Blind Diabetics Can Draw Insulin

Blind Diabetics Can Draw Insulin

BLIND DIABETICS
CAN DRAW INSULIN
WITHOUT DIFFICULTY
by Ed Bryant

(This article appeared in VOICE OF
THE DIABETIC, Volume 11, Number 1, Winter 1996. Because of frequent requests
for this information, and our greatly increased circulation since then, I decided
to run it again.)

A major aim of the Diabetes Action Network of the

National Federation of the Blind is to provide support and information for blind

diabetics, so they might better maintain or regain independence and productivity. Our

national support and information network allows communication across a wide area,

something important for blind or visually impaired diabetics and their families. With the

trauma of sight loss, sometimes the newly blinded do not realize that most blind men and

women with diabetes CAN self-manage safely and accurately, by use of alternative

techniques.

I became blind from diabetic retinopathy about 17

years ago. When I first lost sight, I didn't use insulin gauges to help draw my insulin,

as I had never heard of such devices! Fourteen years ago, I designed my own insulin gauge,

and I used it for approximately three years, with no difficulties. I do not advocate the

use of nonstandard or homemade insulin-measuring devices, unless they have been checked

out by someone knowledgeable in insulin-measuring techniques.

Members of the health care community sometimes

forget that although a diabetic may be newly blinded, he or she has often been

successfully self-managing the disease for 15 years or more. Most long-term type 1

diabetics have had years of experience drawing their own insulin. Veteran blind diabetics

often have more experience with adaptive insulin preparation devices than do many sighted

health professionals. The following observations are only a small sample.

Because of my experience with diabetes and

blindness and my editorship of VOICE OF THE DIABETIC, I am often asked to evaluate

insulin-measuring gauges designed for the blind or visually impaired. I have tested

numerous measuring devices, and in my opinion the Count-A-Dose, from Jordan Medical

Enterprises, wins the blue ribbon. (Note: The Count-A-Dose is available from Jordan:

1-800-541-1193, or from the NFB Materials Center: (410) 659-9314). I hasten to add that no

one instrument is ideal for everyone; however, the Count-A-Dose provides a very easy

method of insulin dispensing. Designed for the Becton Dickinson LoDose syringe, the

Count-A-Dose holds two insulin vials and directs the syringe needle into the vials' rubber

stoppers. Using the thumb-wheel, which clicks for each unit measured (clicks can be both

heard and felt), the blind diabetic can reliably draw and mix his or her own insulin.

How to Get Air Bubbles Out of
an Insulin Syringe

There are techniques by which a blind
diabetic may draw and mix insulin without drawing air into the syringe. Like
many others, I have used them successfully for years. I first draw four or five
units of regular insulin into the syringe and then inject all of it back into
the vial. I then repeat the operation two more times. The fourth time, I draw
the full amount of insulin needed from the first vial. Then, when I draw insulin
from the second vial, I draw the exact amount needed. I have put this to the
test; 100 repetitions without air bubbles. Diabetes Action Network First Vice
President Janet Lee has twice performed the same test. In both cases the complete
absence of air in the syringe was independently verified.

"Tapping the syringe to remove air

bubbles," a common technique used by the sighted, becomes unnecessary. The one to two

units of air in the hub of the needle (where needle meets syringe) are expelled during the

procedure used with the first vial of insulin. I demonstrate this technique to nurses, who

are delighted to see that air bubbles are not present and the insulin measurement is

accurate. Of course long-term insulin users will be familiar with the need to inject as

much air into the vial as the amount of insulin they withdraw, to facilitate getting the

insulin into the syringe. For further information, consult your health care team.

How to Know When an Insulin Vial
is Getting Low

Each vial of insulin contains 10cc, 1000 units.

The maximum number of units used per day, divided into the vial's 10cc (1000 units)

capacity, gives the maximum number of days the bottle can be used. When I open a new vial

of Regular insulin, I divide its 1000 units by 20 units, the maximum I use daily, so one

supply should last me 50 days, but as a safeguard, I assume that the new bottle contains

only 940 units (9.4cc), which should last a maximum 47 days instead of 50. I measure my

NPH insulin in a similar manner. As long as at least 60 units of insulin remain in the

vial, the needle will remain submerged while filling, and there is no danger of drawing

air. In drawing out the insulin, I keep the syringe vertical, needle straight up in the

vial, so as not to inadvertently draw out air. Many blind consumers (and diabetes

educators) are unaware of this point's importance—that the natural tendency is to

tilt or slant while drawing, which can lead to inaccurate filling and air in the syringe.

