2011-06-09-living_well_with_diabetes - hadley · web view2011/06/09 · a1c or hemoglobin a1c test...

2011-06-09-LIVING_WELL_WITH_DIABETES

Seminars@Hadley

Living Well with Diabetes and Visual Impairment

Presented by Margaret ClearyNaomi TuttleJerry Munden

Moderated by Billy Brookshire

June 9, 2011

Billy BrookshireWelcome to Seminars@Hadley. My name is Billy Brookshire; I’ll be your moderator today. We’re going to be talking about “Living Well with Diabetes and Visual Impairment.”

Your speakers today, we have some great presenters. We have with us Rehab Nurse Consultant Margaret Cleary. We’ve got Hadley Instructor Naomi Tuttle; and we’ve got the Vice President of Business and Development for Prodigy Diabetes, Jerry Munden. All great speakers – I know you’re going to enjoy the presentation today.

©2011 The Hadley School for the Blind of 41


So folks, let’s begin the presentation. I don’t want to waste any more of the time of these great presenters than I have to. I believe Margaret’s going to begin this morning so Margaret, if you’d like to start and get us going I’ll hand the microphone over to you.

Margaret ClearyI have worked for the Carroll Center for the Blind for over 30 years. Today I’m very happy to be here explaining some of the highlights of the Hadley course toward Diabetes Self-Management, of which I am the author and Naomi Tuttle, the instructor. Jerry Munden supports our recommendations with progressive, accessible products.

Let me give you some basic information about Diabetes mellitus – so much to say and so little time. Diabetes mellitus is a chronic disease affecting more than 150 million people worldwide, many of whom have not been diagnosed. Now developing countries such as India and China are experiencing Diabetes due to the trends of obesity, urbanization and lifestyle changes. Today, the outlook is most favorable with the onset of many advances. Diabetes mellitus – also referred to simply as “Diabetes” – is a disorder of the way the body uses food, characterized by high blood sugar levels that result in circulatory damage. Thus it is chronic,



meaning over a long period of time; systemic, in that it may affect all the body systems; a disorder of metabolism in which the body is unable to properly process food into energy and the circulatory system because it alters the structure of blood vessels.

Conditions that may come early to Diabetes mellitus include pre-Diabetes. It’s a high-risk state that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of Diabetes. An individual is likely to develop Diabetes and may already be experiencing adverse health effects.

Gestational Diabetes is high blood sugar that starts or is first diagnosed during pregnancy. It is not life-threatening to the pregnant mother or infant. The importance can be a precursor to Type II Diabetes in mother of infant.

There may be as many as 30 specific types of Diabetes. We will discuss the most common: Type I and Type II. In Type I Diabetes the pancreas with or without the aid of other body systems does not produce the insulin needed to maintain a normal blood glucose level. In Type II Diabetes, the pancreas and other body systems may function but a problem develops in the way the body makes or uses



insulin. Blood sugar does not get into the cells to be stored for energy.

Type I usually begins before the age of 40 with three-quarters of the cases occurring before the age of 18. Type II is usually found in adult individuals but is becoming more prevalent in obese teenagers. Type I occurs in 5% to 10% of people with Diabetes; Type II is the most common form, occurring in about 90% to 95% of diagnosed individuals.

Type I cannot be prevented at this time but it can be more readily identified by a blood test that reveals active autoimmunity action directed against the pancreatic beta cells. Type II can definitely be delayed or prevented with treatment changes once tests reveal gradual higher levels of glucose in the blood.

Type I symptoms develop rapidly and prompt treatment is essential, usually in undernourished persons. Type II develops gradually over a long period of time, usually in overweight individuals. Type I seems to have a genetic tendency: 1 in 20 offspring may develop it. It seldom occurs without a related trigger and an example of this is a viral infection. Type II offspring have a 50% chance of developing



the disease, and a 30% chance of developing pre-Diabetes. Thus it is both genetic and environmental.

Type I symptoms are three: excessive urine, excessive appetite, and excessive thirst. More often people with Type II have no symptoms at all but are diagnosed when the person goes to the doctor for a seemingly unrelated problem. Type I Diabetes treatment includes a meal plan, exercise and insulin replacement injections prescribed in such a way as to balance each other. Type II treatments include weight reduction, lifestyle change, and possible medications.

Type I complications are usually related to damage to the nervous system – for example, the kidneys, eyes, and peripheral nerves. Type II complications usually show up in the blood circulatory system causing heart conditions and peripheral artery disease.

