Sunday, January 31, 2016
"Potato bread?!" I exclaimed. "I wouldn't be able to eat that, either!"
"Oh, that's right," he chuckled as the doctor walked back into the room with the blood test form.
I didn't realize it at the time, but it was my first hint that often people with one autoimmune disease develop another (or several others). I learned that fact years later as I delved into reading online diabetes content.
Thankfully, I didn't have celiac disease when I was tested back in 1991, and I haven't developed it since. In fact, I've gone for over 20 years without developing another autoimmune condition, although my immune system has remained plenty overactive in the form of allergies and related conditions. Over the past year or two, these allergic conditions have clamoured for a spot that rivals diabetes in terms of their effect on my everyday life. I actually found myself getting a bit cocky. My immune system has been so focused on attacking the external world—maybe I won't be one of those people who develop multiple autoimmune conditions.
But then, sometime during the fall, things began to change.
I gradually began to feel tired. Exhausted, in fact. Getting up in the morning or running errands became great feats of willpower. I worked at getting my sleep schedule exactly right, as it had somehow become messed up with me being unable to fall asleep for hours or waking up restless and hungry and hot in the middle of the night. I worked on exercising as consistently as I could, which I'd stopped doing because I felt so tired all the time. I worked on eating better, because my stomach had been getting upset a lot lately. I worked on controlling my blood sugar better, since it seemed that my pump settings were suddenly all wrong and I was spending a lot of time battling highs. I worked on keeping my allergies under better control, thinking that those could be the cause of my tiredness as well as my eyes being in a constant state of (at times almost unbearable) irritation.
A small alarm bell went off in my head when I found my arm getting tired just lifting a one-litre carton of almond milk to pour. I called my GP and made an appointment. It was my first inkling that this wasn't normal tiredness. Around the same time I also noticed that my heart was pounding much of the time for no reason. One day I also found that my hands were trembling when I did things like cooked or unlocked a door, which raised my level of concern a notch farther but that I thought must be from my muscles being so ridiculously tired. And, as things approached the coming climax, I found myself feeling overheated and dizzy at times, but who wouldn't when their body acted as if cooking dinner was running a sprint?
Fortunately or unfortunately, I didn't make it to the appointment I'd scheduled with my doctor. One weekend, in the middle of sitting having a lengthy text conversation with a friend, my heart started to pound faster than it ever had before. I interrupted our conversation to tap out: I don't think it's normal for my heart rate to be 140+ while I'm just sitting here. :(
As my friend's alarmed return text popped onto the screen and my fitbit's readout climbed to 186 bpm before cutting out completely, I sensed that things may have reached a new level of severity. I tried lying down, and although that lowered my heart rate somewhat, it still beat far too fast. A text came through from my friend suggesting I go to a walk-in clinic. I called my parents to ask their opinion. They suggested the hospital. I decided to wait an hour to see what happened, but when nothing changed, my parents came to pick me up and together we headed for emergency.
Upon arriving at the hospital, they wouldn't even let me walk to the bed; I was immediately taken into the back in a wheelchair. In short succession I got hooked up to monitors, had a chest x-ray, got a bunch of blood drawn, had an ECG done, and had an IV inserted after only two failed attempts (not bad for me). I told them about how bad I'd been feeling lately, at least everything I could remember amid my mind's worried thoughts. A couple of hours later I had another ECG done and got more blood taken. And then I lay there for hours, alternatively talking to my parents and texting my friends and resting because even texting raised my heart rate and tired my arms out, wondering what was causing my body to go haywire. Emergency doctors and cardiologists came by and ran through some possibilities related to my heart, none of them sounding particularly good.
At some point after midnight my parents left to go get some sleep. And then, during the early hours of the morning, one of the doctors came by again to tell me that my blood test for TSH had come back so low that it was undetectable.
"Thyroid," I thought. I felt a jumble of emotions all at once. On one hand, this was probably the answer to why I'd been feeling so horrible, and I was positive that a thyroid problem was way better than a heart problem. On the other hand, I had no idea how an undetectable TSH level was treated. I also had a hunch that thyroid problems were autoimmune, and felt a flash of annoyance that my immune system had screwed up once again.
I stayed in the hospital until the following afternoon. During the night I was given a beta blocker to slow down my heart rate and lower my blood pressure. Not having my heart pounding as if I was exercising while lying still allowed me to sleep for a couple of hours. During the night and the next morning I was visited by a number of endocrinologists who ran through a list of symptoms. Obviously my heart rate was fast and my blood pressure was high, but had I been tired lately? Yes. Trembly? Yes. Upset stomach? Yes. Trouble sleeping? Yes. Hungry? Yes. Hot and sweaty? Yes. Irritated eyes? Yes. About the only symptom on their list I hadn't experienced was losing weight. And although they didn't ask about my blood sugar lately, I did learn that thyroid hormone affects almost every part of the body, including the speed at which food digests. That would probably explain my struggles with spikes and why it seemed as if all my pump settings were wrong.
The endocrinologists also explained what was going on. My thyroid was pumping out way too much hormone, which is why my TSH level was so low. I was given a medication to block my thyroid from making the hormones T3 and T4. The exact cause wasn't known yet but, as I suspected, they said the most likely cause was an autoimmune attack.
I texted my parents in the morning to let them know what was going on. My hospital breakfast was not terrible and, impressively, accommodated my multiple food allergies. (I'm not sure why I find this so impressive; perhaps because the last time I was in hospital my mom inspected the food as if she thought they were trying to kill me.) The doctors offered to keep me admitted for another day or two, but said it was safe to go home if I wanted that option. Of course I decided to go home, bringing with me two prescriptions, a form for lab work, and information about getting a few other tests done.
After I got home, I continued feeling awful for the next month. I used up a fair number of my work sick days, although luckily the Christmas break provided me some built-in recovery time (even though it's not great feeling sick over the holidays). Some complications happened in terms of medication—I found out when I saw my allergist that beta blockers can block asthma medications and epinephrine. Not good for someone with asthma and food allergies. So, I took as little as I possibly could with plans to stop as soon as I felt better (which had been the plan all along).
