The other day I was looking at the Multiclix lancing device I use under my video magnifier. This is an older video magnifier that has been broken for some time, and so I haven’t had access to this kind of high magnification for a while and have therefore been looking at a lot of things under it.

I was looking at the little lines towards the back of the device, on the part which you press to “cock” it. I have done this before and knew that there were five lines there, but this time I couldn’t find them and realized there were none. I was confused for a moment, and twisted the back to try and load a new lancet, but the drum was at its last one and thus the back wouldn’t twist. It was then that I realized that the number of strips represented the number of unused lancets in the device: five when a drum of six was first loaded (meaning there were five unused ones left), and none when the last lancet had been loaded and used.

How neat!

Tonight I was testing with my Contour USB under the video magnifier so that I could tag a reading related to exercise. I don’t usually use the tags because I can’t read the fonts when out and about, but for some reason had decided to tag this one. While I was doing so I realized that not only can you tag readings as before and after meals (and stress and activity, etc.), but you can also specify how long after a meal a reading was taken.

This makes that meal tag a lot more useful!

Unfortunately neither of these are features I can use without being around a video magnifier. But I am hoping to get a portable video magnifier that I can use with digital screens since I’ll be getting a OneTouch Ping soon and, at least at the beginning, will not have the menus memorized (and this pump also doesn’t beep with each button press as the Cozmo I’m currently using does). Still, I like finding little useful features like this that make the device that much more useful. (Incidentally, an easy way to make the bars on the Multiclix accessible would be to make them raised so they could be counted with a fingernail.)

In their most recent issue I came across an article by James Hirsch about whether or not type 1 diabetes should be considered a disability. And, while I agree wholeheartedly with his conclusion that it generally should not, something about the article rubbed me the wrong way. I couldn’t quite put my finger on what it was, but here I’d like to share some of my thoughts on why it may have struck a negative cord with me as I read it from the perspective as someone with type 1 diabetes, but also from the perspective as someone with a disability.

Having experienced both a chronic illness and a disability for the majority of my life I feel that the two are very different. Hirsch says that in a way diabetes is like having a disability, because both require that you take care of something every day. But this isn’t really true, at least in my experience. I think what makes a chronic illness different from a disability (and it’s interesting to note that, in his speculation of appropriate terms, “chronic illness” was never mentioned) is that with one a person must manage something internally—an aspect of how their body functions, while with the other someone must manage something externally—the way society thinks and functions.

There is, of course, some overlap. Chronic illnesses can, of course, lead to disability, as can happen with MS, diabetes, cancer, and many others. Chronic illnesses can also be temporarily disabling during an acute flare-up or crisis. On the other hand, a disability can be caused by a condition which requires ongoing medical treatment and thus has aspects similar to a chronic illness. But, by and large, the experience of living with a disability is very different from the experience of living with a chronic illness.

As a chronic illness, I have to manage diabetes day in and day out, on a 24/7 basis. But as long as I manage it well, and (if necessary) am given a few minor accommodations to enable me to do so, I can function regardless of the external environment. Diabetes, as with asthma and epilepsy and depression and a myriad of other chronic conditions requires me to pay intense attention to my body, to how I’m feeling, and to the environment around me to the extent that I may have to modify some aspect of my treatment to accommodate it. It requires that I manage daily treatments, doctor’s appointments, and symptoms. But, once these are done there is nothing about society that stops people with chronic illnesses from functioning at near-normal levels (I say “near-normal” simply because I don’t consider taking medication throughout the day, jabbing oneself with needles, being attached to medical equipment, or constantly having to think of one’s physiology “normal”).

On the other hand blindness, as a disability, has nothing to manage on a daily basis. The accommodations I use daily are rather static. Although I may have to perform ongoing tasks—scanning print books into a format I can use, or leaving the house with enough time to catch public transit and find my way to an unfamiliar location—there is nothing about my disability itself that I need to manage. Instead, I have to manage society and the environment, in that I need to constantly come up with adaptations to do things that other people are able to do without thinking, and then put in the extra work required to utilize these accommodations. Society is designed around the idea that people can see, or walk, or hear, or learn, or understand in generally the same way. When someone isn’t able to do one of these things due to a sensory, physical, learning, or cognitive disability, they become “disabled” because they are no longer able to function in society without significant adaptations.