Now I would like to switch to Diabetes and vision. The leading cause of blindness in persons age 20-74 appears to be diabetic retinopathy. Visual impairment appears as a complication of both Type I and Type II Diabetes. Modern techniques, technology and technicians have made great strides in preventing severe vision loss. Diagnosis of early visual changes can be found through a yearly exam by an eye doctor,



a dilated eye examination, and Fluorescein angiography.

When I worked at the Carroll Center in the early 1960’s, sometimes three-quarters of the students were blind from proliferative diabetic retinopathy. Now there are occasionally periods when no one has Diabetes. I understand some of my former students are online today – I say a fond “Hello.”

Visual complications of Diabetes, common ones that occur in the general population, include cataracts, glaucoma, neuropathies and retinal detachment. Some of the more common visual conditions in Diabetes include things that you’ve heard, such as fluctuating vision, diabetic retinopathy, maculopathy, central vein occlusion, retinal bleeding and non-proliferative retinopathy.

In the most serious condition, diabetic retinopathy proliferans, abnormal fragile new blood vessels proliferate in the retina and vitreous. The delicate vessels may hemorrhage, causing vision loss, scarring, and retinal detachment. Treatments vary from eye diseases and degrees of vision depending on the cause and the extent. Some treatments for eye changes are directed more at general health and a



holistic approach to diabetes rather than the eyes specifically.

In all situations with Diabetes and visual impairment there is a change that does occur, and next, to discuss that change with you in “Adjusting to Change” is Naomi Tuttle.

Naomi TuttleI’m glad to be part of this webinar and I want to discuss changes that come in our lives. Changes come with everybody; some changes are easier than others and some are much harder. Friends move away, there’s a new baby in the home, a new job, a death of a parent – a diagnosis of Diabetes can cause many changes that are hard, also.

A young, healthy person may tend to deny their need to manage Diabetes. They feel perfectly okay and they wonder “Why on Earth do I need to do all this stuff?” Some people are able to deal with blindness but then when you had Diabetes to it, it can become overwhelming. But it is manageable and this is the purpose of the seminar. We need to take seriously the goal of self-management and then other goals will follow.



I want to discuss now the results of change. Sometimes families, relationships may be disrupted. The family may not understand what’s going on and they may put guilt on you or your client by saying “You can’t eat that!” Or on the other hand they don’t understand the idea of a meal plan and they want you to eat everything.Relationships may be disrupted in the workplace or school when peers do not understand the need for snacks. This happens especially at schools. There’s a time for testing blood sugar that can also be very confusing.

Billy BrookshireNaomi do you want to take it from here?

Naomi TuttleLet me back up just a little bit on how relationships may be disrupted. Your family may not understand and they put guilt on you and your client. They say “You can’t eat that.” On the other hand they may not understand the idea of a meal plan and want you to eat everything. In the work place of school peers may not understand the need for snacks or the need for taking time for testing blood glucose.

Now I want to go on gain to grieving. That’s a very normal part of adjusting with blindness and diabetes.



There is normal grieving after the loss of health, loss of ability to drive if you just lost vision and associated independence. There is temporary depression, denial, anger and guilt. This is all normal. You may ask “Why is my body not working the way it used to?” You may worry about future job, health or hobbies. You may blame yourself and say “because I didn’t take care of myself.” It’s important to recognize this sadness. It’s important to watch out for signs of abnormal depression.

This gradually becomes worse even when a person is in rehabilitation. There is increase disinterest in life and managing diabetes. They may exhibit self destructive behavior and it could include avoiding parts of self care, meal plan, exercise and even suicidal thoughts. And a person that is abnormally depressed may completely withdrawal from family and friends.

There are some stressors I want to talk about now. Personal stressors is just worry about blood glucose lows, chronic anxiety over complications, job loss, and worry about the future. They’re interpersonal stressors. Family food choices, birthday parties, and this is especially true for young kids, and then for a mom, how to explain to your young child why mom has to take shots. Then there are environmental



stressors. When a person is on a business trip over different time zones it’s hard to try to figure out when you need to take your insulin next. Or alternating shift work is hard to adjust your meals and your medications.

For everyone with diabetes and vision loss it’s important to be actively involved in a management plan to encourage an optimistic rather than a pessimistic view of life to include and an attitude of “I can manage this.” Rather than “I can’t and I’m’ overwhelmed.” And now back to Margaret.

Margaret ClearyGlycemic control is the goal of the diabetes self managing program. A1C or hemoglobin A1C test describes a blood test that measures and individual’s average blood glucose level over the last two to three months. A1C is a percentage from four to 13. High A1C results put an individual at risk for future health problems. The American Association of Diabetes Educators recommend an A1C of 6.5 or lower. Your glycemia refers to a blood level of glucose content in the blood. It depends on a balanced schedule of exercise and food. And any necessary medications.

