reading that wasn't quite as dangerously high as it had been, and I ran headlong into a brick wall of reality--I was a type 2 diabetic.

A few days later, a trip to my family physician's office started me on a journey that I will be on for the rest of my life. In this article, I will tell you a bit about my journey, give you some tips about how you or a loved one who is blind can manage this disease as a blind person, and explore the possibilities that lie just around the corner.

Managing Diabetes as a Person with a Visual Impairment

My doctor immediately placed me on oral medication to help reduce my glucose (blood sugar) levels, protect my kidneys, and lower my blood pressure. Later, I began to take medication to assist with lowering cholesterol--all important elements in the proper treatment of diabetes. Although I could have used braille or some other tactile method to label my pill bottles, I chose to keep them in separate locations in order not to mix them up. Whatever method you choose, the important thing is to keep your medications straight. For me, injections have not yet been necessary, but we will discuss them later in this article.

I have always been a reader, so I began doing as much research on diabetes management as I possibly could. For anyone who is comfortable with technology, electronic books on the subject are in abundance, and there are titles available from the National Library Service (NLS) program for those who have specialized players or smartphone apps for reading this content. I will not recommend one specific title, since a book that speaks directly to one person might not be as helpful to another, and new research is taking place on a regular basis.

As important as proper medication is to the successful management of diabetes, healthy eating is vital. A nutritionist with whom I spoke stated it this way: "Everyone should eat like a diabetic." I became intensely interested in how many grams of carbohydrates (carbs) were in my food, as well as other key ingredients. The My Fitness Pal app on my iPhone became my best friend, giving me instant access to all of this information no matter where I was. The service can be accessed from the web and other mobile platforms as well. Later, I began using the I.D. mate Galaxy from En-Vision America to read the information found on the bar codes of the foods I was preparing for myself. I later wrote about this bar code scanner in the August 2016 issue of AccessWorld.

Monitoring Blood Sugar as a Person with a Visual Impairment

For the first few days of my diagnosis, my sighted wife checked my blood sugar regularly, since I had no way of doing so independently. My pharmacy told me that they had access to a talking glucose meter--a device that shows the glucose level on a digital screen and, in some cases, announces it audibly. The glucose meter obtained by my pharmacy was the AutoCode from Prodigy Diabetes Care, LLC. I later learned that this is the oldest product from that company, and it didn't quite meet my needs. It is not possible to fully set up the unit without sighted assistance, it does not allow for 90 day averages of glucose levels--something that we will discuss later--and the use of one button to do most actions made the device inconvenient for me to use.

The Prodigy Voice is fully audible from setup to test results, has a button to repeat the last message spoken, has buttons that are easy to distinguish from one another, has a screen that is easier to read for those with low vision, provides 7, 14, 21, 30, 60, and 90 day averages, and has a headphone jack that will afford privacy for those who don't want their glucose levels announced to the entire world. Quoting from the company's website, "The Prodigy Voice is the only meter to receive an Access Award from the?American Foundation for the Blind?(AFB) and an Access Plus Award from the?National Federation of the Blind (NFB). The Access Plus Award is given to products that afford blind patients the same?convenience and features available to everybody else."

My first attempts at checking my own blood sugar were spectacularly unsuccessful. I was stressed, my motions were clumsy, and I managed to smear any drop of blood that I successfully acquired before I could get it to the test strip. Six months after my diagnosis of diabetes, I still find that I sometimes need to stick myself three or four times before I am able to get a drop of blood onto the test strip. I do not have dexterity issues, but the test strips are fairly small. They come in a bottle that resembles a pill bottle with a hinged lid. When the container is full of strips, it can be a challenge to remove only one strip without bringing several of its friends along. There are times when I am able to perform a glucose level check on the first try. Sometimes a finger is particularly easy for me to use, until, that is, a callous forms on the place where I inevitably stick myself several tests in a row. I then have to find a new spot, and the process of getting comfortable with sticking myself in that spot starts all over again.

Lancets, the needles used to stick yourself in order to acquire blood for the test, are small, and some may have difficulty handling them. I use a lancet holder, and change the lancets regularly. You are supposed to change them every single time. I have discovered that, if I decide to re-use a lancet, a stick will become increasingly painful the duller the lancet becomes. It is possible to obtain disposable lancets that are only used one time, and do not require the use of a lancet holder. I am told that disposable lancets, which have a preset penetration level when performing a stick, are more painful than using a lancet holder, where the depth of skin penetration can be adjusted.

I have a high pain tolerance, so others may disagree with the following statement, but I would not say that sticking my finger to perform a glucose level check is particularly painful. The lancet is retracted into the lancet holder. Placing the holder on your finger and depressing a button will cause the lancet to spring forward and administer the stick. For a while, I tried using a lower penetration setting, but found that, with a fresh lancet, setting the level to the maximum penetration depth was more likely to produce a good drop of blood, and did not cause me significantly more discomfort than a lower penetration level. Sticking the sides of the finger seems to cause less pain than the pads, and certainly the tip of the finger, which has the most nerve endings.

I find that washing my hands in warm water helps with blood flow, as well as providing a clean environment for performing the test. Milking--gently massaging--the finger can also help to bring blood to the area before performing a stick. I find that having a plastic container that contains all my supplies--glucose meter, test strips, lancet holder, lancets, alcohol wipes, and tissues to help ensure that blood flow has stopped after the test has been performed--is invaluable to my success since it helps me stay organized.