Still, this pondering didn’t help me answer what it was about the article that made me uneasy. The one other major difference I could think of between most (but not all) chronic illness and most (but not all) disabilities is attitudes, both of the public at large and of people with disabilities themselves. In many, perhaps most, cases the public has an often subtle attitude that people with disabilities are less capable, even helpless. Someone with a chronic illness may encounter some trouble entering a few select careers, such as joining the army or being a pilot, but by and large the world is just as open to them as for someone with perfect health. Talk to many people who have disabilities—people who were told they could not become a teacher, a doctor, a scientist, a carpenter or raise children, travel abroad, live independently, or earn a university degree—and you would quickly realize how shockingly prevalent these attitudes can be. People with disabilities routinely get praised as “inspirational” or “amazing” for walking down the street without assistance, reading a book in braille, or holding down a job. If these average things are considered inspirational, what does that say about the overall societal expectations?

Once I began thinking of attitudes, it finally hit me. In the article I’m sure Hirsch did not mean to shed a negative light on people with disabilities. Who does? Yet, when I re-read the article I picked out the phrases which bothered me:

Still and all, I think we’ve made Garrett feel that his diabetes is not going to limit him in his life.

But Mrs. Graham also told him that just because you have diabetes shouldn’t prevent you from doing want you want in school or in your life.

The article concludes that diabetes is not a disability, and yet, the only difference it seems to point out between the two is that diabetes should not limit someone in what they can do in life. It’s not explicitly mentioned, but if this is the only thing that separates diabetes from disability, what does that imply for a disability? Perhaps it limits them physically—and perhaps this is what Hirsch was trying to get at—but I can’t help but wince at the thread of negativity that has crept into there. If diabetes is not a disability because it shouldn’t limit someone in their life, the completion of that statement means that disability, then, must limit someone in their life.

I would argue that’s not the case, at all. People with disabilities can do anything and everything——they just have to perform it in a different way. People with disabilities face limits because of the way society is structured. If we all relied on public transit instead of individual vehicles, there would be few transportation barriers. If all information were published in a universally accessible format such as electronic text, there would be no “print” disabilities. If all buildings and products were designed with the idea that there is no “one user” who is assumed to have complete use of all senses, limbs, and to all understand information presented in the same way, then there would be no inaccessibility. Inaccessibility, in addition to attitudes such as I mentioned above, are what make someone disabled. Diabetes and other chronic illnesses, despite the very formidable challenges they present, do not result in these same barriers.

I freely admit that this post comes from the perspective of only one person—me. I would be interested in hearing from others about their thoughts on this issue, especially people who live with a chronic illness and a disability concurrently. What do you feel the similarities and differences are, and where is that dividing line? Are the negative attitudes I find focused on people with disabilities also turned on those with chronic illness—it is possible that my blindness simply overshadows my diabetes in this regard, because it’s always the thing people notice, hear about, and comment on first.s

Now, logging and data analysis are supposed to solve all the mysteries of diabetes. It’s supposed to make all those “random” highs and lows make sense, and supposed to help guide us in making changes to our regimen. However, I myself find logging most useful as positive reinforcement and a way to stay accountable to myself. It’s reinforcing to see rows of nice readings, a nearly flat line on a graph, or a large chunk of green on a bar graph. It’s discouraging, however, to begin logging when things are out of whack and get a graph like the one to the right, with lines zig-zagging all over the place and often out of view (meaning those readings are really, really out of range).

But aside from the self-motivation and accountability, I don’t find the actual data these software generate all that useful. If I want averages it’s a simple matter of using my glucose meter or pump to get that data. If I want a line graph I can download my meter data onto a computer and see it that way. I began to think of what would make these apps and computer applications invaluable to me, so that I would use them all the time instead of just in short spurts when I’m motivated.

The first, obviously, is if the information were all collected automatically. For some people who use an integrated meter and pump, or CGMS and pump, this is almost a reality. However, I and likely many others use a pump and meter (and CGMS) which are not compatible with one another. Plus, I don’t think I would be alone in saying that most of the applications designed by the meter companies aren’t exactly rich with innovative features. It would be nice if any and all data could be accessed from all devices and uploaded to a single program. That way my meter could collect my glucose readings, pump could collect my carbohydrates, food (if using an integrated food database, such as the Animas has), and insulin. My iPhone could collect any notes or exercise I did. And then at the end of the day I could upload it all into once place for analysis. There would need to be some way of merging entries which were minutes apart so that you wouldn’t end up with tons of duplicate data (a glucose reading from the meter and a second that was input into the pump for a correction bolus, for example). I’m not sure this is technically even possible, not being a programmer or engineer, but it would be very nice.

