By Ann S. Williams, Ph.D., RN, CDE Listen to Living with Diabetes and Visual Impairment—Monitoring (Windows Media Player) Listen to Living with Diabetes and Visual Impairment—Monitoring Audio (VLC Media Player) When managing diabetes, your good health depends on your ability to both monitor and understand your blood sugar, as well as your blood pressure, weight, and body temperature. If you have vision loss, there are a variety of large print and talking blood glucose meters, blood pressure monitors, thermometers, and weight scales available, with newer, more advanced models frequently becoming available. Below are a few guidelines for the care and use of these items: Monitoring Your Blood Glucose: The Q&A Available Talking Blood Glucose Meters Monitoring Your Blood Pressure: The Q&A Available Talking Blood Pressure Meters Other Monitoring Devices

Monitoring Your Blood Glucose: The Q&A

What is a %27normal%27 blood glucose reading?

Your blood glucose (blood sugar) will fluctuate throughout the day; however, it should remain within a certain range. Currently, there are two sets of blood glucose recommendations in the United States: the American Diabetes Association (ADA) guidelines, and the joint recommendations of American Association of Clinical Endocrinologists (AACE) and the American Association of Diabetes Educators (AADE). ADA Recommendations for Adults:
  • Blood glucose before eating: 90-130 mg/dl.
  • Peak blood glucose after eating (one to two hours after meal): less than 180 mg/dl.
  • A1C (a blood test done in the doctor%27s office): less than 7.0%.
AACE and AADE Recommendations for Adults:
  • Blood glucose before eating: less than 110 mg/dl.
  • Peak blood glucose after eating (one to two hours after meal): less than 140 mg/dl.
  • A1C (a blood test done in the doctor%27s office): less than 6.5%.
All three of these organizations emphasize that their recommendations are general guidelines. People with diabetes should work with their doctors and diabetes educators to decide what blood glucose goals are best for them as individuals.

How do I set my goals?

Start by discussing options with your doctor. In general, keeping your blood sugar close to normal helps prevent complications; however, you want to keep it high enough to avoid hypoglycemia. For many people, if the blood glucose has been high, it is best to bring it down gradually.

What should I consider when purchasing a blood glucose meter?

If you have a visual impairment, your first consideration is accessibility: “Can I read and use it accurately?” When considering a large print meter, check out the size of the numbers on the display and whether the contrast between the print and the background is strong enough for you to read it easily. Minimal glare and the display%27s backlighting are also important considerations. PLEASE NOTE: Take extra precautions if your eyesight fluctuates, as is common to people with diabetes-related vision problems. Vision quality will be lowest when your blood sugar is highest (and the need to read your monitor is critical). Be sure you can read your meter accurately when your vision is poorest. If in doubt, choose a talking meter instead.

Will any talking meter do?

You will want to weigh your decision carefully. You will want to determine how you will handle your monitoring if certain features are not accessible since not all talking blood glucose meters are created equal. Here%27s a convenient check list for a talking meter that is truly accessible:
  • The instructions for the meter are available in a recorded format.
  • The meter speaks or makes some other noise when it is turned on.
  • A calibration code is not needed, or the meter announces the calibration code number on the batch of disposable strips you use to obtain a blood glucose reading.
  • If a calibration code is needed for each batch of strips, it can be discovered non-visually.
  • The voice is clear and medium-pitched.
  • The meter can be used with an earphone for privacy.
  • The meter announces the time and date, and they can be set non-visually.
  • The buttons to operate the meter are distinctive, either by placement or by shape.
  • The opening for the placement of the strip is easy to feel.
  • It is easy to feel which end of the strip to place in the meter.
  • It is easy to feel the location for the drop of blood on the strip.
  • Only a very small blood drop is necessary for an accurate reading.
  • The meter does not give false low readings when too little blood has been applied.
  • The memory of the meter is accessible by voice, and includes dates and times of all readings.
  • The meter speaks or makes some other noise when it is turned off.
  • The meter turns off automatically if there is no activity for several minutes.
  • Strips are readily available.
  • The meter and the strips can be purchased from suppliers that bill Medicare and other health insurance providers.

Will Medicare pay for my meter?

