At its core, di­a­betes dis­rupts the body’s abil­i­ty to reg­u­late blood sug­ar, or glu­cose, which is a vi­tal source of en­er­gy for the body’s cells. How­ev­er, di­a­betes is much more than just high blood sug­ar—it’s a con­di­tion that can slow­ly af­fect mul­ti­ple or­gans, from the heart to the kid­neys, eyes, and nerves, if left un­treat­ed.

Liv­ing with di­a­betes can be chal­leng­ing for any­one, but for in­di­vid­u­als who are al­so blind or vi­su­al­ly im­paired, man­ag­ing the con­di­tion can in­volve ad­di­tion­al hur­dles.

In cel­e­bra­tion of World Di­a­betes Day, on No­vem­ber 14, 2024, it is im­por­tant to high­light the unique chal­lenges the blind and vi­su­al­ly im­paired have faced while man­ag­ing di­a­betes.

Di­a­bet­ic eye dis­eases such as di­a­bet­ic retinopa­thy, di­a­bet­ic mac­u­lar ede­ma, and cataracts play a con­trib­u­to­ry role in the preva­lence of blind­ness and vi­su­al im­pair­ment in T&T.

A re­port by the Na­tion­al Eye Sur­vey of Trinidad and To­ba­go (NESTT) in­di­cat­ed that di­a­bet­ic retinopa­thy is one of the lead­ing fac­tors to blind­ness among adults over age 40 in T&T (2019). How­ev­er, it is im­por­tant to note that blind­ness and di­a­betes are not al­ways linked. Many blind in­di­vid­u­als are born with a vi­su­al im­pair­ment or lose their sight due to oth­er con­di­tions, but the hur­dles of man­ag­ing di­a­betes re­main.

For those liv­ing with di­a­betes, mon­i­tor­ing blood sug­ar lev­els, ad­min­is­ter­ing in­sulin, and man­ag­ing med­ica­tions are cru­cial com­po­nents of ef­fec­tive care. How­ev­er, in the past, for peo­ple who are blind or vi­su­al­ly im­paired, the us­abil­i­ty of med­ical de­vices such as blood glu­cose me­ters, in­sulin pumps, and con­tin­u­ous glu­cose mon­i­tors (CGMs) pre­sent­ed a sig­nif­i­cant bar­ri­er to ef­fec­tive self-care.

This lack of ac­ces­si­bil­i­ty and us­abil­i­ty in di­a­betes man­age­ment tools for the blind ex­ac­er­bat­ed health risks and cre­at­ed ad­di­tion­al chal­lenges for an al­ready vul­ner­a­ble pop­u­la­tion. Many glu­cose me­ters, in­sulin pumps, and CGMs re­lied on small screens or tiny but­tons that were dif­fi­cult or im­pos­si­ble to read or op­er­ate for blind or vi­su­al­ly im­paired in­di­vid­u­als. For ex­am­ple, blood glu­cose me­ters typ­i­cal­ly dis­played nu­mer­i­cal re­sults on a screen with­out any tac­tile or voice-guid­ed feed­back that could help some­one with vi­sion loss in­ter­pret the re­sults.

For in­di­vid­u­als with Type 1 or ad­vanced Type 2 di­a­betes, in­sulin in­jec­tions and pens are per­ti­nent in the man­age­ment of di­a­betes. Long ago, the sy­ringes used for mea­sur­ing the cor­rect dosage had small mark­ings, num­bers, and lines, mak­ing it dif­fi­cult for blind and vi­su­al­ly im­paired in­di­vid­u­als to read. Ac­cord­ing to Trief et al (2016), ad­min­is­ter­ing an in­cor­rect dose of in­sulin can have se­ri­ous con­se­quences, ei­ther lead­ing to dan­ger­ous­ly high blood sug­ar (hy­per­glycemia) or dan­ger­ous­ly low blood sug­ar (hy­po­glycemia), both of which re­quire im­me­di­ate ac­tion.