Planning ahead for stressful situations can help the individual to respond appropriately. A crisis plan



includes an organized food source, an emergency supplies, adaptive equipment, medical information, medication lists and pertinent phone numbers. Hyper glycemia can be caused by blood glucose remaining in the blood system rather than entering the cells to produce energy. There are special concerns during illness, surgery and pregnancy.

Symptoms include thirst, excessive urination, weight loss and fatigue. During these times the recommended frequency of blood glucose and ketone testing increases. Flexibility to adjust insulin is essential. If the individual is not prepared to do this independently assistance is necessary. Providing adequate liquids for hydration restores body fluids losses due to fever, vomiting, and/diarrhea. Severe dehydration, inability to absorb insulin, and dizziness or confusion may result.

Sick day guidelines need to be in place ahead of time and sighted assistance available. Ketone acidosis occur when insufficient insulin is present in the blood, for the body to use glucose for energy. Instead, fat is metabolized, producing ketone and showing up in the urine. Ketone testing strips need to be available. Ketone testing of the urine cannot be done non-visually at this time. The individual may pass beyond conscious ability to recognize such signs, call 911.



Hypoglycemia on the other hand is a called an insulin reaction. It occurs when little food is in the body to offset the insulin or oral medication consumed a few hours previously. Causes of hypoglycemia are imbalance of insulin, food and activity. Low blood glucose levels can develop quickly causing a myriad of other symptoms including shakiness, dizziness, sweating and confusion. The symptoms of a reaction disappear quickly if treated promptly with glucose supplement. Sometimes seizures and unconsciousness result if left unchecked. Treatment of hypo glycemia involves blood testing levels as soon as possible, consuming carbohydrates immediately, resting and followed by snack or meal. Once the blood glucose levels become normal regular activities can be resumed. Occasions for increased hypoglycemia during the night may cause concern and need attention.

Planning helps prevent the difficulties that can occur in quickly locating something for hypoglycemic treatment. Fruit, glucose substitute tablet or candy. In the olden days mobility instructors used to carry those things. Now they automatically assume the student will take that responsibility. Sometimes it is necessary to use a hormone injection called “glucone” for a severe hypoglycemic reaction.



The similarity of symptoms in acute alcoholism, hypoglycemia and non-visual disorientation can cause confusion and delay of appropriate treatment. That’s the importance of always wearing a bracelet, identifying that the individual has diabetes. When in doubt call 911. Periodically reviewing and adjusting skills, organization and equipment help to prevent both hyper and hypo glycemia. Talking further about blood monitoring will be Jerry Munden. Jerry has shown a particular interest in the development of accessibly products for which we in the field of diabetes education are particularly grateful.

Billy BrookshireIf you guys want to put forth the question on diabetic diarrhea, I’ll see if one of our speakers can address it while we’re waiting for Jerry to call in.

Maura GritsHi, this is Maura [Grits] and I’m responding to the question about diabetic diarrhea. That’s commonly called “gastro paresis.” And it is one of the complications of diabetes that takes place in the various systems of our body. This particular one takes place within the digestive systems. It occurs because the nerves of the digestive systems are affected by the diabetes. And treatment for it depends on many



different factors. Some of them having to do with basic diabetes self managing and the management from a treatment perspective.

It may include nutritional assessment and recommendations. It may include a chance in insulin. It may include a number of different things from a practical point of view it does behoove a person who has it to have very careful assessment of what causes it. And then there are some other types of remedies that can help with some of the symptoms that cause discomfort. For example, when eating out or going places, it does require a lot of self managing. If anybody would like to talk with me more about that later I’d be very happy to talk with them.

As far as diabetes causing problems in the tactile system there is no question that neuropathy does affect ability to read Braille. That does not mean that a person who as neuropathy cannot learn to read Braille. But there are some very special techniques that need to be used in order for people to learn enough Braille to use it effectively. The goals of diabetic neuropathy may be different in a person with it than it is with a long-term reader of Braille, for example.

Billy Brookshire



Okay, folks. I’ve got Jerry back here with us and I’m going to put him on the line so you can listen to him. And so he can tell you about the new products Prodigy has available. Jerry, go for it.