Finally, one morning more than a month after starting the thyroid-blocking medication, I woke up and actually felt awake and energetic. I went about my day and my heart wasn't pounding and I wasn't wanting to collapse into bed by early evening. It was such a relief. I didn't fully realize how awful I'd been feeling for months until I finally felt better. Once I felt better, my blood sugar also took a dramatic turn for the better.
I saw my regular endocrinologist last week, six or seven weeks after this whole ordeal happened. He had all the test results from the hospital, including the blood test they did to see if I had antibodies attacking my thyroid. Not surprisingly, the antibody test was positive, meaning I have Graves' disease. This is an autoimmune disease where antibodies attack the TSH receptors on the thyroid. Even though my body's TSH level went to zero, trying to tell my thyroid to quit making hormones, my thyroid thinks that it's constantly being told to pump out more hormones because it's being stimulated by the attacking TSH receptor antibodies.
By the time I saw my endocrinoloigst my T3 and T4 levels were one-half to one-third what they had been at the hospital and were in the normal range. My TSH level, though, was still near zero. And so the plan that my endocrinologist outlined is to stay on the thyroid-blocking medication, get thyroid levels checked every six weeks so that he can adjust the dose as needed, and then continue the medication for a year or two. Some percentage of people are able to stop taking the medication after one or two years because their immune system stops producing antibodies, but many aren't. So, if I'm still needing thyroid-blocking medication in a year or two, we can talk about other options. Other options being destroying my thyroid, which doesn't sound appealing to me. Either way, there will be medication for life (either thyroid-blocking medication or thyroid replacement medication), unless I'm in the lucky group that has the thyroid antibodies disappear.
This entire diagnosis shocked me and caught me completely off guard; partly, I'm sure, because of the drama of being diagnosed. Like diabetes, it was a disease I'd not really heard of coming completely out of the blue. And, just like diabetes more than two decades ago, the symptoms were all there, I just had no idea that they were all connected to my thyroid going into overdrive. I've read a lot about hypothyroidism and diabetes, but nothing about hyperthyroidism and diabetes. They are both caused by an autoimmune attack on the thyroid but involve different antibodies.
On the plus side, managing this disease (at least so far) has consisted of taking two little pills a day. There are still some days here and there where I feel bad, but they aren't often, and the daily management of this disease doesn't even compare to diabetes or allergies. I'm not even two months in and I already feel like I've reached an acceptance stage.
Although ... it is perhaps a bit sad that I already find myself half wondering what innocent bystander my immune system might decide to target next.
Friday, December 5, 2014
We wind our way through the maze of tables and luggage as the ferry deck rumbles under our feet. After unloading our coats and bags onto empty chairs and plopping into an empty table, my co-worker digs into her burger and fries and I dig into my bag. My cup of fruit salad sits alone on the table in front of me.
"Aren't you going to eat?" she asks, pausing and peering at me over a yam fry.
"Yep. I just need to check my blood sugar," I say, my meter already out and lancing device poised to pierce my skin. A moment later there's a beep and 7.1 mmol/L flashes onto the screen. My co-worker continues to watch as I unclip my pump from my pocket and dial in my blood sugar, then pick up the fruit salad and rotate it in my hand, simultaneously positioning my cell phone to snap a photo so I can zoom in on the nutritional information.
"Here, let me read that," my colleague says, and I hand the container over.
"I need the carbohydrates," I say.
A moment of silence as she studies the list. "A hundred and fifty," she announces.
"No—carbohydrates, not calories." A few more moments pass as she reads the entire label aloud under her breath. "Ah, here!" she says as she reaches the information I'm looking for. "Fifteen grams." I ask if that's for the entire fruit cup or only half, directing her to look at the listed serving size near the top. It's a handful of moments before she finds the right line and says the serving size is half the cup. I dial the information into my pump.
"Why do you need all that information?" she wonders just as I'm about to press OK to deliver the insulin.
I turn my pump screen towards her so that she can see the calculations displayed there. "I take different amounts of insulin each time I eat based on how many carbohydrates are in the food," I explain. "I enter my blood sugar and the carbohydrates into the pump, and then it recommends an insulin dose. See? It's recommending 4.1 units, but I'm only taking 3.5."
She studies the screen. "Why wouldn't you take what it tells you?"
I hesitate. How to explain the complexities of diabetes ... It's truly not possible to fully convey the challenges of managing Type 1 diabetes without living it. But when someone asks—when someone is truly curious about what's going on—well, then it's hard to turn them down. "Sometimes I override the pump if I think my blood sugar might go high or low," I say. "For example, this morning I woke up high, so I programmed my pump to give some extra insulin over what it recommended. Now I think I might go a bit low since we're running around dragging suitcases, so I'm giving myself a bit less insulin."
"Why is your blood sugar going so high and low?" she asks, her tone almost demanding. I explain that diabetes is sometimes hard to control—your body's need for insulin changes on a moment to moment basis, and you've got to try and respond to and anticipate those chnages to adjust insulin doses. She asks what my blood sugar is and what's normal for someone without diabetes, and seems concerned when she realizes that 7.1 mmol/L is outside the normal range. She asks why it's high right now, tossing out a myraid of possible reasons. I smile rueflly and tell her that my blood sugar is not really that high at the moment—my reading that morning had been 21.3 mmol/L. This time she actually gasps, struggling to understand how I can have such a high reading and not know what caused it.
"I don't know," I say, which is the truth. "Sometimes I just go high or low and can't find a reason why. That's just how Type 1 diabetes is sometimes."
At work, while I am not exactly outgoing about my health conditions, I make little effort to hide them. My visual impairment was out as soon as my co-workers saw me walk into the office with a white cane. My food allergies were out when everyone asked why I wasn't eating at the first office potluck. My diabetes was out the moment my colleague said, "What's that gizmo?" as I bolused for lunch at a conference. My philosophy, at work and in the rest of life, has always been that the only way the general public will learn anything about these conditions is if they talk to real people about real experiences—not through books and movies and even media coverage, where misconceptions run rampant. So, when people ask, I invariably answer.
