Resources for diabetics with severe visual loss

I received a call from a physician’s office regarding a patient who needed education as soon as possible. Her A1C had risen to 7.5 and at 64 years old, the patient needed to make changes. The only problem: the patient was blind.

The patient lived alone with her Seeing Eye dog and was assisted by her brother. She lived a relatively normal life despite her blindness, working a clerical job and visiting the gym 2 days per week.

As an educator, I had never dealt with a truly sightless individual and was feeling ill-equipped to take on this challenge. The majority of the diabetes patients in our small rural clinic have sight enough to manage their disease. I started to think of all the things we take for granted when teaching our patients, such as lancing their fingers, reading a label, even simply putting the correct amount of food on their plate. All that was thrown out the window. How did I help this patient to see her diabetes care?

I accessed the National Federation of the Blind (https://nfb.org/literature-diabetes) and followed the path to gather information and tools to assist the blind patient who also has diabetes. Most of the resources through the National Federation of the Blind (NFB) are free, although I did purchase a braille edition of exchange lists for the patient in hopes that this would assist her and her brother as they shopped for meals. The NFB also provide an audio CD entitled Bridging the Gap: Living with Blindness and Diabetes. Our patient found this CD to be very helpful and empowering and included resources and articles from the Voice of the Diabetic, an out-of-print publication.

Challenges were many and required more effort on our part to make education visible to the patient. We used many hands-on items for the patient to touch to illustrate diabetes management.

The talking meter was an absolute necessity. Lancing fingers became hit and miss until we worked out a better method for the patient. We did use smart technology for her IPhone with apps that included Dragon Dictation, OMoby, and VizWiz that talked to her and assisted her in identifying items and package information. The app Evernote recorded all of our conversations to review and revisit later. Through the American Diabetes Association, we obtained a compartment plate to assist her with portion control.

Our staff spent a great deal of time making sure that our patient understood all the aspects of her care related to diabetes. Daily phone calls helped the patient to see her diabetes for what it is, a manageable disease.

We spent approximately 3 months working very closely with this patient to support her efforts at self-management.  In the end, her A1C dropped to 6%, 3 months after we began working with her. She was pleased with the outcome, had lost a little weight, and felt, overall, better equipped to manage her diabetes. Our primary goal was to allow the patient to maintain her independence and self-care ability by providing her the tools to manage her diabetes successfully.

Our staff walked away with a very valuable lesson regarding diabetes education and its need to be individualized. It is all about what the patient sees, or in this case, what they don’t see.

Lessons Learned:

• Explore all resources possible when helping people with diabetes.
• All patients have challenges, but each challenge is an opportunity to make a difference.
• Assess each patients’ challenges. You may not feel equipped, but there are usually resources to help if you take the time to look for them.

Liz Whelan MSN RN CDE
Coordinator Health and Diabetes Education