Jerry MundenI appreciate the opportunity to talk to everybody and to be part of the conversation now. To give you an update on some of the technology that’s been introduced as it relates to spottiness vision impairment and diabetes. I guess everyone is familiar with the Project (inaudible 0:20:34) that has been published by Access Plus Awards for both the National Federation for the Blind and the American Foundation for the Blind. We have that product, it’s done very well. Also, we have a new version of our (Inaudible 0:20:50) meter. That is a no-code colored meter for languages. I’m talking about a bunch of products I guess because I’m the Prodigy Vice President of Sales and also Prodigy is the forefront of bringing new products to life. I’ll talk about some other companies as well and I’m going to try and share information not just exclusive to Prodigy but new technology in the diabetes industry for accessibility.

Another product that is a Prodigy product is (inaudible 0:21:35). It is a manual device that allows sight impaired or blind person to fill an insulin syringe



without sighted assistance. And we brought that back to market last year at the request of the National Federation of the Blind and other blind associations. It was taken off the market by the company that made it. They went out of business. At the request of the NFB and others we bought the rights to the product and brought it back last year in some projects.

We are working on a new technology, audible insulin pump. It’s called the Prodigy [IQ] Pump. It is a fully accessibly talking pump with a touch screen technology. We’ve been working on that with a team of about engineers for the past year and a half. Where we stand with that right now, we have a prototype in our labs. It’s still being refined. As soon as we can work through the refinement and complete the product we’ll send it to the FDA for approval. To give you an honest answer, right now the FDA is working a lot slower than we would like, particularly on insulin pumps. They’ve been really scrutinizing and they’ve been slow but we’re working as quickly as we can to finish our side of the business so that we can get it to the FDA as quickly as possible.

Another product based on another company is [a Voice Aurex] talking pill bottle. It’s supposed to be complete the third quarter of this year and it will be rolling out in North Carolina and then rolling out to the



other states after the North Carolina evaluation. Well, it’s not evaluation; it will be rolled out in North Carolina. Once North Carolina is set it will be rolled out to other states. I believe the [Voice Aurex] pill bottle will work. It will be a mail-order pharmacy and it will be a disposable pill bottle that will give information from the red label on the prescription.

If you have medications you want in a talking pill bottle that’s how it will be billed and the prescription will be mailed to the person’s store. That will be available at no charge. It will be the cost of other mail-order prescriptions to the patient if they’re on Medicaid, Medicare or a private industry, whatever the payment is for a normal mail-order prescription that will be received and put in a talking pill bottle for no extra charge.

Some other things we’re working on are education pieces. I work personally with North Carolina Diabetes Advisory Council group and we’re working on new education and processes for people to better manage their diabetes. Prodigy also is a member of the Healthy Weight Commitment Foundation and they offer a lot of resources on their website about making wise choices for living well with diabetes, from diet, education, exercise, and different things of that nature.



We’re also personally working with a group based out of New York City called the Network for Health Action and Living with Diabetes. They’ve also got an (inaudible 0:26:05) lab, and innovation and technology with that group too. So looking for new technology to manage to enable people to make healthy living decisions for diabetes and basically get a handle on the diabetes epidemic that’s not excluded to sight impaired people but is actually something that all 25 million people in the United States address each day.

That’s the short version of some of the things I was going to share today. If there are questions I’d be glad to try to answer them.

Billy BrookshireThank you, Jerry. I guess, folks, now we’re open for question and answers. Unless Margaret or Naomi has something else they would like to say. And it looks like Margaret you’re up, so I’m going to turn the microphone over to you.

Margaret ClearyTalking about a healthy meal plan; the American Diabetes Association outlines the following goals for medical nutrition therapy. For individuals with pre



diabetes the goal is to decrease the risk of diabetes and cardio vascular disease by promoting health food choices and physical activity leading to moderate weight loss that is maintained.

For an individual with diabetes some of the goals are to achieve and maintain your glycemia as close to normal as safely as possible. Prevent or at least slow the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle. And addressing the individual nutrition needs taking into account personal and cultural preferences and willingness to change.

An individual with diabetes does not have to give up favorite foods but it is necessary to pay attention to how much is eaten, when it’s eaten and what affect food has on general health. The American Association of Diabetes Educators developed the AADE Seven Self Care Behaviors which describes seven areas identified of importance in diabetes education. Handouts of this are available through the diabetes educator organization. One of the behaviors is AADE Seven health eating, it suggests making healthy food choices, understanding portion sizes and learning the best times to eat are essential to managing diabetes.