My colleague and I are quiet for a moment as we eat and as she processes the information I've just provided. Suddenly she looks up at me and asks, "So what happens if your blood sugar goes really high or low? What will happen? What should I do? Will you die?" The questions come out in a rush, as if it just occured to her that something serious might happen on this business trip.
I launch into a short explanation of highs and lows—that I need sugar if I'm low, and insulin if I'm high, but that if I ever pass out or don't answer my door or phone or am acting weird, she should just call 911. She goes on to ask about allergies—where do I keep my EpiPen, what should she do if I have a reaction? I try to keep the delicate balance between being serious but not scaring her; I don't want her to feel like she's responsible for me. After a few minutes our conversation gradually shifts to other topics.
I think back to the past few months of office potlucks and celebrations. Sitting with my own food while everyone else lines up to pile their plates with dishes others have brought. Sitting as a co-worker beside me tells me how bad they feel that I'm not eating the great food, and offering again and again to help me find something I can eat. Finally, with echoes of my childhood experiences flickering at the edges of my throughts, I accept. A momentary thrill rises in my stomach as I think about actually eating something from the table—but reality sets in as soon as the descriptions of the food come. Wheat, milk, and potatoes are in everything. I finally settle on a few plain veggies, feeling uneasy that they are sitting next to a container full of milk-filled dip. She offers other options—spicy chicken, spring rolls, a vegetable dish—but I don't know what's in them. I think back to a scary reaction I had over the summer—a meal which outwardly contained nothing I was allergic to, but which had chicken cooked in an oven alongside potatoes—and I can't risk it. I turn everything else down. I try, and fail, to think of a way to explain that it's more relaxing for me to eat my own food, which I know is safe, than to eat other people's great home-cooked food and worry that I might have an allergic reaction, even if it looks safe on the surface. I feel frustrated at my lack of words to convey this and my inability to teach my well-meaning colleague anything useful.
I watch my colleague as she sits across from me now. She had been one of those who had constantly tried to convince me to eat foods, suggesting that I remove the part that I'm allergic to so I could eat the rest. I told her repeatedly that food allergies didn't work that way, feeling like she would never learn.
Then, one night in September I ended up in emergency until after midnight due to an allergic reaction. Still feeling horrible and sleep-deprived the next morning, I called in to work sick and explained the reason. Overnight, the cajoling from my colleagues stopped. Suddenly, people were cautiously inching plates of dangerous food away from me as I sat down and double-checking that things I ate were safe rather than trying to convince me to indulge.
Later that evening, after I've settled into my hotel room, I discover that I've forgotten the food I normally pack for trips. I dig a bruised apple and a crumbled cookie from my bag and eat them—I dodn't feel like going on a food hunt, which is difficult at the best of times, alone after sundown. The next morning at the hotel restaurant I order hardboiled eggs and bacon—grateful that I've recently added eggs back into my diet after further allergy tests, and that the restaurant staff seem knowledgeable about food allergies. I steel myself for the long day ahead with no food, since the catering had been arranged a week earlier and there was no time now to have a lengthy conversation with them about allergy requests at the last minute.
The workshop starts early the next morning. It's presented primarily by me, with my colleague flipping slides and attending to technical details. As noon approaches she announces that she's running to the store and will be back by lunchtime. I don't think much of it, thinking that we just need more refreshments for the afternoon session. Everything is going well, so I continue teaching the workshop without her.
When the catering arrives I sit and review the upcoming half of my PowerPoint presentation as the participants fill plates and eat. I'm just beginning to wonder where my colleague is when she bursts through the doors and plunks a bag down next to me. Before I have time to ask, she takes an apple, some Mandarin oranges, and a tub of So Delicious coconut yogurt and places them in front of me.
"Here, is this okay for your lunch?"
I'm literally speechless. Finally, I ask if these are really for me, thinking they might be snacks for the participants.
"Of course they're for you—you need to eat!"
Still hardly able to believe it, I thank her. Then I ask how she knows about coconut yogurt.
"You mentioned it the other day when I asked you how you could eat yogurt," she said. "You said you got it at Safeway. I noticed a Safeway down the street while we were driving here."
I'm grateful that she would even think of my problems—problems that don't affect her in any way. After thanking her several more times, I take my lunch and join everyone else to talk and connect before the afternoon session begins.
In that moment, my co-worker became someone who truly understood at least one small part of what food allergies are about.
As an educator, I should have known better. People need to learn on their own terms and at their own pace and in their own way. Each attempt at providing information, correcting misconceptions, and relating experiences may be having a positive impact, even if it's not immediately apparent and efforts seem futile. While I was getting annoyed with my colleague's misconceptions and feeling as if she would never learn, she—and all my co-workers—were indeed learning. Did they understand everything about my situation? Not likely, but that's an unrealistic expectation, anyway. The important part—what I needed to be reminded of—was that they were slowly soaking up the information I provided, and that's really all that I should expect of anyone who doesn't live )or work) closely with a condition or circumstance.
Saturday, September 27, 2014
A new chronic illness diagnosis. A new job that marks a step up in my career path. The unexpected loss of a best friend. Finishing a master's degree fraught with challenges. Being caught in the midst of a province-wide political struggle.
A series of five events have occured this year in swift succession, with virtually no time for life to return to normal before the next hit. Not all of them bad, but all of them stressful and life-altering in their own way. One of these events alone would be enough to make this year stand out in my mind. Combined, they have each in turn deeply affected aspects of my personal, professional, and social life.
Only two months have passed, and I already find myself looking back at July wondering how I made it—and not only made it, but moved forward despite the challenges. That month has been added to the handful of periods in my life where I had to push through extreme adversity if I had any hope of accomplishing some long-term goals and where, looking back, I honestly don't know where I found the strength to do so.
This year will join the scattered handful of years that divide my life into segments separated by Before and After.
For the past few months I've felt off-kilter and off-balance, as if things were never quite right, because they never quite were. I've been patiently waiting for normalcy to return, knowing that if I waited long enough it eventually would.
