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DIABETES SELF-CARE -- WHEN YOU'RE BLIND

by Ed Bryant

All diabetics need to take care of themselves: test their blood, monitor their diet and exercise, and take the appropriate medications at the appropriate time. If you have type 1 diabetes, you'll need to draw up and self-administer insulin injections -- whether you can see or not. Thousands of blind diabetics successfully meter their blood glucose, accurately draw up their own insulins, and both safely and reliably perform all the other day to day tasks of diabetes self-management, without sighted aid.

Talking blood glucose monitoring systems

There are many different home blood glucose monitors on the market today. Although their "operating drills" vary, and they use different test strips, almost all of them require sight to read the results. The National Federation of the Blind Resolution 97-12 calls upon meter manufacturers to make their machines speech-compatible. Most still aren't.

A few monitors either talk (they have a voice synthesizer and speaker inside them) or are speech-compatible (they couple easily with one or more commercially available voice synthesizers). With these, a blind person can hear the results of his/her test -- but these machines vary in ease of operation, only one of them being fully adapted to independent blind operation.

At this time, there are three meters adapted for speech available in the U.S.A. The oldest is the LifeScan Profile. Speech-enabled rather than talking, the Profile, without modification, couples to a number of commercially available "talk boxes." LifeScan is, I believe, phasing out the Profile, but many remain on warehouse shelves. If you already have a Profile, you can plug it into a talk box, and it will work.

The Profile is an accurate machine, but its "hanging drop of blood" test strip can be difficult, for blind or sighted, to use. It was the best in its time, but some features, even with a "talk box" attached, require sighted aid.

LifeScan's SureStep is a newer and simpler meter, with a touchable test strip, and a large-print screen. To get it to talk, you'll need to buy a Digi-Voice speech module, available from Science Products, of Southeastern, PA; telephone: 1-800-888-7400.

Note: Neither LifeScan meter is supplied with audiocassette instructions, and though their Digi-Voice talk box modules are, those instructions (from Science Products) cover only voice box operation.

My personal favorite is the Roche Accu-Chek Voicemate. A true talking meter, it incorporated the proven Accu-Chek Advantage meter into a system that speaks the instructions and results, and (for users of Eli Lilly and Co. insulins) tells you the insulin type (R, NPH, Humalog, etc.). A Spanish-speaking Voicemate is available. The meter has many advanced features, and its touchable Comfort Curve test strip requires less blood, helps a blind tester find the proper location on the strip, eliminates the need to clean blood off the meter, and does away with the cumbersome and difficult "hanging drop of blood." The meter's "code key" (one is packaged with every vial of test strips) is easy to use without sight, and completely eliminates the need for sighted aid each time you start a new vial of test strips. Each Voicemate comes with an instructional audiocassette -- the only adaptive meter to do so. The Voicemate is the only talking meter available at this time that can be operated 100 percent by a blind individual, without sighted aid -- PRESERVING INDEPENDENCE.

The Voicemate is not without problems. Most serious is the meter's occasional inability to distinguish between low blood sugar and not enough blood on the strip. To resolve this and other issues, our Diabetes Action Network is working with the manufacturer, Roche Diagnostics. See Voice, Volume 18, No. 4, Fall 2003 edition, article titled: "Correspondence Regarding the Accu-Chek Voicemate Talking Blood Glucose Monitor." This is available on our Web site: www.nfb.org/voice.htm

The Voicemate can be ordered through most any pharmacist. Its catalog number is: #2030802, at Roche Diagnostics (#3040208 for the Spanish-speaking unit); telephone: 1-800-428-5076. Roche's Customer Service telephone number is: 1-800-858-8072. The Voicemate is also available through the National Federation of the Blind Materials Center; telephone: (410) 659-9314, for $475, the lowest price on record.

Medicare

Medicare recognizes home blood glucose monitors as "Durable Medical Equipment," and coverage is provided for diabetics, under Medicare Part B. Glucose meters without audio output have one specification on the "Fee Schedule" (EO607), and glucose meters with voice synthesis, or add-on voice boxes for home blood glucose monitors, have another (E2100), available to diabetics who are at least legally blind. Be sure to use the correct specification, and to follow all guidelines for reimbursement. For further information, call Medicare's main telephone, 1-800-633-4227, and ask for "Durable Medical Equipment."

Drawing Up Insulin

Once you know how much insulin you should take, you need to reliably "draw it up" (measure it), and then administer it. At this time, all insulins must be injected through the skin, via syringe, insulin pen, or insulin pump. Blind diabetics successfully use all three methods.

Although government regulations require all insulin pens to be sold with the warning: "Not for use by blind individuals without sighted aid," properly trained blind diabetics have used them successfully for years. The different pens, both "pre-filled" (disposable) and reloadable models, from Novo Nordisk, Owen Mumford, Eli Lilly, and Disetronic, are all somewhat tactile, and one may be right for you.

The biggest weakness of any insulin pen is the inability to mix your own insulins. You either use one of the few insulin pre-mixes already prepared (like "70/30"), or else you use two different pens, and take two shots. The pen may be convenient, but it is not that precise.

Many blind diabetics successfully use insulin pumps. Although pumps are expensive, complex, fragile, and not equipped with speech, several have sufficient audio cues that motivated blind pumpers can and do use, successfully and independently. There are many more pump manufacturers selling in the United States that there were a few years ago, and a product from Minimed (U.S.A; 1-800-646-4633), Disetronic (from Switzerland; U.S. phone: 1-800-280-7801 -- and look for them to return to the U.S. Market around the end of 2004), Deltec (from the U.K.; U.S. phone: 1-800-826-9703), Dana Diabecare (from Korea; U.S. phone: 1-866-342-2322), Animas (U.S.A.; 1-877-937-7867), or Nipro (from Japan; U.S. phone: 1-888-651-7867) may suit you. New, easier to use machines are arriving all the time. Hopefully, one of them will be designed to ease blind use.

Most of us, however, are going to keep it simple, and use the syringe. Now people with normal vision use their sight to judge when they have drawn the correct amount of insulin into the syringe. Does a blind person have to have a sighted person fill their syringes? No.

There are two devices that allow a blind individual to insert a syringe, attach the insulin vial, and then, using tactile and audio cues instead of sight, reliably draw up an accurate insulin dose. The best of these is the Count-A-Dose, once made by Jordan Medical, now manufactured by MediCool. The current model (the 1cc size is no longer available) utilizes the 50-unit, .5cc BD syringe. With the Count-A-Dose (available from the NFB Materials Center for $40; phone: 410-659-9314), a blind diabetic can reliably draw up and mix insulins, in the same syringe, without seeing them -- or asking someone else to do it for them. The Count-A-Dose is an excellent choice; many blind diabetics have used it for years. Audiocassette instructions are included.

A simpler, less-expensive device is the Canadian-made Syringe Support, available in the U.S. through the Cleveland Sight Center's Eye-Dea Shop; (216) 791-8118, extension 278. It costs $26, and lacks definite audio cues, but has sufficient tactile indicators that most could use it -- except that, to mix insulins, it is necessary to remove vials from the device, unlike the Count-A-Dose. Note: Cleveland Sight Center can create an instructional audiocassette for you.

To learn more, consult the following articles: "Blind Diabetics Can Draw Insulin Without Difficulty," "Many Blind Diabetics Successfully Use Insulin Pumps," and "Talking Blood Glucose Monitoring Systems." These, and 20 others, make up the book titled DIABETES ACTION NETWORK ARTICLES, available free in large print or 4-track audiocassette, from the Materials Center of the National Federation of the Blind, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314; email: [email protected]; Web site: www.nfb.org