But the actual data entry aside, there are other features that would make me manually enter data. What I want to see when I analyze data is not just lists or graphs of my readings throughout the day. That isn’t very useful other than showing me that I might be going high every afternoon or waking up low too often in the morning. What I’m really interested in seeing is relationships between that data, between any two types of data I choose. That being said, I would wish for apps and other software to have the following features:

• Graphs with more information: For some reason most graphs seem to only display one type of data. This is beginning to change, since some now display glucose readings and food or insulin intake on the same graph. However, it would be nice to be able to display everything at once: glucose, food, insulin (separated into basal and bolus), exercise, standard deviation, etc. on a single line graph. (On a side note, it boggles my mind why standard deviation is not yet being built into glucose meters, as it’s now thought to be just as important as averages in terms of control.) Furthermore, it would be nice to be able to select different time periods (including one portion of the day, such as just the evening) and certain types of data (see below) to display.
• Tagging of entries: Current software lets you enter “categories” which usually correspond to the time of day, such as “before dinner.” While this is useful for generating graphs, it would be even more useful to have tags that could be added to entries. For example, I would like to be able to tag a glucose reading with “ketones” if I happen to have ketones at the time, or tag a meal entry with “ate out” if I’m eating at a restaurant (and I could then note specifically what I ate in the “Notes” section most software has). And, in addition to tagging individual food, insulin, glucose, exercise, and notes entries, it would be nice to be able to tag entire days, such as tagging a day “sick” or “menses.” Some (such as the OneTouch UltraSmart, and perhaps the Ping as well) allow you to add such tags to individual entries, but personally I’m not usually sick for just an individual entry, it’s usually for an entire day. You could add the same tag to every entry in that day, but how tedious is that?
• Connecting related data: Most of the programs out there right now don’t do this very well. What if I have tagged several entries as “after exercise” and I want to see these listed beside corresponding “before exercise”-tagged entries? What if I want to further narrow this to only show these tags for entries in the “after dinner” category? It would also be nice to be able to view an entry tagged as “eating out” with the following entry(ies) following in time—perhaps the next one or two, to see if highs or lows tend to follow. It would be nice when I am eating out to be able to look up all entries tagged “eating out” and have shown the corresponding insulin dose I took, along with the blood glucose reading, so that I could see if I should change anything this time (perhaps this would be all entries categorized “dinner” that fall on the same days as dinner entries tagged “eating out”). Again, I have no idea if this is technically possible, though with all the ways tags are being used online, I would think it could be done.
• Pattern management: It would be useful to incorporate some pattern and trend alerts into the software, similar to John Walsh’s ideas for future insulin pump features. Perhaps this is asking too much of software, and yet if it’s being suggested for inclusion in insulin pumps surely it could be included in desktop or mobile applications. Or, having the software (again, based on user preferences) look at all readings above a certain threshold, perhaps 16.7 mmol/L (300 mg/dl) and see that all readings two hours after that have been high (meaning more corrective insulin is needed) or low (meaning overcorrections). Features and alerts such as these would be especially useful to users with visual impairments who can’t always see to look at a graph of daily readings overlaid upon one another showing highs in the afternoon, or a histograph showing that after-breakfast readings tend to be much lower than the rest. Suggesting actual dosage changes might be a bit much, but an alert saying (based on user preferences), “The last five after-breakfast readings you entered have been below your set target range” would be hugely useful and would be a big motivator for entering all that data (assuming the dream of having it all collected automatically wasn’t a reality).

So, there you have my wish list for new features. I am sure there are a million other amazing ideas out there. I am sure some of the people making this software, especially those who live with diabetes themselves, are creating some amazing things I haven’t even though of! These are the things that, for me, would make the logging of readings and other information much more useful, if not necessarily any less tedious, and I hope some of them will become a reality as pumps, meters, computers, and other technologies continue to be developed.