Yet, even in the midst of these experiences, I don't think of this as a bad year. In reflecting—and I've been doing a lot of that lately—I've remembered that it's during these times of tormoil, whether positive challenges or negative chaos, that I've experienced the most growth. I would not be who I am today if not for these types of changes that I expereicned in the past and that I'm positive to experience again in the future.
It's these events that push me or challenge me or make me rethink everything that has happened in my life so far. Or that make me realize that i am way, way stronger than I sometimes feel.
Over the past week or so I've finally started to feel more normal. I've started to find the beginnings of some stable footing so that I have something to stand on as I move forward. Hopefully, I won't find this stable surface crumbling under my feet again any time soon.
But if I do, I only have to think back to these Before and After events that have altered my life in the past ... and that I've come through changed but unscathed. Each time I am faced by adversity and survive, and even thrive despite it, I get stronger. I reflect on what I've been through, and I'm better able to handle the next thing to be thrown my way. If I can handle that—if I can handle five of them at once!—then I think I can handle anything.
Friday, June 27, 2014
"I don't see anything ..." my youngest brother said.
"You need to look in opposite directions," the other advised. A few seconds later there were exclaims of amazement from the younger of the two as image the came into view.
"Can I try?" I asked.
"It won't work for you," my brother informed me. "You can't hold it close." But he held out the book for me and stared over my shoulder as I held it at arms' length and tried to make my eyes look in opposite directions at once. (This was exceedingly difficult considering I have both nystagmus and strabismus in addition to my primary eye condition.) I scrunched up my forehead, tilted my head and squinted, then closed each eye in turn, trying to make an image appear. I imagined a castle rising out of the surface of the page, thick guard towers anchored to the ground and triangular flags flying high in the breeze.
But I knew this was just my imagination, not the real thing. I handed the book back to my brother. "It doesn't work," I confirmed.
As a teenager, I often wondered what it was like to be fully sighted. Like my imagined experience of looking at a Magic Eye picture, I imagined what it must be like to look down a street and see objects a block or two away. I would often ask my brothers questions about what they could see. A nearby mountain looked to me like a section of horizon painted matte grey. No depth, no colour, just a bunch of dry, grey paint. I was awed when my brothers told me that they could see trees and patches where trails or ski slopes cut through the woods. I would challenge them to read print from a piece of paper held a metre away and laugh in amazement when they read words that I couldn't read even with the page held a centimetre away from my nose.
In grade five or six I discovered Jean Little, a Canadian children's author who was born legally blind and later in life lost the remainder of her vision. In elementary school I read volume one of her autobiography, Little by Little, which I subsequently read almost yearly throughout my childhood and adolescence. In high school I discovered part two of her life story, Stars Come Out Within, and in the pages of the book she described what she could see as a child:
I had never seen a skyful of stars on even my best nights. But I had always seen a scattered few, perhaps six, sometimes a dozen. I had seen more by looking through a monocular and had put together a mental image of the thronging brightness of the Milky Way.Reading this, I remembered a camping trip as a child where, having gone to bed before everyone else, I reluctantly crawled out of my sleeping bad when my mom called me to come outside to see something. Shivering, I unzipped the tent door and ducked through the flap. I stepped outside into splendour: more stars than I had ever seen in my life were flung across the night sky overhead. Dozens, maybe even hundreds of stars. It was breathtakingly beautiful and awe-inspiring.
I knew, of course, that my parents and brothers probably saw thousands of stars glowing in that sky. Yet, up until that point the night sky usually looked empty to me. On really dark, clear nights a group of us would sometimes walk up to the high school half a block from my house and lie in the field to look at the stars. During these occasions I might see one or two of the brightest stars. I'd lie with my monocular to my eye, my friends directing me where to look to find a few more that I couldn't see with my naked eye. Our view was always obscured by the city lights, but I knew that while I saw half a dozen stars with my monocular, on those nights my friends could see dozens.
As much as I wondered what good vision was like, the curiosity also went the other way. My family and close friends often had an uncanny sense about what I could and couldn't see, and made accommodations automatically. And yet, occasionally they would question me about what the world looked like from my perspective, and occasionally even after being around me for years they had misconceptions.
Several years ago, while in the car with my parents, I commented about how odd the clouds looked.
"I'm surprised you can see clouds," my mom said from the front seat.
"Of course I can see clouds!" I said indignantly. I couldn't believe that my parents had lived with me for more than a quarter century thinking I couldn't see such a thing.
Communicating what the world looks like from my perspective is difficult, because I have never had good vision with which to make a comparison. In medical terms my visual acuity is 20/600; yet, my vision is not the same as someone who is nearsighted and simply takes off their glasses. For one, the world doesn't look blurry to me much of the time. For another, although I am able to see more detail the closer I get to an object, I am never able to see as much detail as someone with good vision, even when that object is right up to my nose. In theory I see an object at 20 feet with the same clarity as someone with normal vision sees it at 600 feet, but what does this mean in real life?
Within arms reach, I actually see fairly well, at least from my perspective. Looking at a copy of Harry Potter and the Philosopher's Stone sitting on the desk directly in front of me, I can see the red at the top of the page and the red and green of the Hogwart's Express in the middle of the page, though I cannot read the writing on the green plaque. I can make out the vague semblance of a person in the bottom right-hand corner but cannot tell what they are doing. I can't make out any details of the background. I can't see the author's name. I can see the yellow of HARRY POTTER but not the rest of the title underneath.
But can I really see all this? I have, after all, seen this book a million times at much closer range (up to my nose) and under high magnification. In fact, I just looked at it under magnification before placing it in front of me to describe what I could and couldn't see. Would I be able to make out the semblance of a figure in the bottom right corner or the yellow of HARRY POTTER if I hadn't already known it was there?
The fact that I remember so much of what I see up close visually, and use it again when I encounter things in the future, leads a lot of people to think I have much more vision than I actually do. I will remember people in the office by the colour of their clothes and the shape of their body and the manner in which they move. Unless I am within arms reach of someone or slightly beyond, I can't make out any details of their face except maybe the colour of their hair and, possibly, if they're wearing glasses. I can't see facial expressions, or see see most nods or shakes of the head. I have no understanding of what eye contact feels like.
