Diabetes Management with Low Vision

Low vision is one of my favorite areas to work in, and would love to share some ideas for adapting equipment for diabetes management. Last Summer, I had a patient with diabetes, diabetic retinopathy (resulting in low vision),  neuropathy (pain and numbness in his hands and fingers), and also happened to be somewhat hard of hearing (for starters). Very rarely do I work with patients who have one single medical diagnosis so it's always important to consider all systems. This particular patient expressed to me that he would really like to be able to independently monitor his blood glucose levels as advised by his doctor.

Due to his low vision, the first thing that came to mind was a Talking Glucose Meter. With Medicare, many patients are eligible for free diabetes supplies so with a doctors order he was able to obtain one for free. 

http://www.independentliving.com/prodinfo.asp?number=235721

 

Once the Talking Glucose Meter arrived, I was able to read the (very small) instruction sheet and rewrite the steps to checking his blood glucose in permanent marker on bold and wide lined paper. I later used more of the same paper to make a chart for his to record glucose readings by date and time. Though the device had large print on the screen, the fact that the screen was relatively made it difficult to see so he preferred to put the device directly up to his ear when it spoke a reading--which he heard loud and clear.

http://www.independentliving.com/prodinfo.asp?number=671999 

In order for the patient to draw blood from his finger, he needed to be able to 1) insert a lancet (needle) into the lancet device (finger prick tool), 2) set the lancet finger prick size, 3) line up and prick his finger. Thankfully with practice the only difficult part about this was that spin knob tended to turn to wider/more narrow settings without his knowing. I was able to mark the preferred setting with bright orange fabric paint for him to line up. (I drew a line on the main devise at the start position and the second line on the spin knob along the "3" line. With these bright and raised lines, the was able to ensure the lancet would always make the correct size prick.

 

http://www.libertymedical.com/perfectpoint-lancet-and-liberty-ii-lancing-device

http://www.independentliving.com/prodinfo.asp?number=785320

Due to the neuropathy in this patient's fingers paired with his low vision, the next problem was in  getting the test strip into the small slit of the Glucose Meter. To solve this problem, I used adhesive white bumps on either side of the small slit as both a visual cue (high contrast of white bumps on dark gray Glucose Meter) and a tactile guide for the strip to fit between.

 

http://www.independentliving.com/prodinfo.asp?number=730152

With these adaptions and lots of practice with supervision, the patient was able to reach his goal in a matter of two weeks!

*Even with specialized equipment, it is important to remember that creativity and personalization can still be necessary in order for one to safely and effectively use diabetic testing supplies. This particular patient was not insulin dependent at the time however, check out http://www.shoplowvision.com/catalogsearch/result/?producttype=&q=insulin&x=0&y=0 for equipment which may make drawing and injecting insulin safer and easier for someone you know with low vision.