The Vision Rehabilitation Therapist and Diabetes Management
Over the years, as a vision rehabilitation therapist (VRT), I worked with several individuals managing their diabetes with vision loss. In most cases, the individual used insulin in a syringe vial. This occurred because the insulin click pens, which might be easier to use with reduced vision, were more expensive and not covered by their insurance, or the co-pay was outside their budget. As a result, syringe needles got broken, the amount of insulin drawn into the syringe was not exact, or the wrong type of insulin was administered at the wrong time. In most cases, the person had been prescribed a glucose meter they could not read because the medical practitioner did not know a talking meter existed, or the talking meter, like the click pen, was more expensive or not covered in their health plan.
Problems with Referrals
In nearly all of these cases, my services for medication management with low vision or blindness were not referred or suggested by the physician, the diabetes educator, or the occupational therapist. Often the referral came roundabout through a friend, vocational counselor, support group, etc. In each case, I wondered, “Why the delay?” As professionals, this is one of the things we do. We work with individuals on adaptive daily living skills like medication management.
The Usefulness of Low and High Tech in the Management of Diabetes
In several instances, I was able to help obtain handheld magnifiers or desktop video magnifiers for the individuals I served at no cost to them. These magnifiers greatly increased their ability to draw and measure insulin from a vial and read its labels. In other cases, professional advocacy or a referral to the state’s Older Blind Independent Living Program resulted in obtaining a talking glucose meter and training with it at no cost to the person. With each of them, we worked on alternative types of labeling, organizing medical supplies, meal preparation, accessing information for diabetes management, advocacy, and more.
The caveat is that not every state offers the same level of service regarding devices or assistance that a VRT can directly offer. Some states employ a diabetes educator on staff. In other states, VRTS may refer you to a licensed practitioner. So you would need to check with the program in your state.
Advocating for Yourself
The good news is that accessible devices are now more readily available and affordable. For example, Walmart sells a talking glucometer now for a very good price. You may need to advocate for yourself and educate doctors and pharmacists to get the device you need. For example, pharmacists may not realize they can order talking meters such as Prodigy even though they do not carry them in the store. Suppose your insurance turns you down for a device. In that case, you may be able to appeal, and the doctor can submit a “medically necessary” form to obtain the needed durable medical equipment. When choosing your meter and supplies, you must check with your insurance provider to compare co-pay and self-pay costs.
Risk of Diabetes and Importance of Management
A simulation of the ocular and functional
effects of diabetic retinopathy
According to the National Eye Institute (NEI), diabetic retinopathy, one of several eye diseases caused by diabetes, is currently the leading cause of vision loss among working-age individuals. In fact, 40%-45% of individuals with diabetes have some stage of diabetic retinopathy. With the risk of eye disease and loss of vision so high with diabetes, it is baffling to understand why medical professionals so often overlook the opportunity of incorporating the vision rehabilitation therapist in their plans for patients with diabetes. Ironically, research suggests that the risk of diabetic eye disease can be greatly reduced through proper medication management and healthier lifestyle choices, which can be supported by a vision rehabilitation therapist for those with a vision impairment.
Commit to Better Eye Health
During this month, commit yourself, a family member, or a friend to better eye health. Here are some suggestions:
• The National Eye Institute (NEI) recommends a dilated eye exam from an ophthalmologist once a year for anyone with diabetes so diabetic eye disease can be detected, monitored, and treated.
• Check out the NEI website for a list of links to get help paying for an eye exam.
• If you have vision loss and want to learn more about managing your diabetes or other daily living skills, look for vision rehabilitation services using the APH Directory of Services. Select your state, then look for the local or state agencies providing services for people with vision loss. These services are often available at no out-of-pocket cost or on a sliding scale.
•Alternatively, you can call the APH ConnectCenter I&R line at 800-232-5463 or email [email protected].
National Eye Institute National Diabetes Month