Here I would like to review Glucose Buddy, a diabetes management app which also happens to be very accessible to blind and visually impaired users.

The App

Glucose Buddy is a free app available from the App Store. It consists not only of the iPhone app itself, which can be used to record blood glucose, insulin, food, and exercise data while on the go, but an accompanying website (www.glucosebuddy.com) where the data can be uploaded for more detailed analysis. Glucose Buddy is by far the most feature-rich free iPhone app for diabetes available, so if you’re looking for something low-cost it might be your best bet.

The app itself consists of a home-screen like environment when first launched, with various icons that can be used to access various functions within the app. The “My Info” icon can be tapped to change settings, such as age, type of diabetes, and blood glucose meter used. Glucose Buddy can be set to use either mmol/L or mg/dl blood glucose units, which means it’s usable anywhere in the world (mg/dl is used mostly in the United States). Worth noting is that, although VoiceOver reads menu items in this list it does not read the setting that is selected, even though this is displayed visually.

The “Logs” icon accesses a list of recently-entered logs. It can also be used to add new logs, although the icon beside it (“Add Log”) is a way of doing so directly from the main screen without entering the Logs section. The list of logs is fully accessible with VoiceOver and all information displayed is properly read.

Entering information into Glucose Buddy is quick and easy. The screen for entering new logs consists of several tabs along the top for Glucose, Meds, Food, and Activity. Below these tabs are areas to modify the current date and time if entries are to be back-dated (this is preserved across tabs so only needs to be modified once if entering more than one type of information), and an area for entering notes for each entry. Below this is an area on the Glucose screen to enter your blood glucose level. When tapped, a panel of numbers pops up allowing you to quickly enter your glucose. To the left of this number pad is a spinner where you can select the “category” such as before breakfast or after exercise, including the ability to create your own entries to correspond with your “Testing in Pairs experiments” (explained later in this review).

For screens other than the Glucose screen, the last item after the area to enter notes is a button which allows you to add a type of medication, food, or exercise. When this area is tapped a list of options which you have entered previously appears. You can add new items to the list, but I was unable to find any method of deleting entries, which I found extremely irritating if I made a typo or accidentally entered an item twice (as can be seen in the screenshot to the right). Adding some way of editing these lists would be a welcome feature to a future version! Also, there is no ability to save groups of foods as entire meals, as the list is a single-level rather than multi-level list, and this was one of the main reasons I did not continue using the app after several months of use. The items in the list do not store any nutritional information, so after a food or several foods are entered you must enter how many carbohydrates you are eating. Integration with a nutritional database would be nice, although this is a lot to ask for in a free app and is covered nicely in paid apps like Diabetes Pilot.

The only area of log entry that I found to be inaccessible was that the date was not read by VoiceOver. Since the date is infrequently in need of change this was a minimal problem. If any entries need to be entered backdated a screen reader user can do this easily through the website. I also found that when changing categories Glucose Buddy tended to crash often. This was inconsistent and I haven’t heard complains about it from other VoiceOver users, so it’s possible it was just a glitch with my phone. A workaround for this if it does happen is to enter the log without entering the category, and later go into the “Logs” list to edit the entry and enter the correct category.

From a low vision perspective, the text in this area for entering logs is presented in either black (usually) or white (occasionally) on a grey background. This provides very low contrast and makes it difficult to read the text. Because the text on the iPhone cannot be adjusted in size, contrast is extremely important for someone with low vision using the device. The buttons for entering numbers are large and have nice contrast, however. The one other area of difficulty occurs when trying to select from a list of items while using magnification. Since check marks appear to the far right, it is impossible to tell what has been selected. It’s very easy to accidentally select and item while moving the zoom window or while adjusting the magnification level, and the only way to check what has been selected is to zoom out, at which point the actual text cannot be read. Moving the check marks to be before each item on the left, and making the background white rather than grey (or perhaps providing an option for this within the settings) would make this section much more usable for people with low vision who may not necessarily need to use the speech output of VoiceOver.

Moving back to the home screen, the “Quick Sync” button is used to upload recorded logs to the Glucose Buddy website. Here the data can be analyzed and graphs can be printed out for a healthcare professional to review.

