Diabetes is still the leading cause of blindness in working age adults.
Rates of severe eye disease have diminished vastly due to better glycemic control and advances in eye care, but there are still millions of people with diabetes who are visually impaired. After 20 years with diabetes most people have some evidence of retinopathy, in addition to possibly having age related conditions such as cataracts.
And, frustratingly, many of the self management tasks required of people with diabetes require good vision and a steady hand. So if you or a loved one with diabetes has vision problems, start with a visit to an opthalmologist familiar with diabetes-related vision problems, such as the Beetham Eye Institute at Joslin Diabetes Center.
Then, you should become familiar with the tools available to help make things easier.
There are three important aspects to diabetes care in which vision is particularly important: checking blood glucose, giving injections, and reading medical instructions.
For patients with low vision, lighting is especially important. The use of a task lamp along with magnifying equipment can make it easier to ensure you are taking the correct doses of oral medication and insulin.
Standing magnifying glasses are helpful, as they allow hands free manipulation of your tools. Syringe magnifiers attach directly to the insulin vial and syringe making it easier to see the dosing lines on the barrel.
For patients who have completely lost their vision, the advent of insulin delivery pens has been a boon. On a pen, dialing the insulin dose is accompanied by an audible click that can be used to count the units being dispensed.
Count-a-dose type syringe-filling systems can also allow users to administer the correct insulin doses without help from a sighted person. Just move the dial the number of clicks corresponding to the units of insulin needed.
For patients using syringes with fixed doses of insulin, the syringes can be coded with tactile markers highlighting the appropriate target. Or, as a last resort, some insulins can be given in pre-filled syringes when patients are unable or unwilling to use a pen or dosing counters. Â The FDA (Food and Drug Administration) approves of insulin syringes only for the immediate delivery of insulin.
However, the American Diabetes Association does recognize the use of pre-filled syringes for patients with disabilities under some circumstances. NovolinÂ® and HumulinÂ® insulin can be stored in prefilled syringes with the needles pointing up in a refrigerator for 30 and 21 days, respectively, according to the American Diabetes Association. The makers of Levemir and Lantus do not recommend pre-filling their products, and clinical research is lacking on the stability of the rapid-acting insulins when stored in a syringe over time. .
Checking Your Blood Glucose
If you have low vision, using a meter with a large screen and print helps. Â Â For those who are blind or who have severely compromised vision, a talking meter may be the best solution.
But activation of many of the talking meters on the market requires someone with good vision. If you donâ€™t have access to that kind of help, itâ€™s important to make sure the meter you are considering is fully voice compatible.
The old adage says that you remember only about 10 percent of what you hear, which is why most educators give patients written materials to go home with. If your vision is poor, most of the materials provided will be too small to read without a magnifying glass.
But a number of government agencies have addressed this problem by making diabetes materials available in large print.
The Centers for Disease Control have two publications written in both English and Spanish that explain the basics of diabetes management and provide lists of community resources.Â The National Institute of Diabetes, Digestive Disorders and Kidney Disease also have a series of publications for people with diabetes available in large print.
You can find some of these materials here:
Take Charge of Your Diabetes
En EspaĂ±ol: Controle su Diabetes
Your Guide to Diabetes
En EspaĂ±ol: GuĂa para personas con diabetes tipo 1 y tipo 2
The National Institute of Diabetes and Digestive and Kidney Diseases
In addition, patients should feel comfortable bringing in recording devices to tape their education appointments. Listening back later can be an excellent memory aid.
Further information about services available in your state can be found at the National Council of State Agencies for the Blind, which lists names and contact information for the state agencies responsible for advocacy on behave of those with vision disabilities.