Any talking glucose meter should tell you if there is not enough blood on your test strip, if the strip is wet or has been used, if the glucose reading is out of range, and certainly, what the actual glucose reading is at the time of the test. It should be possible to cycle through a history of past readings, and be able to look at averages over a period of time. When I went back to my family physician for a three-month checkup, the average reading obtained from my doctor's lab was very close to that given by the glucose meter I was using at the time. These readings are known as your a1c, which is a marker found in your body that allows your doctor to know what your average glucose level has been over the past two or three months. While your glucose meter will give you an average reading of, for example, 154 milligrams per deciliter, your a1c will be read as 8.0. It is possible to find a1c converters using a smartphone app, or looking on the Web.

It used to be necessary to manually calibrate glucose meters when a new bottle of test strips was opened, but this is no longer the case with any of the current meters on the market, so far as I am aware. Each test strip has a notch on the end that needs to fit into the meter, and a good talking glucose meter will tell you when the unit is ready for testing. Finally, meters allow for alternate site testing--taking glucose readings from your arm, for example, but from what I have read, results are often less accurate than those obtained from the finger, so I have never attempted alternate site testing.

Because I was not happy with the glucose meter I first tried, a friend recommended the Solus V2 from Biosense Medical Devices. The meter is currently available from Amazon for $13.99. However, in researching prices for this article, it appears that the test strips for the Solus V2 are no longer available. If I can't find them again, I will need to consider purchasing the Prodigy Voice, available for $39.99 from Amazon. Amazon also sells a 50-count box of Prodigy test strips for $8.80.

In the February, 2012 issue of AccessWorld, an article by Darren Burton, John Lilly, Matthew Enigk, and Ricky Kirkendall entitled Diabetes and Visual Impairment: An Update on Accessible Blood Glucose Meters discusses what to look for in a glucose meter that is accessible both from a totally blind, and a low-vision perspective. In that article, four glucose meters were considered fully accessible. They were:

  • The Prodigy Voice from Prodigy Diabetes Care
  • The Solo V2 from BioSense Medical Devices (Also known as the Solus V2)
  • The Fora V20 from Fora Care, Inc
  • The Fora V22 from Fora Care, Inc

Of the first two, it appears as of this writing that the Prodigy Voice may be the only meter still available whose test strips can be easily purchased. The Fora Care V20 and Fora Care V22 appear to have been replaced by the Fora Care V30a, although I have been unable to find any reviews of this product from a blind person's perspective.

There are currently glucose meters that connect with a smartphone via an app, but I have yet to find a review or audio demonstration from a blind person who can recommend one of these units.

When Pills Aren't Enough: Administering Diabetes Injections as a Person with a Visual Impairment

As I stated earlier in this article, I have not needed to give myself injections of insulin or other medications thus far in the treatment of my diabetes. In the July, 2006 issue of AccessWorld, Darren Burton and Mark Uslan wrote an article entitled Diabetes and Visual Impairment: Are Insulin Pens Accessible? Although 10 years old, this article gives some excellent tips on deciding whether to use re-useable or disposable insulin pens. It appears that the pens recommended in this article are still available today.

Independent Blood Pressure Monitoring for People with Visual Impairments

My blood pressure has been stable every time I have visited my doctor, and I have not been told to regularly keep track of blood pressure readings. If I ever decide to do so, however, there are talking options available to me. A search for talking blood pressure monitors from Independent Living Aids yielded two results, with prices of $59.95 and $79.95. Maxi Aids lists one for $79.95.

A search on the AppleVis website yielded a review of the QardioArm wireless blood pressure monitor written by Elena Brescacin. Rob Armstrong has recorded a podcast of the Review and Demonstration of the QardioArm Wireless Blood Pressure Monitor and its Companion iOS App, also on AppleVis. I am confident that, should I need to monitor my blood pressure, I could do so independently, thanks to these talking devices.

Looking Toward the Future of Accessible Diabetes Management

Continuous glucose monitoring (CGM) using such technology solutions as Dexcom incorporate a sensor placed under the skin, a receiver that fits onto the sensor, and an app that sends the data to your mobile device. According to a friend who uses this technology but wishes to remain anonymous for privacy reasons, the system is a bit tricky to set up, but can be used by a blind person.

Researchers in South Korea are working on a wearable patch that can use sweat to monitor glucose levels,and deliver medication through microneedles. In conjunction with an accessible app, imagine how convenient this could be for blind people who need to regularly monitor their glucose levels.

The Bottom Line

This article from the American Foundation for the Blind gives some excellent guidelines that will help you determine what your blood glucose levels should be at various times of the day, along with information previously discussed in this article. This YouTube video walks you through setup and use of the Prodigy Voice glucose meter.

For anyone, whether blind or sighted, a diagnosis of diabetes is a life-changing, and likely stressful experience. For someone who is losing their vision, or is totally blind, the experience can be even more daunting. The good news is that, with the right monitoring tools and techniques along with patience, no matter whether you are young or old, it is possible to manage your diabetes independently, or with minimal assistance from others.

Although diabetes is a serious disease, there is no reason to let it keep you from living your life to the fullest extent possible. Whether you are a young person who is just finding out who and what you want to be, or an older adult who wants to enjoy their retirement years, you can take control of diabetes starting today!

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