Glucose Buddy includes a graph of the highest, lowest, and average glucose reading per day, which can be accessed through the “Graph” icon on the main screen. This graph obviously is not read by VoiceOver, but is a feature appreciated by many sighted users and may be similarly useful to users with low vision. The graph presents blue, purple, and red lines over a grey background with a green shaded area showing the target range. Unfortunately, the grey background provides extremely poor contrast for users with low vision and makes the lines in many cases impossible to distinguish, although using the iPhone’s “white on black” mode does enhance the contrast considerably. A black background as an option (perhaps with options to change the colours for average, high, and low lines as well) would greatly enhance accessibility. An increase in functionality would also be beneficial, such as being able to view changes in glucose level throughout the day (this feature is currently only available on the Glucose Buddy website).

The “Settings” icon seems pretty straightforward and is used to set up account settings with the Glucose Buddy website (accounts are also completely free). This section is fully accessible. The “Reminders” icon on the main screen goes to a section where Push Notifications can be set up for events such as a reminder to test at a certain time or after certain events.

The remaining icon on the main screen, “Testing in Pairs,” is a tie in to Accu-Chek’s “Testing in Pairs” initiative. The idea is that by selecting an event (such as eating a particular food or doing a particular type of exercise) and testing before and after it, you can track changes in blood glucose level in order to make more informed decisions in the future. The screens in this section allow you to conduct “experiments” to see how a particular event affects your blood glucose level. Events entered as “experiments” then appear in the list of categories that are available while entering logs. I was unable to find a way to edit information in this section once it is entered, which resulted it in being nearly useless to me when information was entered by mistake. There may be a way of editing that I have simply not discovered, but if this is the case it should be made much easier to find.

Although this section is partially accessible in that you can enter information you would like to learn about, the results are displayed in a grid format which is not read well. However, the results of entered information are also synced with the online website and can be accessed more easily with a desktop screen reader which offers table navigation features. This is the only area of the app where the “Back” buttons are in non-standard locations, including one section where it’s placed at the bottom left of the screen instead of the top left, which can result in a lot of dragging and searching for someone who is new to the app.

The Website

Like the Glucose Buddy app, the website where data is stored and analyzed is extremely accessible. When www.glucosebuddy .com loads a user selects the “My Diabetes” link to log in and access the diabetes logs they have synced from the mobile app. Unfortunately, at this time syncing is only one way (from iPhone to web), so information entered on the website is not then synced back to the iPhone. Although this would be a nice feature, it’s not critical at this time because a majority of the number crunching is done on the website.

For screen reader users, all graphics on the site use proper alt tags, and the logs are presented in a nice table layout which can be jumped to directly with some screen readers. Links and forms fields along the top of the page provide a quick means of entering new data, and old logs can also be modified or deleted, all of which is completely accessible. If there was one thing which could improve the site in general it would be moving the Google ad text to the bottom of the page. Although most screen readers have commands to skip past such text, not all of them do, particularly the lower-cost options many people are beginning to use (traditionally screen readers have cost upwards of $800). Alternatively, a hidden “skip to navigation” anchor could be put at the very top of the page (invisible, too, by making it a 1×1 pixel image).

The graphs on the site provide analysis of all the uploaded data. Obviously these graphs are not accessible to those with no usable vision. For low vision users the graphs are presented in bold, high contrast colours which look good whether positive or negative colours are used with screen magnification software. For those who cannot see the graphs, useful information such as ranges and averages are still presented at the top of each graph. Each heading such as Glucose, Medicine, Food, and Glucose by Event is properly tagged so that users can jump directly to a particular heading, and relevant textual information is presented directly below, with the graphical information below said text. There are also options to print information for doctors or other healthcare providers to review.

Other features the website includes the ability to view Testing in Paris experiments (the results of which can be read by using table navigation commands with most screen readers), an A1c estimate calculator which calculates estimated A1c based on collected data over a period of weeks (it won’t work sooner than that), and an area to receive help and support.

Summary

Glucose Buddy is one of the most feature-rich diabetes management apps available for the iPhone. The combination of the app plus the website provides an easy way to record and analyze data. Furthermore, this combination provides one of the most accessible means of recording, analyzing, and sharing diabetes-related data for people who are blind or visually impaired. The few accessibility-related areas that could be improved are minor and do not hinder the overall use of the app.

