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This podcast is presented by the Centers for Disease Control and Prevention. CDC – safer, healthier people.

[Dan Hazelwood] Thank you for joining us for this edition of Clinical Diabetes Management brought to you by the National Diabetes Education Program or NDEP. NDEP is a joint initiative of the Centers for Disease Control and Prevention and the National Institutes of Health. I'm your host, Dan Hazelwood.

Our topic today is living with vision loss. Diabetes and other conditions can lead to loss of vision, but quality of life can still be maintained. Here to discuss this important topic is Dr. Susan Primo, Associate Professor of Ophthalmology at Emory University and a member of the NDEP. Also joining us is Eileen Rivera Ley, Director of Diabetes Initiatives at the National Federation of the Blind, and, by phone, Mr Tom Ley, a person with vision loss and diabetes. Welcome.

[Dr. Primo] Thank you, Dan.

[Ms Rivera Ley] Thank you.

[Tom Ley] Thank you.

[Dan Hazelwood] Dr. Primo, why are people with diabetes at risk for vision loss?

[Dr. Primo] People with diabetes can develop a condition called diabetic retinopathy which damages the tiny blood vessels in the back of the eye, causing them to leak. People with diabetes can also develop other eye conditions like cataract and glaucoma, which is a disease where the pressure becomes too high. All of these eye diseases can lead to decreased vision and blindness. Poor diabetic control greatly increases the risk of developing these diseases, so it's very important to have good control of diabetes.

[Dan Hazelwood] Will treatment for diabetic retinopathy cure blindness?

[Dr. Primo] Well, unfortunately the treatments don't actually cure the disease; they can help control some of the damaging effects of the disease, but they actually don't cure blindness.

[Dan Hazelwood] Is there anything you can do once a person loses his or her vision?

[Dr. Primo] Absolutely. I think the most important thing is that health care professionals realize there are people like myself who are low vision specialists that are really trained and dedicated to working with people who have lost vision from diabetic retinopathy.

[Dan Hazelwood] Give us some examples.

[Dr. Primo] There are a whole host of devices, those that are non-optical, as well as optical. Things like large-print glucometers, magnifiers to be able to see the medication better, and other devices, such as those that can really help the quality of life and make a patient remain independent.

[Dan Hazelwood] Thank you, Dr. Primo. Mr. Ley, tell us about your experiences living with blindness and diabetes.

[Tom Ley] I have been blind from diabetes now for a number of years and my experience has been that once you've gotten enough information and have the right tools, you can manage diabetes just as well, whether you have full sight or whether you’ve lost some or all your vision. I take insulin and I can do that without any vision whatsoever. I measure my blood sugars frequently, several times a day, with meters that are adapted for people who have no vision. So there are lots of tools available, but if you don't know the tools are there, it can be a really frustrating circumstance and your diabetes and your health will continue to suffer.

[Dan Hazelwood] How do you measure your insulin? I mean, those little syringes. It's hard for me to see the markings on them. How do you do it?

[Tom Ley] Before I went totally blind there were some magnifiers that you can use but some days I found that my vision fluctuated so much that some days I could use a magnifier and some days I couldn't. More recently, most people are taking insulin now with insulin pens. There's a tactile clicking that the pens make when you dose them. I find that it's actually very easy now that pens are very prominent in the market to take insulin, as a diabetic who has vision loss. I have heard several cases of people who felt that they should be on insulin, wanted to be on insulin, but their doctors were fearful and didn't prescribe it. And the lead that the doctor takes, the confidence that the doctor shows in the diabetic really tells the patient a lot. Patients really believe in doctors, so it's really crucial that doctors know all the tools that are available and know that having vision is not, in any way shape or form, something that should keep a blind person from using any form of diabetes treatment, whether it be taking an oral medications, or insulins, or insulin pumps. I think the key is for the clinician to have the information first and provide up front a person losing vision all the information they need right in the doctor's office so they, they don't have to walk away feeling lost and feeling like they've lost control over their ability to manage their diabetes.

[Dan Hazelwood] So Tom, what do you say to the clinicians out there?

[Tom Ley] Get yourselves educated on the capabilities of blind people and what's available for people who have vision loss in terms of managing their diabetes. There are thousands of diabetics who are doing it today, successfully. It's just really knowing that you can do it, oftentimes, that is the most critical component.

[Dan Hazelwood] Mr. Ley, thanks for joining us.

[Tom Ley] Thank you.

[Dan Hazelwood] Mrs. Ley, tell us more about your role at the National Federation of the Blind.

[Ms. Ley] Well, I get to work on the diabetes initiatives of the National Federation of the Blind. We do anything we can to educate, empower, and inspire people facing diabetes and vision loss. We publish a magazine, a free magazine, called Voice of the Diabetic.

[Dan Hazelwood] Who would benefit by contacting the National Federation of the Blind?

[Ms. Ley] Anyone who wants information about how people live with vision loss, be they health care professionals or individuals and family members.

[Dan Hazelwood] And how can people contact the National Federation of the Blind?

[Ms. Ley] Well, there's lots and lots of resources on our website. That’s www.nfb.org and also we have a toll-free number 888-581-4741. And that’s for anyone who has questions about diabetes and blindness.

[Dan Hazelwood] What other options are there for improving quality of life if a patient has vision loss and is dealing with diabetes?

[Ms. Ley] Well, the great thing is that, when you lose your vision you find other ways to accomplish the same tasks. And in the Federation we can teach people how to access printed information, how to safely test their blood sugar non-visually, how to measure insulin and organize their medicines, how to cook independently, really all the tricks that we have developed to live a quality of life.

[Dan Hazelwood] I see. Dr. Primo, in addition to referring patients to the National Federation of the Blind, what else can health care professionals do to help their patients with impaired vision?

[Dr. Primo] Well, I think first, Dan, it's important that health care professionals realize that people, even though they may have suffered severe vision loss from diabetes, they still are at risk for other eye diseases, so it's important that they continue to encourage their patients to get annual dilated exams by eye care professionals to make sure they aren't suffering from any other problem.

[Dan Hazelwood] That sounds like a lot to learn. How can we possibly keep up with it all?

[Dr. Primo] There are at-a-glance tools available to help health care professionals keep abreast of the basics. NDEP has recently produced a booklet called Working Together To Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists, and Dental Professionals, and this guide focuses on the importance of team care and team management and what all health care professionals need to know about preventing diabetes complications. Working Together and other tools for health care professionals are available free from the NDEP. Visit www.YourDiabetesInfo.org or you can call toll-free 1-888-693-NDEP.

[Dan Hazelwood] Dr. Primo and Mrs. Ley, what is the one take-home message you'd like to leave with our listeners?

[Dr. Primo] Even if your patients do suffer from vision loss, whether it's mild or severe, your patients can still manage and control their diabetes proficiently and effectively. So, it's important that you make sure that you are a good resource for them to be able to get the help they need, to be able to use what sight they have, or other resources like the NFB, to be able to manage their own diabetes independently.

[Ms. Ley] Well, we'd like the doctors and health care professionals to know that there's lots of resources available from the National Federation of the Blind. For example, "Voice of the Diabetic" is a free magazine available in all types of formats that'll help people manage their diabetes, even when they have complications.

[Dan Hazelwood] NDEP has information and free educational materials for health care professionals and people with diabetes. Visit www.YourDiabetesInfo.org or call toll free 1-888-693-NDEP.

For the most accurate health information, visit www.cdc.gov or call 1-800-CDC-INFO, 24/7.