Audrey Demmitt, RN, BSN, is a nurse diabetic educator, VisionAware Peer Advisor, AFB Career Connect mentor, and author of the VisionAware multi-part blog series on diabetes and diabetes education. At age 25, Audrey was diagnosed with retinitis pigmentosa and continued to work as a nurse for 30 years with her visual impairment.
She has worked as an Adjustment to Blindness Counselor and Diabetic Educator for Vision Rehabilitation Services of Georgia and as a school nurse providing in-service training for school staff and developing care plans for newly-diagnosed students and their families.
In the first installment of her series, Audrey discusses specific ways that diabetes education can help lower your blood sugars and reduce the risk of diabetic retinopathy. As Audrey says, “Education + Motivation + Support = Improved Blood Sugars, Fewer Complications and Increased Quality of Life.”
Diabetes: A Major 21st Century Public Health Issue
According to Healthy People 2020, diabetes has been identified as a major public health issue that affects an estimated 23.6 million people in the United States. It can lower life expectancy by up to 15 years and is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness.
The Centers for Disease Control and Prevention report that diabetes is the leading cause of new cases of blindness in the United States among adults. Diabetes is on the rise and more people are living with vision impairment caused by its damaging effect on the eyes.
Diabetic retinopathy is a disease that causes swelling, leaking, and bleeding in the fragile blood vessels of the eye, resulting in vision loss. About one-third of all individuals with diabetes will develop it and if you are a male, or Hispanic, or black there is an even higher chance you will have this complication. Clinical factors that increase a person’s chances of developing diabetic retinopathy include:
- number of years living with diabetes
- chronically high blood sugar levels
- the use of insulin
- the presence of high blood pressure.
So What Can You Do to Lower Your Risk?
The primary treatment goal for diabetes is to maintain healthy blood sugars and keep your A1c (long-term measurement of blood sugar over time) as normal as possible. In addition, it is very important to monitor and treat high blood pressures since this causes damage to small blood vessels in the eyes, kidneys, and other vital organs.
Managing diabetes is all about balancing healthy eating with the right amount of physical activity for you and taking your medications as prescribed. This is easier said than done, as diabetes is complicated and requires constant self-care and daily vigilance. In my experience as a diabetic nurse educator, I have seen the barriers people must overcome in order to learn to manage their diabetes. Among the most common are:
- lack of information and training
- lack of access to proper medical care, classes, and services
- the financial burden of treatment and supplies
- the emotional impact of this disease including feelings of being overwhelmed, discouraged, and even depression.
Vision loss and neuropathy make it even more difficult to manage one’s diabetes. How does a person read information to learn about their disease? How do they find the tiny drop of blood to test their blood sugars? How can they operate their glucose monitor or draw up insulin if they can’t see? Even difficulty with cooking healthy meals can have an impact on the blood sugars of a person with diabetes.
Managing diabetes effectively requires specialized education and training. And if you are experiencing vision loss as well, you may need additional support services and even specialized equipment, such as talking glucose monitors and blood pressure cuffs.
Where can you turn for help and resources?
VisionAware has Excellent Information on Diabetes and Vision Loss
A good place to start is here on this site. There is an entire section devoted to diabetes and diabetic retinopathy written by a diabetes educator, Debra Sokol-McKay.
Additionally, there are two different courses offered through the collaboration of the American Foundation for the Blind and the Diabetes Association of Greater Cleveland. The first is The Basics About Living With Diabetes. The second guide provides specific information about vision loss and diabetes and is called A Guide to Caring for Yourself When You have Diabetes and Vision Loss.
Both are available as audio lessons with transcripts. They were produced for people who have trouble reading print. The second guide is also available in Spanish.
I found them very helpful as a lesson plan for people with diabetes and visual impairment. The topics include the Seven Self-Care Behaviors established by the American Association of Diabetes Educators:
- Healthy Eating
- Being Active
- Taking Medications
- Problem Solving
- Healthy Coping
- Reducing Risks
These lessons are full of great information that can help you improve your knowledge and skills to control your diabetes. These guides will also be useful to diabetes educators to learn about adaptations for vision loss.
A Formula for Success
There is much to learn as a person with diabetes and it can be overwhelming. But this is the only way to manage your disease successfully in order to live well with diabetes. The time is now and whether you are new to diabetes or have had it for years, I encourage you to renew your commitment to practice good self-care:
- Seek updated information and education from a diabetes educator, dietitian, and a vision rehabilitation agency if you are visually impaired.
- Consult the VisionAware Directory of Services to find these services in your area and ask your doctor about local diabetes classes, counseling, and one-on-one consultation with a nutritionist.
- Set goals and make an action plan. Consider what motivates you toward your goals. Is it your family and the desire for quality of life? Stay focused on your motivation for making changes.
- And lastly, ask for help and support from loved ones, healthcare professionals, and others who are living with diabetes. Contact the local chapter of the American Diabetes Association and ask if there are any support groups in your area. Some vision rehabilitation agencies offer support groups for people with diabetes and vision loss. You will learn about many local resources that can offer you support if you reach out for help.
Remember: Education + Motivation + Support = Improved Blood Sugars, Fewer Complications and Increased Quality of Life
Read Part 2 of the Series
In Part 2, Audrey emphasizes the significance of the A1c test in the effective diagnosis, treatment, and management of diabetes.