Up until very recently (the late 2000s), people who needed speech output in their meters were stuck with old, bulky meters from the mid-1990s attached to “voice boxes” which made them talk. Needless to say, these units were not only lacking features but required very large blood samples and were not very portable because they were too large (combined with the voice boxes) to easily fit into a purse, never mind a pocket! Recently a few more modern offerings have appeared: the Prodigy Voice if you live in the United States, the Accu-Chek VoiceMate Plus if you live in Canada, and the SensoCard Plus if you live in the United Kingdom. Unfortunately those are essentially your only options, one meter per country depending on where you live.

I recently got an e-mail about the Oracle, a new talking blood glucose meter that has been approved for sale in Canada. The meter is not earth-shattering in its features: a small blood sample size (though the site does not mention how small), no coding test strips, a seven-second test time, 450 test memory, and 7-, 14-, 21- 30-, 60-, and 90-day averages. The results can also be downloaded to your computer (with the cable which is sold separately, as usual), although the site fails to mention whether the meter software is accessible. Judging by all other talking meters out there, the software is very likely not acceessible to those using access software. The site fails to mention whether this meter has a headphone port—something that is important for anyone wanting to test away from the privacy of their own home.

It is worth noting that the setup and memory functions on the meter are NOT accessible via speech. A user will require sighted assistance to change settings or review results stored in memory. The meter also has no repeat function—meaning that if you are in a noisy environment and miss the announcement of your blood glucose level, there is no way to have it repeated. The meter does have adjustable volume, but it is only accessible by going through the settings, and thus cannot be done quickly or independently by a visaully impaired user. Although this meter has some speech output, then, it is not truly an accessible meter because it requires sighted assistance for some aspects of its operation. Judging from the picture on the site the display does appear to be quite large, including the time/date stamp for each reading, and so this may be a suitable choice for users with low vision who may only need speech output in certain lighting conditions.

Like many other talking products, I get the impression that this meter (with its “simple” one-button operation) has been designed with the needs of seniors in mind rather than as an accessible meter for people with diabetes and a visual impairment. The needs of a senior who may have type 2 diabetes and relatively easy access to sighted assistance are very different then the needs of an active college student or working-aged adult with type 1. A truly accessible meter needs to be usable by both populations.

In future entries I am going to try and get a review of this (and other) talking meters up, by either getting hold of them myself or finding guest bloggers to review them. If you use any of the newer generation of talking meters and are interested in writing a short review about your experiences using it, please contact me.

Diabetes can be difficult, especially if one lacks essential information about managing it. Blindness or vision loss can be all the more frustrating when one lacks critical know-how. So what happens when one is experiencing both diabetes and blindness? Where can one turn for answers? Where does someone with diabetes turn when he loses vision? Where does a blind person turn when she develops diabetes?

Bridging the Gap: Living with Blindness and Diabetes, a one-of-a-kind resource, provides the necessary link between diabetes and blindness, and the facts about successfully managing diabetes as a blind person. The word “blind,” as used in this volume, refers to any significant degree of vision loss that a person experiences that markedly limits the ability to do things visually.

This five-part volume draws from articles originally published in the Voice of the Diabetic, a magazine that the National Federation of the Blind (NFB) published for twenty-four years that met the informational needs of blind people with diabetes. We begin with “Personal Portraits: Success Stories about Living with Diabetes and Blindness.” Readers of this book (particularly blind people who also have diabetes) need to know that they are not alone and that people everywhere are adopting a positive approach to coping with these dual conditions.

Next, we present “Diabetes Basics: What Everyone Should Know.” Few diabetes resources are available in accessible formats, so in this section we make sure that readers have access to necessary information. In “Secrets of Success: Managing Diabetes as a Blind Person,” we offer a wealth of wisdom developed especially for and by the real experts, blind people who manage their own diabetes. Seasoned diabetes specialists and rehabilitation professionals, as well as blind diabetics, will find this section enlightening and instructive.

In “Continuing the Journey” we share personal stories and important technical information from medical experts in the field. This should prove especially informative for those blind diabetics who may also be encountering concerns like dialysis, amputation, wound care, neuropathy, and gastroparesis. Finally, in “Resources” we gather a treasure trove of useful community-based resources for enhancing independence, many of which are free for the asking. We have even included sample jumbo-print diabetes logs, available for the first time.