Diabetes nutrition education classes taught by a dietician or nutritionist assist individuals in diabetes and gaining such knowledge. The rehabilitation therapist provides instruction to adapt the skills to visual or adaptive methods. A word about non-FDA approved dietary supplements. Supplements are not approved for use for diabetes treatment but there are pharmacological active products that may have the benefit in diabetes treatment. Strides are being made in this area with different verification programs and with use of standardized extracts. New risk accessible resources are available to the American Association of Diabetes disabilities community of interest. For information please call them at AADE.

Moving along to exercise and relaxation, I know that our time is more limited now so I’m going to skip along on that other than to mention the importance in exercising of anchoring. Anchoring is a term used in many ways. But for purposes of rehabilitation it refers to the process of securing or connecting to somebody or something. Anchoring provides stability and keeps the individual in place when exercising. An example of anchoring exercises include using exercise equipment such as a stationary bicycle, etc, standing near a wall, sitting in a chair, placing hands on a table. Performing exercises that are conventionally done lying down or bending forward from the waist instead while sitting in



a chair. Walking with a sighted guide on a treadmill or in a designated area that has been equipped with a guide wire, rope or railing.

The important thing to know is that people with diabetes just don’t get enough exercise. Precautions regarding the possibility of hypoglycemia need to be taken into consideration. Wearing a medical alert tag or bracelet, having available appropriate food ready, taking blood glucose along, making food, fluid and insulin adjustments during exercise and informing other persons around when exercising at community facilities. There is no best time to exercise as long as you’re consistent. Pay attention to fluid intake, adjust medications, and consume appropriate calories.

A relaxation program becomes equally important as exercise and physical activities. A variety of techniques can be used from visiting to friends, to yoga to listening to music. I once worked with a lady who told me whenever she felt stressed she reorganized her spice cabinet.

A few words about medication, taking medications at AADE Seven states that diabetes is a progressive condition. Depending on what type the person has the health care change will be able to determine which medications they should be taking and help them



understand how medications work. Effective drug therapy is combined with healthy lifestyle choices. The goal for the patient to be knowledgeable about each medication includes action, side effects, efficacy, toxicity, prescribed dosage, appropriate timing and frequency of administration, effects of missed and delayed doses and instructions for support, travel and safety.

In order to achieve these goals the healthcare provider prescribes the treatment plan. The diabetes nurse educator takes responsibility for teaching procedures for healthcare recommendations to the individual and any involved rehabilitation personnel. And the rehabilitation vision therapist offers expertise in the use of adaptive skills.

Medication therapy management is collaboration among the pharmacist, the patient, and other healthcare professionals for affective medication therapy. There are three kinds of possible medications. There are oral diabetes medications, non-insulin inject able medications and insulin injections. Oral diabetes medications include some type that increase the production of insulin and improve output of glucose from the liver, help move circulating from the blood stream into the blood cells and other specific actions.



Keeping track of information about each medication is essential. A system to organize, label and take the right medication at the right time and the right amount is essential. That includes the name of the medication, the amount to take, how many times a day to take it, when to take and if when prescriptions can be refilled. The device that Jerry mentioned that may be coming on the market in the fall sounds like a very interesting addition to the types of resources that are available to help manage medication.

A fairly new product is called a Ten Friend. It’s available from either Independent Living Aides or Maxi Aides. This audio labeler for non-visual marking of medications can be used for many labeling activities. The consumer merely talks into a device placed on a label. The label is then attached to an item. The device reads back what has been imprinted on the label. I talked with a young man yesterday that I’ve been working with here in Colorado who told me that he has labels on everything in the house now and he just walks around with his little pen friend wand.

Noninsulin inject able medications work in hand with oral hypoglycemic agents but are not necessarily the types that effective the insulin itself. But it does stimulate the pancreas and helps with weight control.



You may be familiar with the terms Byetta, Dictosa and Similan. My friend Anne a diabetes educator lost 30 pounds with the help of Byetta.

As you know insulin’s role is vital in order to process food. Because of time involved I’m not going to go into the various types of insulin. I’m just going to say that there are many ways of utilizing insulin now. The syringe with an adaptive device such as the counted dose, the pump, alternative methods and the insulin pen. The disposable insulin pen is becoming more and more popular. They look and feel like an old fashion cartridge pen. They’re convenient, small enough to fit in a pocket and are generally disposable.

Finally, I would like to mention complications. Complications of long-term diabetes affect skills. An understanding of the implication and functional outcomes of various complications of diabetes help achieve the best rehabilitation results. Rather than discussing specific complications I would like to leave you with some suggestions to consider.For the educators and therapists who are listening to this webinar, skill teaching needs to be adapted to compensate for complications. Remember, difficulty with stairs, uneven pavement or detection of surface irregularities challenge adaptive measures and may even access to your office. Reduce hand and finger



dexterity effects manipulation. Timing of medications, meals, treatment periods, weather and need for rest all affect the individual’s ability to perform. Bending or lifting restrictions alter activities. Sensory losses can make acquiring new skills more difficult.

