Updated January 30, 2007

Tools and Techniques for Visual Impairment

by Connie Kleinbeck, R.N., B.S.N., C.D.E.

The use of contrasting colors can make locating dishes and food easier. Instead of placing white dishes on a white tablecloth and serving white foods such as mashed potatoes, try placing white dishes on a brightly colored tablecloth or place mats and serving colorful food. (As a bonus, brightly colored fruits and vegetables tend to be higher in nutrients than pale ones.)

Pouring liquids can be challenging. Using a container with a spout may make pouring easier. To decrease spills on the floor or counter, put your cup or bowl on a cookie sheet, pie pan, or tray when pouring or carrying liquid. Some people pour milk or juice into a colored glass to better see the level of fluid. A nonvisual technique is to place a finger inside a cup to judge fluid levels. You can also judge the level by sound and by how heavy the container feels. Some people prefer to use an audio liquid level indicator, which hooks over a cup or glass and beeps when fluid is about an inch from the top of the container.

Measuring out portions of food with measuring cups or spoons will make your carbohydrate counting or exchange calculations more accurate. Look for measuring cups and spoons that are color-coded or marked with raised bumps or letters for easy identification. To make portions of foods such as breakfast cereal easier to measure, first pour the entire box into a resealable, wide-mouth, storage container. Measuring out small amounts of oil or salad dressing may similarly be easier if the liquid is stored in a wide-mouth container; just dip in your measuring spoon to remove the portion you want. Another way to judge portion sizes is to pour a measured amount of water or breakfast cereal into the cups, glasses, and bowls you commonly use and note how full they are.

Restaurant serving tools such as ladles or scoops can help with portion control as well as improve safety when serving hot foods. Cutting food is easier and safer when a slicing guide is used. There are various styles of slicing guides, but most help hold the food steady while guiding the knife to make a straight cut. Using a cutting board also makes cutting food safer.

Diabetes care
Diabetes can be managed safely and independently with visual impairment, but it helps a lot to work with a certified diabetes educator or low-vision rehabilitation specialist to learn the ropes. The person you work with should be knowledgeable about devices that can assist with diabetes self-management such as talking blood glucose meters, bathroom scales, blood pressure monitors, thermometers, and prescription bottle holders. Devices that don’t talk but that emit audible clicks or beeps can also be useful.

Insulin administration. Many people with low vision use insulin pens instead of syringes. One pen-like device, the Novolin InnoLet, has a dial similar to a kitchen timer with a raised bump every five units, making it easy to dial in the right dose. With any pen, a new pen needle must be screwed onto the end of the pen for each injection. A “test shot” of one to two units is dialed in, and the delivery button of the pen is pressed, filling the needle with insulin. By holding one hand near the pen needle, you can feel a drop of insulin on your skin, and you may notice the smell of insulin. The desired dose is then dialed in by counting the clicks or feeling the raised bumps. Once the insulin has been injected, the pen should be held in place with the needle under the skin for a count of 5–10 to make sure the full dose is given.

For those who use syringes, syringe magnifiers or devices that hold the syringe and insulin vial can help with drawing up the correct doses. These devices can typically be purchased either at the pharmacy or directly from the manufacturer. (See “Product Manufacturers and Distributors” for more information about where to purchase assistive devices.) Products currently available include the following:

• Count-a-Dose, a Medicool product, is a device for filling BD 50-unit syringes. It holds two insulin vials so that different types of insulin can be mixed, and it makes a distinct click that can be both heard and felt with each unit of insulin drawn into the syringe.
• Borin-Halbich, Inc., manufactures Safe Shot, a syringe loader that can be set once then used repeatedly to draw the same amount of insulin into the syringe each time.
• Insul-Cap, by Palco Labs, is a plastic cap that fits over an Eli Lilly, Novo Nordisk, or Aventis Lantus insulin bottle and guides the syringe needle into the bottle.
• The Ezy-Dose Inject Assist holds one insulin vial and a syringe in place while a dose is drawn up. It can be preset to draw up the same dose over and over again.
• The Ezy-Dose Injection Safety Guard is a large disk that can be placed under the stopper of an insulin vial. The user can then grip the vial without fear of an accidental needle stick.
• NeedleAid is a tapered device that is placed on the injection site. The syringe is inserted into the device, which then guides the needle during the injection process.
• The BD Magni-Guide snaps onto an insulin vial, guides the needle into the vial, and magnifies the syringe markings 1.7 times.
• Ezy-Dose’s Syringe Magnifier clips onto 50-unit and 100-unit syringes, doubling the size of the markings.
• Tru Hand, by Whittier Medical, holds the insulin bottle steady and has a magnifying window that doubles the size of the syringe print.

Also in this article:
Product Manufacturers and Distributors
Resources

Connie Kleinbeck is a Certified Diabetes Educator at Truman Medical Center Hospital Hill in Kansas City, Missouri, and a member of the Disabilities/Visually Impaired Specialty Practice Group of the American Association of Diabetes Educators.

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