More than 30 million people in the U.S. live with diabetes, and this high number likely includes many of your clients.
Diabetes impacts every part of the body, and the eyes are especially vulnerable. Many of your clients may be struggling to manage their diabetes with decreased vision. This might look like a client who cannot read their blood glucose meter or indicates difficulty with carb counting due to small print on labels.
Occupational therapists have an important role to play when it comes to helping clients manage their diabetes, but how much do you know about the basics of this chronic condition? The more you know, the better care you can provide your clients.
The Basics of Diabetes
There are three major types of diabetes:
- Type 1 diabetes, which usually appears during childhood and requires insulin to manage
- Type 2 diabetes, which usually appears later in life and may require medication or insulin to manage
- Gestational diabetes, which usually goes away but may turn into type II diabetes following delivery
Diabetes is the seventh leading cause of death in the U.S., and people who have diabetes have a two to four times higher incidence of heart disease and stroke. Diabetes is also the leading cause of kidney failure.
What Does Diabetes Have to Do with Low Vision?
A number of eye conditions are associated with diabetes:
- Diabetic retinopathy
- Corneal disease
- Refractive errors
- Extraocular muscle impairment
- Macular edema
- Optic neuropathy
Diabetes is the leading cause of new cases of blindness in the U.S. for 20- to 74-year-olds, primarily due to diabetic retinopathy. Nearly half of all people with diabetes will develop diabetic retinopathy.
As an occupational therapist, you will likely be called on to provide education to clients who may be struggling with managing their condition and the resulting complications.
Adaptive Techniques for Diabetes Management
While there’s no such thing as a “diabetes diet,” one of the tasks your clients with diabetes will need to perform to manage their diabetes is carbohydrate counting. For those with diabetes, the emphasis is on the total amount of carbohydrate intake, with a specific amount of carbohydrate servings assigned to each meal.
Several resources are available for teaching about counting carbohydrates, including the American Diabetes Association’s own website.
Clients with low vision may struggle to both determine the number of carbohydrates they should be tracking and maintain a log of their carbohydrate intake. Adaptive techniques for counting carbohydrates include using a magnifying glass to read food labels as well as text-to-speech software and apps.
Blood Sugar Monitoring
Regular monitoring of blood sugar is the best way for people with diabetes to avoid complications like diabetic retinopathy. To obtain this information, a person needs to be able to:
- Prick their finger and see the blood
- Insert the test strip into the slot on the glucometer
- Transfer the blood to the test strip
- Wait the required amount of time
- Read the blood glucose levels on the glucometer’s screen
For someone with visual impairment, any of these steps can be challenging. One option to address this issue is the use of a talking monitor, such as a Prodigy Voice or a Glucocard. Other available modifications include:
- Placing bump dots on the monitor to mark where the strip should go
- Using contrasting colors to help the opening in the monitor stand out
- Placing a rubber band on the finger to obtain a larger blood sample
- Placing the meter on the table and bringing the finger to it
People with diabetes may take oral medication or they may need to inject insulin. Some of the challenges around using insulin include:
- Identifying the correct vials
- Placing the syringe in the vial
- Drawing the correct amount of insulin
- Injecting the insulin into the appropriate site
- Storing the insulin
Adaptations for administering medications, including insulin, include:
- Using rubber bands or bump dots to mark the pill bottles or vials
- Predrawing insulin and storing it in the refrigerator
- Using a syringe magnifier
- Requesting a count-a-dose pen, which uses clicks to count units
One common complication of diabetes is peripheral neuropathy, which masks symptoms that might indicate injury to the foot. Additionally, diabetes causes slower healing, making it more likely that an otherwise minor injury could become infected and cause serious damage.
Regular foot checks (at least once a week) are crucial for anyone with diabetes, but vision loss can make this process more challenging. Check the shoes of your clients with diabetes to make sure that they are wearing shoes that fit properly and have a sole to help prevent injury to the foot. If your client has severe neuropathy, they may require a thermometer to test water temperature before bathing.
Additional adaptive foot check measures include using other senses to check the feet rather than relying solely on vision, for instance using the hands to check the feet, providing there’s no neuropathy in the hands, or even smelling socks to make sure that there’s no foul odor, which could indicate an infection. Another option is to have a “foot check buddy” (such as a spouse) who can provide assistance with foot care.
Even small steps can make a large impact on someone’s health. You don’t have to be a diabetes educator to inform your client about diabetes management. Knowledge about talking blood glucose meters and other resources can be a game changer for someone who struggles with these most basic aspects of diabetes management.
Learn more about diabetes and additional adaptive techniques you can provide your clients in the MedBridge course, “Diabetes Management for the Low Vision Client.”
- Centers for Disease Control and Prevention. (2019). After 20-year increase, new diabetes cases decline. CDC Newsroom. Retrieved from https://www.cdc.gov/media/releases/2019/p0529-diabetes-cases-decline.html
- Beck, J., Greenwood, D. A., Blanton, L., Bollinger, S. T., Butcher, M. K., Condon, J. E., & Cypress, M., et al. (2017). 2017 national standards for diabetes self-management education and support. Diabetes Care, 40(10): 1409–1419.
- Haltiwanger, E. P. (2012). Effect of a group adherence intervention for Mexican-American older adults with type 2 diabetes. American Journal of Occupational Therapy, 66(4): 447–54.
- Bohorquez Robles, R., Compeán Ortiz, L. G., González Quirarte, N. H., Berry, D. C., Aguilera Pérez, P., & Piñones Martinez, S. (2017). Knowledge and practices of diabetes foot care and risk of developing foot ulcers may have implications for patients of Méxican heritage living in the US. Diabetes Educator, 43(3): 297–303.
- Ley, T. R. (2007). Does anyone have a pen? Voice of the Diabetic. Retrieved from https://www.nfb.org/sites/www.nfb.org/files/images/nfb/publications/vod/vod215/vodwin0708.htm
- Sokol-McKay, D. A. (n/d). How can I manage my diabetes? VisionAware. Retrieved from http://www.visionaware.org/info/your-eye-condition/diabetic-retinopathy/managing-your-diabetes-5709/125
- Diabetes Forecast Consumer Guide. (2016). Blood glucose meters. Retrieved from http://main.diabetes.org/dforg/pdfs/2016/2016-cg-meters-chart.pdf
- American Association of Diabetes Educators. (2017). The Art and Science of Diabetes Self-Management Education Desk Reference, 4th Ed. Chicago, IL: AADE.