Once, when I was young I was sitting on the couch with my mom, leaning very close to her, when I suddenly burst out laughing. She was perplexed. Nothing funny had happened. When she asked, it turned out that I had been close enough that I had seen her blink. It was the first time in my life I'd seen someone blink, and the fluttering eyelid seemed hilarious to me.
As a kid I was a budding artist who loved drawing, writing, and crafts. I spent hours with pencils, markers, scissors, and paper creating pictures, stories, and all kinds of other creative projects. I'd work holding material so close that it often touched my nose. I cut with scissors a centimetre from my better eye. I usually worked so close that there was no room for my hand between my face and the page I was working on, and the frames of the glasses I used at the time for magnification became permanently deformed due to my forcing my hand into the space and making the necessary room.
I didn't usually think of how close I had to hold objects to see them until someone mentioned it. Standing behind me talking to a friend as I worked, I once heard my mom say that she often forgot I couldn't see until she saw me working on art projects at such close range. I went through a period where I was teased at school by kids who thought I was "kissing" objects when holding them up to my face. To this day, I sometimes get complete strangers in grocery stores ask if I'm smelling products, which has caused me to consciously try to avoid holding things close in this setting. For me, having a working distance of four or six centimetres is natural, but for most around me it's not.
At a distance my vision is much less distinct, even from my perspective. I have enough vision to orient myself to a small room I walk into for the first time, such as a doctor's office. Walking down the sidewalk I can see someone approaching me from a couple of metres away. Looking at a car parked across the street I can see its colour, its type, and (depending on the colour) where its wheels and windows are. I can't see door handles, stickers in the windows, the style of the car, or whether it has a flat tire. A person walking on the other side of the street appears as a moving splotch of colour. I can't see traffic lights, usually, or drivers who might be waving at me from within their vehicles. When I swim, I can see the lane markings at the bottom of the pool that indicate when the lane is coming to an end, and the flags strung across the ceiling to indicate the same—though the latter requires more concentration and is easy to accidentally miss, given its much lower contrast and having to spot it through often foggy and water-streaked goggles.
I found a piece of paper years ago while sorting through old files which documented my participation in adapted downhill skiing as a child. On it, someone had written that I could see as far as four feet in front of me. And, in a sense this was true, since I always got uncomfortable if my guide moved much beyond this distance—but the reason for this was not that I couldn't see them as much as the fact that I have no depth perception and therefore found it difficult to determine when they stopped or made subtle adjustments to their course (although they always communicated these changes verbally to me). My vision, like anyone's vision, does not simply stop at a certain distance. It gets less detailed and distinct, but I am able to see trees, buildings, mountains, clouds, and the sun and stars.
It is not true that those of us with little or no vision develop superior senses to those who are fully sighted. What is true is that we pay much more attention to our other senses, so much so that we often notice things that others don't. This is true for me and, as my mom relates, caused some consternation when I was younger and used to reach out and touch anything and everything, whether it was a toy or wet paint.
Many times, to those observing, I appear to have more vision than I do not because I can see something but because I am relying on subtle clues from other senses to supplement what I see. Whenever I reach for an object I'm using my vision to aim my hand, but I'm using my fingers to determine when I've reached the object and should stop moving my hand forward. When I turn on my computer the hum of its hard drive gives me as much information as the blue indicator light that blinks on. When I'm crossing a road I'm listening to the flow of traffic just as much as I'm watching it. When walking through a grocery store I pay attention to the smells coming at me from various aisles in addition to the colours.
I rely on visual cues a lot, too, but different cues than most sighted people. I can tell when I'm approaching many bus stops by the way the colour and lighting changes outside the bus window, even though I often can't identify landmarks from within a moving bus. The way the light speckles through the trees on the sidewalk lets me know that I'm getting close to the entrance of my apartment building more than the numbers bolted above its door. The shifting movement of colours on a TV screen give me clues about what's happening, even if I couldn't describe the visual scene to the person sitting next to me on the couch.
Memory, senses, and visual information all come together and play into what I can and can't see living with low vision, much more so than a single letter on an eye chart.
There are times, when I am highly familiar with what an object looks like, that I can "see" things that I shouldn't be able to. I can take a letter, for example, and hold it as close as possible to my eye, and if I squint and the print isn't microscopic, I can figure out if the letter is addressed to me. I can walk into a mall I have been to many times before and make a beeline for a particular store. I can scan a shelf for a well-known product and spot it from half a metre away without any assistance. But when I do these things I don't really see these objects. More often than not I see a fuzzy shape or some mashup of colours that I happen to know, form much past experience, represents a certain word or logo.
Yet ... what I've spent the last few paragraphs describing don't really describe what I see. They describe what I see when my full attention is on something, and when lighting conditions are near ideal. Throw me onto a congested downtown sidewalk and I may only discover a bike rack when my cane clangs off its surface. Put me facing the sun without the aid of sunglasses and the resulting glare can all but obliterate nearby people, cars, buildings, and landmarks. Put me on an unfamiliar footpath as dusk falls and I may rely completely on the tactile feedback of my cane to keep me from straying off into the grass.
Occasionally I'll have a friend or extended family member ask me if I'm ever sad about what I can't see. When I was a teenager I read Sight Unseen by Georgina Kleege. In the introduction, she describes how writing the book made her aware of how little she saw, and also aware of how much information sighted people take in visually:
[...] I knew I could see something—light, form, color, movement—and assumed that this was close enough to what other people saw. As I wrote this book and forced myself to compare my view of the world with what I imagine a normal eye sees, what I learned astounded me. [...] It might seem that this discovery would lead to sadness—what else have I been missing all these years? In fact, it has inspired a kind of perplexed wonder—what do sighted people do with all this visual detail?Like Jean Little, I instantly felt a connection with Georgina Kleege. Here, again, was someone who understood what I experienced. And not only what I experienced, but how I felt about it. I have never been sad about what I might be missing. Frustrated sometimes, perhaps, when I can't see something that would otherwise be useful to see. But never sad. Like Kleege, I merely feel a fascination about how much information someone with 20/20 vision must be taking in, and how they can possibly process it all. But then, they probably wonder the same thing about me, sometimes, processing multiple incoming streams of sensory information and integrating it into an understandable whole.