Proximity to toilet facilities often becomes a factor. Reduce schedule or shorter lessons need to occur. Weaknesses of strength and stamina often indicate the need for changes in techniques, such as using a long cane or guide dog.

For individuals who have diabetes here are some helpful hints to cope with related complications. Be aware of any changes in your physical or emotional conditions. Report suspicious changes in the body to the primary care provider as soon as possible. Obtain a third assessment of the functioning of the other sense. See the care team on a regular basis, usually every three to six months. Visit your eye doctor for a dilated eye exam once per year. Take care of your feet; perform a daily non-visual self examination of the feet. And ask the healthcare provider to do a complete foot exam every year. Have your cholesterol, lipids and A1C checked regularly. Check blood sugar and blood pressure regularly with adaptive devices. Maintain your individualized recommended blood glucose levels.



Participate in regular exercise of a comfortable type and duration. Plan to eat according to a meal that includes nutrition. Plan to perform self managing tasks when symptoms calm down or are at a minimum. Avoid temperature extremes; take into consideration the size, materials and protective availabilities of footwear and other clothing. Use devices that are prescribed such as orthotics, hearing aids, and support cane. Work with related professional to clarify any factors that might interfere with their recommendations. Assess the added reliance up sighted assistances. Prioritize when it is essential to need family and friends and arrange for volunteers or paid providers when possible.

As I complete this formal presentation I want to encourage you to investigate Hadley’s diabetes course toward self management if you have not already done so. Also be aware of the upcoming, fully accessible online courses soon to be available through the Carol Center for the Blind. Brian Charleston, the producer, and myself is the curriculum developer. These courses will be “Diabetes and Visual Impairment; A New View for Professionals.” And “Diabetes and Visual Impairment; a New View for Patients and Families.” Also, AER has an upcoming preconference this summer in Boston and in



Cleveland in October, featuring the topic that we presented today. Stay tuned, we’re not open for questions.

Billy BrookshireOkay, as Margaret said we’re going to open everything for questions now. I noticed in the chat room there were several questions for Jerry so I thought we’d just begin with those and then I’ll leave it open to the microphone for all of the questions that come in.

There were several questions for you Jerry. One was a little bit about who you work for, the company you work for; then there were questions about the pill bottle, the talking pill bottle. How long do you think it’s going to be available? And are there any online studies that people can read up on?

Jerry MundenI’ll start off with a little bit of information about Prodigy. Prodigy Diabetes Care is the manufacturer again of the Prodigy voice meter. I’ve been in business for over 20 years. The owners of the country have previously; they were making private label products for some of the big manufacturing companies; began the Prodigy line about five years ago. That’s about when I joined the company. The main product to get it



out there prior to that was the (inaudible 0:40:23) Voice Mate, and unfortunately that product was taken off the market. When that happened the NFB and a lot of the major blind associations asked all of the major meter companies if they could make a talking meter. And unfortunately the answer was "No.” They asked us, I’m the Vice President, I said “Yes.” Our president is diabetic. His grandfather was a blind diabetic so we said yes. We made the first standalone talking meter. That was Prodigy Audio.

The next question was how does a blind person code their meter? Can you make a no code meter? We made one of the first no code meters, the Prodigy Auto Code which is our flagship. That did very well, with that product. The next question was Can you, Prodigy, make a fully accessible meter? We worked with NFB and other groups for over a year in the development of Prodigy voice meter and that’s how that came about.

To give you a little history, I work with about 700 leaders in the blind associations on a regular basis. I listen to what the needs are and try to make products that fit those needs. We’re working on a talking insulin pump. Again, we came out with the CounterDose when that product was taken to the market; we also had other products in the works. Let me see, another



question was when is the pill bottle going to be available? Again, the company that will make that is called the Voice Rx and they’re looking to release that product in the third quarter of this year. It will be sold through a mail-order pharmacy, Voice Rx and it will roll out in North Carolina. After a period of time, maybe 90 days it will be released to other states across the country.

Was that the question that was answered for the Voice Rx pill bottle?

Billy BrookshireThat was it. That was it. You got a couple of more questions while we’ve been talking. One is “Is the Prodigy Voice going to be made available in Canada?

