Diabetes and visual impairment—you can help!

You are providing care to a patient using insulin to manage type 2 diabetes. The patient has macular degeneration and is living alone. What options are available to help them continue to independently manage their diabetes?The eyes are vulnerable to the effects of diabetes. Ideally, it is best to prevent visual impairment through managing glucose levels, hypertension and cholesterol. However, despite best efforts, visual impairment affects every third or fourth person with diabetes. This condition is often age-related, mostly occurring among adults over 50 years of age.1,2Visual impairment is a heterogeneous condition with a multitude of potential causes. It has varying levels of severity and differing rates of progression.2 Eye conditions associated with diabetes include diabetic retinopathy, glaucoma, corneal disease, cataracts, refractive errors, extraocular muscle impairment, macular edema and/or optic neuropathy.1-5 Patients with visual impairment are at elevated risk of experiencing diabetes-related morbidity and mortality.5Issues faced by sight-impaired patients with diabetesPatients with vision loss or blindness face limitations in their ability to visually perform many of the daily self-care practices needed to maintain their health and optimize blood glucose. They may become anxious or depressed about limited vision and discouraged about playing an active role in their own care. Those with low vision often struggle with assessing the integrity of the insulin injection site, delivering the complete insulin dose, accurately using the blood glucose meter and completing a visual check of the device (e.g., insulin pump, blood glucose sensor) site.2Treating diabetes and the recognition of both hypo- and hyperglycemia depend upon the ability to carry out blood glucose monitoring.3 Individuals with visual impairment experience disproportionately higher rates of poor quality of care compared to those without visual impairment. Relying on a family member or external help to administer medication may impact adherence and even incur additional costs.6 Issues that patients with visual impairment may face include difficulty with blood glucose testing, rotation of insulin shots, manipulation of insulin pumps and changing sets, or placement of a continuous glucose monitor (CGM). They may also have difficulty with carb counting due to small print on labels.1,2Helping patients with sight impairment manage their diabetesMany medical products are available to help with the management of diabetes, including blood glucose monitors, insulin pumps, CGM devices and insulin pens. To get the most benefit, people with diabetes need to interact with these systems, which requires them to have visual acuity. Despite advancements in technology over the years, medical devices and/or products that are accessible for patients with any form of vision loss are scarce.3,6Blood glucose monitoringPatients with visual impairment face challenges with blood glucose testing, including the ability to pick out a small test strip from the container and insert it into the small slit of the blood glucose meter. Following this, the person needs to prick their finger to get a blood sample and ensure that enough blood has been placed on the strip. The next challenge is to read the measurement results on the glucometer’s screen.1,3To help increase the amount of blood applied to the strip, advise the patient to wash their hands with soap and warm water, hang the hand to be tested down and shake, massage the finger to warm it up or wrap a rubber band around it. Using lancets that have a drum may be more helpful than having to replace each lancet separately. Bringing the finger to the meter placed on a hard surface makes it easier to apply blood. Placing bump dots (or having a tactile marker on the monitor to mark where the strip can go) helps to guide the patient as to where to put the test strip in the meter.1,4,6Blood glucose monitors that are ideal for people with visual impairment have a good backlight allowing high contrast for readability. Meters available in Canada with this feature include Accu-Chek Guide,8 Freestyle Lite9 and Contour Next One.10 Other features that are helpful include not needing to code strips, smaller blood samples and the ability to add additional blood if needed.3,6,11Meters with the ability to announce blood glucose levels are also helpful.1,4,7,12 In Canada, the Oracle blood glucose meter has this ability.13 Currently, the only CGM system on the market suitable for visually impaired or blind patients is the Dexcom G6. It can be integrated with Siri to audibly report the patient’s blood glucose and indicate the arrow trend.14Other suggestions would be to place bump dots on the monitor to mark where the strip can go, or to place the meter on a contrasting surface (such as a coloured tray or table top) and bring the finger to it. As a side note, using a tray may help to organize diabetes supplies and contain any dropped medications.1,6,15Insulin dosingWith insulin pens, it is helpful to choose a pen with a loud and audible click.1,3,4 Ideally, prefilled pens should be dispensed, but it is important that the patient is aware of any concentration changes (e.g., for insulin degludec, the 100 u/mL pen increases in 1 unit increments, whereas the 200 u/mL pen increases in 2 unit increments).16 If a patient is using more than one type of insulin, try to ensure that the pens are different colours or have different tactile markings to make them easily identifiable.12 Another option would be for the patient to use premix insulin, as they would receive both the basal and bolus insulin twice daily instead of needing to do separate basal and bolus insulin injections up to four times per day. It may also be advantageous to pre-draw insulin into syringes and store them in the refrigerator.1Other suggestionsSome adaptations for patients with visual impairment who are administering medications include using rubber bands or bump dots to mark the pill bottles or vials, and using a syringe magnifier. Syringe magnifiers that attach to the insulin vial and syringe make it easier to see the dosing line.1,12Other suggestions for patients with visual impairment include using a brightly lit lamp and magnifying equipment to help ensure the correct doses of oral medication and insulin. Standing magnifying glasses offer a hands-free alternative for using devices, administering medication, reading labels for medications and carbohydrate counting.1,4,12,17SummaryIt is important to identify the needs of patients with visual impairment to ensure the safe administration of their medications.2 Unfortunately, even though diabetes is a major cause of visual impairment, manufacturers indicate that the development and approval of medical products for this population is associated with additional costs and product liability risks.3 Any support that you can provide to your sight-impaired patients can help keep them self-sufficient in their diabetes management.Rhonda Roedler is a pharmacist in Calgary, AB. She maintains an ambulatory clinical practice in diabetes.References:Medbridge. Managing diabetes with low vision: adapt and overcome. (accessed June 11, 2025).Healio. Diabetes self-management still possible with vision loss. (accessed June 16, 2025).Heinemann L, Drossel D, Freckmann G, et al. Usability of medical devices for patients with diabetes who are visually impaired or blind. J Diabetes Sci Technol 2016;10(6):1382-7.American Diabetes Association. Living with low vision. (accessed June 13, 2025).Heydarian NM, Brown-Podgorski B, Ramirez J. Visual impairment and self-efficacy in diabetes management. Sci Diabetes Self Manage Care 2021;47(5):346-54.Nguyen C, Lim L, Conard E, et al. Accessibility of diabetes therapy management for patients with visual impairment. Innov Pharm 2024;15(3):10.24926/iip.v15i3.6233.ConnectCenter. Managing diabetes with vision loss: tools and techniques. (accessed June 18, 2025).Accu-Chek. Meter systems. (accessed July 3, 2025).Abbott. Blood glucose monitors. FreeStyle Lite. (accessed July 6, 2025).Ascensia Diabetes. CONTOUR NEXT: Blood glucose meters and test strips. (accessed July 6, 2025).American Foundation for the Blind. Managing diabetes with a visual impairment. (accessed July 6, 2025).Diabetes Care Community. Managing diabetes with impaired vision. (accessed June 10, 2025).Oracle. Talking blood glucose monitor. (accessed July 6, 2025).Dexcom. How do I set up Siri on the Dexcom G6 app for iPhone? (accessed July 6, 2025).Association for Vision Rehabilitation and Employment. Managing diabetes with vision loss. (accessed June 17, 2025).Novo Nordisk Canada. Tresiba (insulin degludec injection) product monograph. Mississauga, ON; October 27, 2022. (accessed August 12, 2025).Felman A. Coping with vision loss from diabetes: tips, causes, and more. (accessed June 16, 2025).

Diabetes and visual impairment—you can help!

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