Along with the afore­men­tioned, oth­er as­pects of di­a­betes care, such as di­etary man­age­ment and ex­er­cise, can al­so be chal­leng­ing for those who are blind when there is no prop­er ac­ces­si­bil­i­ty to in­for­ma­tion and phys­i­cal space for ex­er­cise. In terms of man­ag­ing di­et, blind and vi­su­al­ly im­paired in­di­vid­u­als ex­pe­ri­enced dif­fi­cul­ties in read­ing food la­bels or recog­nis­ing in­gre­di­ents.

Iden­ti­fy­ing whether a food is high in car­bo­hy­drates, sug­ar, or fat is es­sen­tial in con­trol­ling blood sug­ar lev­els. De­spite these chal­lenges, with the ad­vance­ment of tech­nol­o­gy, blind and vi­su­al­ly im­paired in­di­vid­u­als liv­ing with di­a­betes can ef­fec­tive­ly man­age their con­di­tions. There are nu­mer­ous tools and in­no­va­tions in the 21st cen­tu­ry that en­hance the qual­i­ty of life for this pop­u­la­tion.

Some of these are:

Au­di­ble Blood Glu­cose Me­ters: Many blood glu­cose me­ters now come with au­dio fea­tures that ver­bal­ly an­nounce blood sug­ar read­ings. These me­ters may use a voice out­put or a sound that in­di­cates whether blood sug­ar is in a safe range, help­ing blind in­di­vid­u­als man­age their di­a­betes with­out need­ing to re­ly on sight.

Smart­watch­es and Wear­able de­vices: De­vices like the Ap­ple Watch or Sam­sung Galaxy Watch can pair with glu­cose mon­i­tors to pro­vide time­ly, au­di­to­ry, or vi­brat­ing alerts about blood sug­ar lev­els, in­sulin sched­ules, and ex­er­cise goals. Wear­ables can al­so pro­vide no­ti­fi­ca­tions when a per­son’s glu­cose lev­els fall out­side a safe range, help­ing blind in­di­vid­u­als to take im­me­di­ate ac­tion.

Braille and Tac­tile La­bels: For those who read Braille, in­sulin pens and sy­ringes with Braille la­bels are avail­able. Ad­di­tion­al­ly, food man­u­fac­tur­ers may of­fer prod­ucts with tac­tile la­bels or Braille in­for­ma­tion, en­abling in­di­vid­u­als to iden­ti­fy nu­tri­tion­al de­tails with­out need­ing sight­ed as­sis­tance.

Voice As­sis­tants and Smart Home Tech­nol­o­gy: Voice-con­trolled smart de­vices, such as Ama­zon Alexa or Google As­sis­tant, have be­come in­valu­able in pro­vid­ing hands-free con­trol of tasks. These de­vices can be used to set re­minders for med­ica­tion, meals, and ex­er­cise rou­tines and can even be in­te­grat­ed with di­a­betes man­age­ment apps to log blood sug­ar lev­els or in­sulin dos­es.

Vir­tu­al As­sis­tant Apps: Smart­phone apps like “Be My Eyes” and “Aira” al­low blind in­di­vid­u­als to con­nect with sight­ed vol­un­teers who can read prod­uct la­bels or help iden­ti­fy foods.

Ex­er­cise: A cru­cial as­pect of di­a­betes man­age­ment is reg­u­lar ex­er­cise. Many in­di­vid­u­als who are blind or vi­su­al­ly im­paired suf­fer­ing from di­a­betes en­counter nu­mer­ous chal­lenges when try­ing to find safe spaces for walk­ing or run­ning, par­tic­u­lar­ly in out­door ar­eas with un­even sur­faces. They can, how­ev­er, en­gage in ex­er­cise from the com­fort of their own homes.

This col­umn is sup­plied in con­junc­tion with the T&T Blind Wel­fare As­so­ci­a­tion Head­quar­ters: 118 Duke Street, Port-of-Spain, Trinidad. Email: ttb­wa1914@gmail.com; Phone: (868) 624-4675; What­sApp: (868) 395-3086.