Medicare pays for talking blood glucose meters billed under a special code number that allows a higher level of payment than non-talking meters. Most private insurance policies will also cover your talking blood glucose meter; however, each policy is written differently and some may require you to use a particular brand of meter. Contact your insurance company for clarification.

Available Talking Blood Glucose Meters

There are many currently available blood glucose meters that have at least some speech function. Brand names include Advocate Redi-Code, Clever-Chek, Embrace, Perfect 3, Prodigy AutoCode, and Vocal Point. All of these meters are small, inexpensive, highly portable, and fit easily into a shirt pocket or purse. In addition, they feature clear, easy-to-understand recorded human speech that reads the results of your blood glucose measurement aloud through a built-in speaker with adjustable volume levels. These meters are available with voices that speak in either English or Spanish. While relatively easy to use, the meters listed above do not offer speech output for every function they provide. For example, you cannot set the time and date or access the memory through the speech function. These meters can be useful to someone with mild vision loss and the ability to read large print. However, a person who needs to rely on audio feedback will not be able to operate these meters independently.

Fully Accessible Talking Blood Glucose Meters

There are 3 fully accessible talking meters on the market with speech supporting every function but new talking meters, and new features on older meters, are being introduced often, and the newest ones may not be covered in this article. The three available now are: All three meters meet the accessibility requirements listed in the checklist under “Will Any Talking Meter Do?”. They each have slightly different features than the others, such as other languages available, and download capabilities. For more information on these blood glucose meters, including how useable they are by people with low vision, read the January 2008 and March 2007 AccessWorld® articles, Diabetes and Visual Impairment: An Update on the Blood Glucose Monitor Market and Diabetes and Visual Impairment: New Talking Blood Glucose Monitors Enter the Market. Although newer monitors are now available, the evaluations can help a person decide whether newer meters will be accessible. To find these articles on the Internet, search their titles using any search engine.

Monitoring Your Blood Pressure: The Q&A

How important is controlling my blood pressure to managing my diabetes?

When it comes to avoiding dangerous complications from diabetes, controlling blood pressure is at least as important as controlling blood glucose. In the case of those with type 2 diabetes, and those who have high risk for heart disease, some researchers think that controlling blood pressure is even more important to overall health. This means that home monitoring of your blood pressure is important.

What should be my blood pressure goal?

Blood pressure fluctuates throughout the day. When measured after you%27ve been sitting quietly for at least five minutes, your pressure should be less than 130/80.

What should I consider when choosing a large print or talking blood pressure meter?

Home meters are widely available at your local medical supply store or pharmacy. To ensure accurate readings at home, when choosing a meter, you will need to consider three important factors: accuracy, cuff size, and technique. In general, meters that measure blood pressure on the upper arm tend to be more accurate than those using the wrist or a finger. Before ordering a blood pressure meter, ask your doctor or diabetes educator to identify your cuff size, and be sure to ask one of them to teach you how to use the meter properly for an accurate reading.

Can I get reimbursed for my blood pressure meter?

Currently, Medicare does not provide payment for blood pressure meters, but some private insurance policies will cover the expense. However, each policy is written differently, and some may require you to use a particular brand of meter. Contact your insurer for clarification of their policy.

Available Talking Blood Pressure Meters

Only one talking blood pressure meter, the UA-767T, has been approved by the FDA to be sold in the U.S. Its voice output—a high-quality recorded human voice—is clear and understandable, its buttons can be identified by touch, and it is generally easy to use. It also features a volume-control slider and headphone jack for privacy. For more information on this monitor, and other models without speech output, see the AccessWorld article, Diabetes and Visual Impairment: Are Home Blood Pressure Monitors Accessible?

Other Monitoring Devices

Weight Scales Appropriate weight loss is another important goal when managing your diabetes. Shedding as little as five to ten percent of excess pounds can make a huge difference in bringing your blood glucose, blood pressure, and cholesterol numbers to acceptable levels. Large print and talking scales are widely available. Be sure to test products in the store before you buy. Talking Thermometers Although not needed on a daily basis, it%27s a good idea to keep a talking thermometer on hand in case of illness. Mouth and ear varieties are inexpensive and are available at your local pharmacy.