Saturday, May 17, 2014
What does daily life with Type 1 diabetes look like?
Friday, May 16, 2014
Ah, I love lifehacks. I used to just do everything status quo with diabetes, but in the past few years I've begun to get creative with my diabetes equipment and routines so that it makes things as easy for me as possible. Here is some of what I do.
Weights and Measures
I weigh almost everything I eat. I used to use measuring cups, but then I discovered carbohydrate factors (a la Pumping Insulin)—basically the percentage of food that is made up of carbohydrates. This way I only have to remember one number, and I can serve food normally rather than having to use measuring cups (and then wash them afterward). So, when I want to eat fruit and yogurt, I can easily remember that the carbohydrate factor for my fruit is 0.10, and for my coconut yogurt (I'm allergic to dairy) is 0.15. I put my bowl on top of my scale, tare to zero (to get rid of the weight of the bowl), serve the yogurt, tare again, serve the fruit, and then multiply the weigh of the yogurt by 0.15 and the weight of the fruit by 0.10, and get a carbohydrate count by adding the two together.
It sounds more complicated than it is, especially once you get used to it. And, for foods I eat less often, I simply write the carbohydrate factor on the package so that I can instantly get to it. You can learn more about carbohydrate factors in Pumping Insulin by John Walsh or from this article in Diabetes Self-Management. The other advantage is that this is a very exact method of measuring carbohydrates (since there is no air between bits of food as can happen with a measuring cup) and takes very little extra time (and trust me, I'm not a math person!).
For travel I also have a pocket-sized scale that I bought several years ago. It's smaller than a cell phone and allows me to weigh foods that I haven't pre-measured, such as fruit I purchase or other items not in a package. I keep this in my purse, as well as bringing it on longer out-of-town trips.
Out and About
Since I live with food allergies in addition to diabetes, I pack virtually all my own meals. (When I do eat out, it's almost always limited to chicken salad with vinegarette dressing.) This includes packing all meals for extended trips. For work lunches and other meals I use an insulated lunch kit that has a mesh pocket on the lid where I place an ice pack. For business trips and vacations, I have a larger insulated cooler which I put inside a hard-shell suitcase to minimize squashing of food (for Canada only, since you can't take produce or meat across the border).
To make things as easy as possible, I measure as many foods as I can as I'm packing. I put them into individual servings in various sizes of Ziploc bags (which I try to reuse as much as possible if the foods are dry) and then write the carbohydrate count on a piece of masking tape with a felt tip pen, which I then stick to the bag. Due to my low vision, I can't read the writing if I write directly on the clear bag, and even though I've seen special labels that you can buy to write carbohydrate counts on, masking tape is super cheap and I've never had a piece fall off.
Cases and Bags
When I first got my Animas pump I immediately hated the case. It was enormous and bulky and, because it had hard plastic casings for the meter and strips, it couldn't be used for anything other than holding meter kit. I happened to find a case for an Accu-Chek Aviva somewhere and found that it fit my meter and lacing device perfectly. Speaking of lacing devices: I never use the one that comes with the meter. I use the Accu-Chek Multiclix, which is particularly nice since it doesn't have any sharps to worry about and makes changing lancets really easy (I've never changed lancets so often!).
In my purse I always carry backup supplies in case of pump issues. I keep an infusion set, cartridge, and alcohol swabs in a portable hard drive case, which fits these supplies almost perfectly. I have a tiny case from Case Logic (which I think is meant for SD cards) where I keep quarters, extra pump and meter batteries, pen needles, and some pills like antihistamines and painkillers. I keep both these cases, as well as an insulin pen (with insulin) and an EpiPen in a pocket in my purse or whatever type of bag I'm carrying, so that it's all easily accessible in one place.
I've put an individual key ring on the zipper in my meter case, which makes the mesh pocket (which I use for temporary test strip disposal) extremely easy to find and open by hooking a finger through and pulling; this is especially helpful when low!
When I travel on extended trips, I use a large Tic Tac container as a temporary sharps disposal container until I can get home and put the sharps in my "official" sharps container I get from the pharmacy. I have tried the needle clippers but found that it could not clip through infusion set needles.
Business Trips and Vacations
For extended trips, I have both the Dia-Pak Deluxe and the Dia-Pak Classic. I use the Dia-Pak Deluxe to hold about a week of diabetes supplies when I travel out of town. I use the Dia-Pak Classic to hold all of my allergy medications (yeah, I really do need a whole separate case). I bought these two cases specifically because they come in bright blue. After an experience of having an airport security agent remove pump supplies from my pack and not repacking them, I wanted something that would be visible not only to airport security but also to me if it was left on the conveyor.
I recently bought a Double-Pocket SPIbelt for going for walks or to other forms of exercise where I don't want to carry a bag. It has two pockets, one where I can put glucose tablets and an inhaler, and one where I can put my cell phone, keys, earbuds, and a small glucose meter (like the Accu-Chek Nano). When I go to the gym, I use a MEC Sling Pack to pack a towel, folding cane, and anything else i want to keep nearby (I don't wear the pack, I just hang it off the equipment I'm using).
One form of exercise I greatly enjoy is swimming. I haven't yet found a great solution for keeping supplies nearby (and dry) on the pool deck. At the moment I tend to just put my white cane, glucose tablets, and inhaler on a bench on the pool deck, but I'd like a case I could put them in (ideally that would also fit a swimming-friendly glucose meter like the Accu-Chek Active) that doesn't look like a wallet or digital camera that might get stolen. I am open to suggestions!
I am sure there are countless other little things I have done to make daily life with this time-consuming disease easier. The above are the things that I've implemented recently enough that they pop out at me.
Thursday, May 15, 2014
I used to be very worried about forever.