Jerry MundenThe answer, will Prodigy voice be available in Canada? We’re working as quickly as we can to get the Canadian approval to release it in Canada. Unfortunately it’s been a slow process. I was up in Canada a year and a half ago talking with folks up there at the trade shows. But unfortunately we have not gotten the Canadian approval to sell them to Canada yet. We are making an effort to get that done. We have an employee up there and we would love to



sell products to Canada. It’s just meeting their approvals.

Billy BrookshireThanks, Jerry. Some of the folks were having trouble understanding the names of all of the resources and have asked for a resource list. If you wouldn’t mind sending me that I can post it with the webinar when it’s archived.

Jerry MundenSure.

Billy BrookshireOne more question here and it’s related to any resources somebody might use who needs a talking glucose meter but doesn’t have any insurance?

Jerry MundenWell I know a lot of folks, is this someone who would not be covered by Medicaid or Medicare?

Billy BrookshireI’m assuming that answer is yes.

Jerry MundenIf they can send me an email I can see if I can get specific information for that person to be of help.



Billy BrookshireOkay, your email address, Jerry?

Jerry MundenIt’s [email protected]

Billy BrookshireOkay, I’ll write that down for folks and put it in, [email protected]

Jerry MundenI didn’t hear what was said by Naomi and Margaret. I’m sure they shared a lot of information. Some other resources we have on our website Bridging the Gap: Living with Blindness and Diabetes. It’s an NFB audio book. 19 Experts on Blindness and Diabetes. We also have audio materials from the Blind Industries and Services of Maryland. There is some audio information on living with blindness and diabetes on our website. And also one of partners is Dave Joffee, who is the editor of Diabetes and Control, which is a large electronic diabetes information source. People can email questions about diabetes to Dave at [email protected] and Dave will give a personal email back to address those questions. If that will be of help.


mailto:[email protected]




Billy BrookshireVery much so, Jerry. I’ve got some more questions coming in. I’m going to turn the mic over to Margaret and Naomi. Margaret and Naomi we’ve got a couple of questions. One is what to refrigerate and what not? And anymore ideas that you have for resources for folks who are low income. So folks, give Margaret and Naomi and chance to talk about these and then I’ll open up the mic to any questions that come through. Margaret the microphone is open now.

Margaret ClearyHi, in working with people doing diabetes assessments and training, I frequently am asked that question about resources that are available for people who don’t have insurance. As far as monitors are concerned, work closely with your diabetes educator or your health professional who specializes in diabetes. They very often do have monitors that are available. Also some of the catalog houses have monitors that they can provide free of charge. But there still doesn’t seem to be any kind of a way of getting the strips without paying the cost. So, that’s one thing that has to be considered.

In addition to that, as far as other pharmaceutical medications are concerned. Many of the pharmaceutical companies do have a plan for people



who are not able to provide their own medications. So contact your pharmaceutical company for the drug that has been suggested or prescribed for you. In addition to that, your county and state organizations often times have ways of providing those things. So you contact your state welfare department, usually this can be done through a vision therapist or the services for the blind in your local community.

Naomi, do you have something to say?

Naomi TuttleNo, you guys are doing fine without me.

JohnI have a question. I was wondering; I’ve only been suffering from diabetes for the last four years and it’s Type 2. And I’m also suffering from Type 2 diabetes as well as bulimia, which is an eating disorder. Is there any conflict there? Is there any easy to get around that besides diet counseling?

Billy BrookshireMargaret, Naomi either one of you want to tackle that?

Naomi Tuttle



My advice would be to know that there is a definite relationship between the two. And the success of the treatment of either depends on addressing a care plan that includes treatment for both. I would refer you back to you r medical care provider if you’re not satisfied with the assistance that you’re getting from your current provider you may need to look for some specialist who deal with that.

There are a number of different articles that have been written about bulimia and diabetes, eating disorders and so forth in some of the magazines, such as Diabetes Forecast and Diabetes Self Management that you may want to pursue. Contact the American Association of Diabetes Educators or contact the American Diabetes association for that kind of information. And good luck. They’re both very difficult problems to have and I wish you well in addressing them. I give you credit for attempting to do that.

Billy BrookshireThank you, Naomi. Any other questions from folks while we’ve got the mic up? Oops, sorry folks, I saw a couple on the chat room. Margaret you probably want to talk with this one. Laura has asked how often should she upgrade her meter and she’s also offered a suggestion for the core reason of the eating



disorder also. She has the same history. She suggests therapy. And how often should I upgrade my meter, Margaret?

Margaret ClearyHi, Laura. Thank you for both of those comments. And yes, I do agree that therapy can be very, very helpful. And there are people that specialize in therapy for eating disorders. They may not be available as a local resource but their writings and their thoughts can be available to you, John.