This book should be an excellent resource for anyone living with or interested in diabetes and visual impairment. Considering the relatively large number of people with diabetes who also have limited vision, and the fact that this is an area severely under-addressed in most areas of diabetes material both on and offline, any new additions are welcome! The book can be obtained free of charge by ordering from the NFB’s store.

I have a few posts in progress at the moment, but I thought I would get the ball rolling by posting something of an introductory post; a bit about me and what I hope this blog will become.

First, a bit about me: I have had type 1 diabetes since I was nine years old (over 18 years now) and have been legally blind my entire life. My visual acuity, which cannot be corrected further by glasses, contact lenses, vision therapy, or surgery, lands somewhere in the range of 20/600, which places me squarely between being sighted and totally blind. I have some useful residual vision, but not enough to function without a combination of low vision aids (such as magnifiers) and nonvisual aids (such as a screen reader). I can, for example, see things within a close range around me and read large print if I’m close enough. Although I use the vision I have to a great extent (I am, for example, typing this post with two-centimetre-high letters on the screen), I also often make use of tools such as audio output, braille, and a white cane. I use an insulin pump to manage my diabetes, use diabetes management software on my computer, and use online diabetes websites regularly, and I’m something of a technology geek. I don’t work in the technology field (I work in education), but I’m beginning to steer my career in that direction. I am a graduate student, a 20-something, Canadian, involved in the disability rights movement, and many other things … but this blog will focus mostly on diabetes, blindness, technology, and accessibility.

Blindness or visual impairment is primarily a disability related to information. Sure, it’s related to perception, but because for most humans vision is their primary means of collecting information, most data in the world today is presented visually. Many of the problems faced by visually impaired people have to do with lack of access to this information. Crossing streets becomes challenging not so much because cars can’t be seen (they can, after all, be easily heard—with the exception of the new hybrid models coming out, but that’s a whole other issue …) but because the traffic light no longer conveys the information relied on to know when it’s safe to cross. Reading becomes a major problem because less than 5% of books published in print ever make it into an accessible format such as braille (and even when it does, it often takes months or years!). Navigation—known within the blindness community as “orientation and mobility” (knowing where you are in space and how to get safely from point A to point B)—becomes harder because all those visual cues people rely on—landmarks, symbols, and signs—become inaccessible. Even something as simple as glancing at a clock to tell the time or setting the oven to medium require vision unless adaptive devices or products are used.

It’s no wonder, then, that diabetes and a visual impairment makes for a major challenge. Unlike most other diseases, diabetes control depends heavily on collecting and analyzing data. And like most other information in our world, this data tends to be presented visually. From glucose meters that flash a number on a screen to computer applications that display intricate graphic breakdowns of food, insulin, exercise, and glucose readings to CGMS receivers that display trend graphs and arrows, almost every diabetes device or technology out there requires vision to operate or interpret. It’s not even so much that vision is required to understand such information … simply that most people don’t consider an alternative.

In the mainstream market, this has begun to slowly change. Devices such as computers, online content, and even cell phones have slowly been designed with accessibility in mind. For example, up until the past few years cell phones were entirely inaccessible to blind and visually impaired consumers. Oh, blind people used cell phones—but to dial numbers only. Address books, text messaging, surfing the internet from their mobile device, and installing third-party applications on phones were entirely out of reach. In the past few years, however, screen readers have been designed for many cell phones. A blind consumer today has the choice between a Symbian-based phone (such as those from Nokia), a Windows-based mobile phone, a Blackberry, or—best of all—an iPhone, which is the first device to be accessible off-the-shelf without needing any third-party software bought or installed.

It is my hope that devices and technologies designed for people with diabetes can follow such a trend. But first the issue needs some publicity. The usual reaction from people, particularly those without diabetes, when they find out that there is no such thing as a talking insulin pump is, “Why?” It seems that everything else has a talking version—watches, pedometers, scales, thermometers, even microwaves and VCRs. It’s not for lack of technological ability that these products don’t talk, but more a simple lack of awareness.

Other things will probably seep into my posts every now and then; my personal struggles managing the ups and downs of diabetes, non-diabetes-related technology for people with visual impairments, and perhaps something entirely different. But mostly I would like this blog to be a place to raise issues and discussion around accessibility products and technology for people with diabetes, and I hope it’s an issue that people are interested in enough to have a read.