When I first took the reins on diabetes and tried for the first time to wrestle it into control on my own (without my parents, who had managed diabetes throughout childhood), I was very concerned about numbers. And I was very concerned about forever.
I would sit thinking about how I was only 24 but had already had diabetes for 15 years. And I would think about all the statistics that said that 90% of people with Type 1 had some complications after 15 years. And how I must be really lucky to be in the 10% that didn't yet have complications. And how my time must be coming up sooner or later.
And I would think about the people who were living with diabetes for 50 years. And how, after 50 years of diabetes, I would only be 59 years old—probably not even retired! And how, if I lived until I was in my late 80s, I would have diabetes for over 75 years.
And I wondered how anyone could possibly manage this disease for 50 or 75 years.
I would think of how many times my skin had been pierced to keep me alive. The thousands of insulin injections, tens of thousands of finger pokes. More than five dozen blood draws. Half a dozen emergency situations. Countless highs and lows.
It was overwhelming. How could anyone possibly do this all day, every day, forever?
The one day I was looking at quotes (sometimes I do occasionally when I'm bored) and came across the quote, "This, too, shall pass."
I immediately thought about diabetes. I immediately loved it. So much so that I put it on my pump's home screen.
I have since switched to a pump that does not allow customized messages on its home screen. But, even since putting that mantra there, I have always tried to keep it in mind. Every time I see a high or low reading, every time I feel frustrated or helpless, I remind myself that, eventually, the high or low or other circumstance will pass.
Diabetes may never pass for me, but that one moment or hour or day or week will. These days I try to take things one reading at a time. If it's high or low I deal with it, without worrying about where the next reading will land. I do, of course, try to anticipate blood sugar in terms of planning for things like exercise and travel. But I no longer begin the day wondering how I'm going to manage for the next 50 years—managing for the next hour is sometimes hard enough.
Wednesday, May 14, 2014
Note: Wednesday's theme for Diabetes Blog Week is "What brings you down?"—the emotional issues in diabetes management and the tools that help us cope.
I stare at the screen, the words blurring in front of my eyes, and take in the lines upon lines of text. Each line began with the words "I'm sick of ..." and spelled out an aspect of diabetes that I hated. I sit slumped, sad and exhausted. I'd had a LiveJournal account for over a year, but until now I had used it simply for mindless memes and a log of daily events rather than as a true journal. I click POST, wondering as I do so what those on my friends list will think.
It was early 2005, before the blogosphere or the diabetes online community had really started. The idea of writing one's thoughts and publishing them to the internet was still a relatively new concept to many people. I had kept a private journal for the previous 10 years, and I knew from past experience that writing out my thoughts, emotions, and worries often made me feel better. But only to myself. I steered clear of sharing negative thoughts and emotions with people, even close friends and family. I would let emotions eat at me before I would let them loose.
But in 2004 I was struggling. I was in university, living on campus. My close on-campus friends had graduated, and because I had a guide dog I was housed in the residence for graduate students. This left me feeling out of place and alone. None of my professors or fellow undergraduate students knew that I had diabetes. I had recently begun devouring any autobiography by a person with diabetes that I could find, and was disheartened to discover that every one of them ended with complications. I knew that, with several years of A1c results hovering around 8.5%, my diabetes was not well controlled. I felt constantly exhausted, struggling to stay awake during classes and commutes. I saw high readings daily, even though I prepared most of my own food instead of eating in the residence cafeteria. Several times I missed classes because my blood sugar was so high and I felt so sick to my stomach (ketones did not even cross my mind at the time) or because I was so low that I slept through my alarm. I was conflicted about whether I wanted to go into teaching—and whether I could be an effective teacher as someone with a visual impairment—which just added to my overall melancholy.
I knew that something had to change. Yet, although I had lived with diabetes for well over a decade at that point, I had never dealt with diabetes at an emotional level.
All that ended one evening, in a flood of keystrokes and tears.
It happened after a particularly bad diabetes day. I had struggled with keeping my blood sugar in range throughout the day, despite doing everything right. The final straw came when I prepared meticulously for some exercise—reducing insulin at the meal prior, eating beforehand, testing several times in the hour leading up to make sure my blood sugar was on track—only to arrive and find that the goalball practice I'd planned to participate in was cancelled. I left with high blood sugar and several wasted hours. As soon as I got home I logged onto LiveJournal and let more than ten years' worth of anger, frustration, sadness, fear, and uncertainty out in one massive, tear-streaked post.
I am forever grateful to the friends—many of whom I am still in contact with today (many of whom have moved from online screen names and avatars to "real life" friends)—for reading the weeks of written turmoil that followed and for their flood of support and encouragement, even though none of them had diabetes themselves. But by the end of the torrent of emotions I knew I had the unflinching support of friends, I had worked out some ideas and a plan for improving my diabetes control, and—at the suggestion of a close "real life" friend who followed my posts—I had sought out and made tentative contact with the fledgling diabetes online community.
I think with diabetes we often try to bury the negative emotions. We make jokes about lazy beta cells and low blood sugar incidents, laugh at sometimes serious mistakes, and live life with our family and friends as if diabetes were simply an inconvenience, like having to floss each night. It's only when a crisis hits or is narrowly averted that we pause and allow ourselves to feel frustrated, scared, sad, or angry at having this disease. And, yes, I am guilty of suppressing the negative emotions—I have to, we all have to, or else we would not be able to cope.
There are people out there who claim that being diagnosed with diabetes is the best thing that ever happened to them. They have achieved excellent control, excellent fitness, and are meeting all of their diabetes care goals. I am not one of those people. I struggle with highs and lows daily, despite my best efforts. There was a time when I was striving my hardest and failing to reach goals, when I got incredibly frustrated and felt intense emotions with each blood sugar reading and each A1c result. It led to nothing but stress and burnout, and so I have tried to disassociate blood sugar and A1c results from emotions. It is not good riding an emotional rollercoaster in addition to a blood sugar one.