Many methods exist to determine how long
a supply will last. One way to keep track of the amount of insulin in the container
is to set aside the number of syringes that will be
needed for 940 units of insulin. Another might be to employ Braille, large print,
tape recorders, or personal computers, to record how much insulin has been used
each day. Many blind consumers, like myself, realize the importance of keeping
their blood glucose under tight control, and follow regimes of insulin mixing
and multiple injections, both of which increase the need for precision. I have
found the more precise the record of insulin drawn, the easier to safely predict
when it is time for a new supply. Note: Though not as precise, before drawing
insulin you can gently shake the vial and, with practice, easily determine whether
it is full, half-full or nearly empty.

The Possibility of Inserting
a Needle into a Blood Vessel

Since injection sites are in fleshy areas,
and insulin needles are short, chances of inserting a needle into a blood vessel
are minimal. The worst that can be done is to hit a small capillary, which would
result in a small area becoming infused with blood—a hematoma. Again, it
is unlikely the needle will be inserted into a small blood vessel. The amount
of insulin entering the bloodstream via a capillary would be insignificant,
and would cause no harm.

Something to Think About

I periodically have my insulin gauge checked for

accuracy; it has always measured precisely. If the diabetic is careful, difficulty in

measuring insulin will not occur. I have found that inaccuracy is often the result of

haste or carelessness.

It is reported that insulin gauges are more

accurate than sight. When the plunger is pushed firmly to the gauge, the same amount of

insulin will be obtained every time. Sometimes my sighted friends make errors in drawing

insulin. Perhaps they would be more accurate if they used insulin gauges! Note: Syringes

are mass-produced. Although there is quality control, some errors are made in syringe

markings. If a gauge is used, the measurement will be accurate no matter what the syringe

shows.

At first hearing, all this may sound like a lot

to remember, but it is not difficult. Marla Bernbaum, MD, CDE, Assistant Professor at St.

Louis University Medical School Department of Endocrinology, states: "In our

experience here, most blind and visually impaired diabetic patients have been capable of

drawing their own insulin with complete accuracy."

Janet Lee, Director of the Independent Management

for Blind Diabetics Program at BLIND, Inc., Minneapolis, Minnesota, states: "In my

ten years of working with blind diabetics, hundreds of them, there have maybe been two,

who, because of a combination of disabilities, could not measure their own insulin."

Ruth Ann Petzinger, RN, MS, CDE, Diabetes Care

Manager/ Educator at St. Peters Medical Center, New Brunswick, New Jersey, states:

"During the time I have been working with persons with diabetes and visual

impairment, I've never had a patient who truly wanted to be independent with insulin

administration or blood glucose monitoring who was not able to achieve these goals."

Ann Reardon, RN, MSN, CDE, with the Georgia Dept.

of Human Resources/Medical College of Georgia, states: "In my experience, with proper

training almost all diabetics are able to prepare and administer their own insulin safely,

regardless of visual impairment."

Ann Williams, MSN, RN, CDE, Diabetes Program

Coordinator, Cleveland Sight Center, and her colleague Marylin Teasley, RN, CDE, state:

"In the last eight years we have taught about 800 visually impaired and blind people

to measure and administer their own insulin independently. Vision loss does not preclude

safe and effective insulin self-administration."

I have no problems managing and keeping my

diabetes under control. I control it through the use of alternative techniques, some of

which are described here. Many members of our organization, the National Federation of the

Blind, use them daily to live active lives. With alternative techniques, blind diabetics

can be as productive as when they were sighted.

Come to us and ask for assistance. We are ready,

willing, and able to help. We want you to know that no matter what your diabetes

ramifications, you are not alone and do have options. We in the National Federation of the

Blind know that blindness is not synonymous with inability.