As far as updating your monitor, I suggest that you pay careful attention to testing it occasionally to make sure that it is still accurate and making sure that you agree yourself that the monitor is working accurately. The update depends really on a number of factors. One is that if you are on insurance the insurance only provides money for meters over a period of time. The period used to be five years. My experience has been that we have been able to provide talking monitors in less time than that. Particularly if the person has not had a talking meter before. So that’s something you need to consider with your insurance.

It may be in your benefit to purchase a monitor or to get in touch with a company that gave you your monitor if you feel that it runs out of the efficient prior



to the time that the insurance company has provided for you.



Billy BrookshireOkay, folks I was hoping we could get a few more questions in there but we have come to the end of another broadcasting day here. I’ve really enjoyed this presentation, I hope you have also. Margaret, Naomi, Jerry you guys did just a wonderful job. I appreciate your information.

I do want to remind folks, this seminar like all of the seminars we have here at Hadley are archived on our website. You’ll find them under “past seminars” on the seminar webpage. They’re available 24/7, 365. If there are resource lists and things like that we post those with them also.

Hadley related courses, we have a couple of things you might want to check out folks. There is another webinar, another seminar that’s archived. It’s called “Managing Diabetes with a Health Diet.” You might want to check that out. We also have a course that probably everybody could benefit from called “Diabetes towards Self Management.” I strongly recommend that also. In fact you heard from your instructor today.

Thanks again everybody for participating. As you know we value your feedback. If you would like to let us know something about this particular seminar or if



there are other seminar topics you’d like to see us address later on just by all means send an email to [email protected] that’s [email protected].

I’m going to hand the microphone back the presenters for a final fair well and since I’ve got Jerry here on the mic with me, I’ll give Jerry the first shot. Jerry any fair well messages to the participants?

Jerry MundenI appreciate the opportunity to speak to everyone today. You talked to me about putting together a resource list and I’ll give you that resource list. I know we do a lot of with the free clinic. There will be several different sources to address some of the product and resources questions that I’ll give to Billy for any questions that might need some answers yet.

Billy BrookshireThank you, Jerry. Margaret, Naomi any final words?

Naomi TuttleI just want to thank you all for the opportunity to do this webinar. And thanks to Margaret and Jerry. I look forward to having a lot of you as students if you haven’t taken the diabetes course.

Margaret Cleary





I echo my thank you to you for listening and for participating and asking good questions. I too look forward to having some of you as students in the upcoming Carol Center course and also continuing with those of you who are working with Naomi as the instructor of the Hadley course. Thank you and thank you to both Jerry and Naomi for helping pull this together.

Billy BrookshireThanks you guys, another labor of love to help lots of folks. I appreciate everything you three have done and everything you had to say.

This is for those folks who want continuing education credit, just bare with me and I’ll tell you all about how to do that. If you want to earn continuing education hours what you need to do is complete a separate registration and payment process. You can find that link on the section “earn continuing education hours” on the seminar page. That’s at www.hadely.edu/seminar the instructions on how to log into the quiz will be given to you by email once your registration is complete.

When a seminar is passed like this one is about to be you can access the information and list of approved seminars for continuing education hours by going to


http://www.hadely.edu/seminar


the past seminars page and link to it off the Hadley website. You need to allow about 48 hours for archival of recordings. It takes us about that long to get them up on the web. But it won’t affect your registration for your continuing education hours process.

The quiz is going to be open folks in approximately 15 minutes after we shut the seminar down. You get two tries per registration to get a passing grade of 70% or more. If you fail twice you’ll have to reregister and pay again. So make sure you do it right the first time. You get seven days from the first failed attempt to try again. But once you pass a certificate is issued electronically right after you complete a short survey and evaluation. The system also provides access within seven days of successful completion for you to view, save or reprint your certificate.

One closing thing here folks and that’s if you ever have a tech problem you can write in about that to [email protected]. That’s [email protected]. And the kind folks there will help you out. If you’ve got general inquiries about anything related to Hadley just write a message to [email protected]. That’s [email protected]







Okay, folks, thanks again to the presenters. Have a wonderful weekend folks, we’re glad you came. Again, remember that on the 21st we’ve got another webinar coming up. It’s called “Everything Eye.” That’s June the 21st at 2:00 PM Central Daylight time. I hope some of you will join us for that also. Fair well, take care of yourselves.

[End of Audio – 0:57:46]


2011-06-09-living_well_with_diabetes - hadley · web view2011/06/09 · a1c or hemoglobin a1c test...

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