By Ann S. Williams, Ph.D., RN, CDE

Listen to Living with Diabetes and Visual Impairment—Problem Solving Audio (Windows Media Player)
Listen to Living with Diabetes and Visual Impairment—Problem Solving Audio (Real Media Player)

When considering the challenges of diabetes, it%27s fair to say that few conditions require so much close and diligent attention to one%27s body and its many workings as this one. Such consistent monitoring and record-keeping of your diet, blood sugar, and other vital information means there%27s never a shortage of problems to be solved.

If you%27ve ever experienced unexpected high or low blood glucose, for example, you will want to figure out why it happened and how to avoid it in the future. Then there are the day-to-day management issues that sound small—finding time to exercise, checking your blood sugar levels before a meal—but can become large as they add up, and will grow very important very quickly if they%27re not addressed. It%27s always best to identify any problems involved in implementing your diabetes plan early on, so that you can take steps to make it easier.

Vision loss, of course, brings its own complications and layers of difficulty to diabetes-related problems. These must be addressed every day. Here%27s some advice to keep in mind as you move forward:

Fundamentally, you are the same person as you were before your vision started to diminish.

If you possessed the ability and personality to learn a complex, precise, detailed set of skills like those required for intensive diabetes self-management, before losing vision, then you still do. If you preferred to keep your care simple, avoiding complex and precise skills, you probably still have those preferences. The only difference is that, in either case, you may need to use low-vision or non-visual methods to accomplish some necessary tasks.

Keep yourself informed about diabetes.

Problem solving begins with accurate information about your diabetes, its treatment, and the many factors that may affect diabetes management. Do you know the type of diabetes you have and how it affects the body? Have you reviewed the full AADE 7 list as it relates to your care? If the answers to these questions are "no" or even "somewhat," then consult with your doctor and a diabetes educator immediately to get personalized information about your diabetes. It%27s also a good idea to seek out updated, accessible reference materials on the disease.

Keep accurate personal diabetes records.

One of the biggest challenges to diabetes self-care for people with visual impairment is finding a reliable, accessible, non-visual method of record keeping—foods eaten, insulin doses taken, exercise duration and intensity, blood glucose and blood pressure monitoring results; the whole gamut. It%27s also important to have access to records of physician visits, lab results (especially A1C), and weight loss/gain. Success here begins with mastering adaptive reading and writing skills for people with vision loss. Here are some quick tips to keep in mind:

  • Large print—Almost all written material, including record-keeping logs and diabetes registers, can be found in large print or enlarged versions.

  • Notebooks—Try simple spiral-bound notebooks with widely spaced lines. You can also find lined paper with extra-bold lines or even raised lines.

  • Low-glare paper—Bright white paper can cause painful glare. Off-white or light yellow paper are good alternatives.

  • Pens—For hand-written records, a black felt-tip pen that writes with clear, sharp edges is easiest to see and is widely available at your favorite office supplies carrier. Pens that illuminate the writing area or have other helpful special features are also easy to find.

  • Large print computer record—These are easy to create if you have computer access. Also, experiment with fonts and font sizes that are easy for you to see. Most find a plain, bold, sans-serif 18-point font works best—for example, Arial or Helvetica Bold.

Other Record-Keeping Options

If you%27re having trouble seeing large print, braille records may be a viable option for you, and it may only be necessary to gain fluency in elementary braille—numbers and the alphabet—to log adequate records.

If you have neuropathy and numbness in your fingers (a common long-term complication of diabetes), learning standard braille may be difficult. Jumbo braille, the braille equivalent of large print, may be easier.

Audio Recording is another option. Hand-held audio cassette and digital recorders are available at most electronic retailers, but you will have to make sure the device and its features are accessible before purchasing. Another issue with audio devices for diabetes records is that you may have difficulty perceiving patterns in blood glucose readings. For example, when a person hears a string of consecutive monitoring results, picking out patterns at particular times of day is more difficult than when a person sees the results arranged in a legible column on a piece of paper by time of day. This difficulty can be at least partially overcome by "marking" particular types of records with sounds that make them easy to find on the recording. For example, pre-meal blood glucose may be "marked" with a high-pitched sung tone, and carbohydrate consumption may be "marked" with three taps on a table.

Many people who cannot see a computer screen use non-visual computer records, programs that have a voice output that "reads" the computer screen to the user. This assistive technology is particularly helpful when used with a blood glucose meter that can download data directly into a computer.