I still experience negative emotions about diabetes on an almost daily basis. I feel angry when I do something to cause my blood sugar to spike. I feel frustrated during a day of high readings that won't come down despite repeated corrections. I feel scared after a night interrupted by a severe low. I feel sad whenever I hear of another child being diagnosed with Type 1 diabetes. When these emotions come I allow myself to feel them—to spend a day being scared, or to write a post venting some fear, or even to tell a close friend that I'm having a frustrating diabetes day. And once I do that, I move on. I have not had such an outpouring of powerful, negative emotions since that post nearly ten years ago.
In a way, my LiveJournal account was my first blog, although the entries were more raw and unedited than true blog posts, and most were only semi-public. I am still relatively private about my emotions surrounding diabetes, but less so today than I was ten years ago. I still keep a private journal, and still find it a tremendous tool for working through emotions. The wonderful thing about blogging, though, is that it is public enough to feel as if you are shouting to the world, but private enough that your real-life friends and family are not likely to find it amongst the billions of websites out there. It provides a unique avenue for expressing sometimes negative feelings, or just venting, and having people who understand completely read and provide support (sometimes just knowing another person is reading is support enough) without the need to walk around in everyday life suppressing an avalanche of fear, frustration, anger, and sadness. Having such an opportunity has been of huge benefit to me in this diabetes journey, which is as much emotional as it is physical.
Tuesday, May 13, 2014
A word, so sharp and new it hurts our ears, floats through the air above us. A day, scattered like fall leaves blown across the lawn, their direction unyielding yet aimless. White walls splashed with colour, thin curtains on squared rails, a smell both soft and sterile. Strangers, carrying kindness and smiles.
Children dash, laughing, falling in the snow, rolling, rising once more to run. Snowflakes dapple their faces like sun, candy melting on warm tongues. Bright clothing against a palette of white, sculpting pictures on the landscape. The world is not large enough for our playground, painting streaks of colour as we play.
Something lurks inside—
coiled in a tiny bead of red;
it can’t be outrun.
Monday, May 12, 2014
ocularcentrism (noun):For several years now I have been at once fascinated and dismayed at how everything in our modern world revolves around vision. Nearly every appliance, computer, service, or policy seems to be designed with the assumption that the consumer of such goods or services will have near-perfect vision.
(1) The privileging of vision over the other senses.
Just think of shopping—something every one of us has to do on at least a weekly basis. Have you ever considered how much you rely on your vision in a supermarket? Everything from the signs informing you of which foods are in which aisles, the price tags, the 50% off sale tags, and of course the items on the shelves themselves, assume that the consumer will have vision sufficient to see and read all this information. The movement inside a grocery store is often chaotic—unlike roads, there is no controlled traffic flow. Carts get tangled in intersections, people come to abrupt halts when they see an item of interest, and carts are left unattended in the middle of aisles while their driver dashes off to get some forgotten ingredient. And then there's the checkouts. A little more organized in terms of movement, perhaps. But everything from the number of the checkout to the price that flashes up on the cash register to the point of sales device you use to enter your PIN is inaccessible. And that's assuming there's a person behind the counter, not the text-heavy, touchscreen-interfaced world of self-service checkouts.
This is just one example of one weekly chore. I could go on for pages about all the tasks we engage in on a daily basis that are based on the assumption that we can see or that vision is the only way of completing a task. Some are more accessible than others, of course. You don't necessarily need to see the readout on an oven's LCD display to cook a gourmet meal, as long as the controls on the oven are accessible. But it's no wonder that people are frozen by fear at the prospect of losing their vision!
Like the tasks in our everyday lives, there are a wide variety of chronic illnesses out there. Each requires its own regimen of treatments and therapies. And, like grocery shopping compared to preparing a meal, some are more accessible than others. A condition that entails little more than popping a pill each morning is going to be more accessible than a multi-faceted, complex condition like diabetes. Most other chronic illnesses, however, are not leading causes of vision loss worldwide. And I would have hoped, just maybe, that diabetes would take the lead in accessible healthcare. Because today, right now, there is precious little in the way of accessible healthcare, and even less in the way of accessible diabetes care.
I'm not just talking about technology. Glucose meters and insulin pumps and continuous glucose monitors are certainly staples of diabetes care, particularly for those of us with Type 1 diabetes, and it is true that these devices have a long way to go. Today people with diabetes are demanding features, style, and choice in the diabetes products they buy. But if you happen to be someone who needs accessible diabetes equipment, you have a choice of two fully accessible talking glucose meters, a choice of zero accessible insulin pumps, and a choice of zero accessible CGMs. Not exactly setting a standard, particularly when you consider that there are numerous talking blood pressure monitors, thermometers, and scales out there to choose from.
But, no, I'm not just talking about technology. The entire world of diabetes care is extremely dependent on vision, largely leaving behind the nearly 1 in 5* people past middle age who have both diabetes and a visual impairment. For me, growing up with a visual impairment, it started right when I was diagnosed with Type 1 diabetes. Within days, it was apparent that I had difficulty getting the drop of blood on the test strip—using strips that, in the early '90s, didn't suck up blood, couldn't be touched, and required a "hanging drop" of blood to be placed squarely on a target area. Then, when I was a teenager and taking on more responsibilities with diabetes care, I was unable to measure insulin into a syringe even with a special syringe magnifier. As an adult, it was my adventures in getting an insulin pump that forced me to find work-arounds to inaccessible equipment yet again. Insulin vials are designated by colour, not by shape or tactile features. The same is true of insulin pens (which, thankfully, do click as units are measured—one of the truly accessible parts of diabetes care). There are dozens of books out there about diabetes, most of which are not available in alternate formats such as braille or audio (or, if they are, have all the helpful graphs and charts omitted). Even carbohydrate counting is challenging, having to read tiny labels off packages of foods. Most diabetes management software is not accessible, including most mobile apps, even though the platforms they run on include accessibility features. And even diabetes education faces challenges as it is more often delivered online using inaccessible software platforms.
But it doesn't have to be this way. The key in my discussion of all of these issues is that the root of the problem is the assumption that customers and participants will have good visual acuity, even in the face of the fact that this disease (and aging in general) is a leading cause of impaired vision. And a big reason for this assumption is that people simply don't think about it until it affects them or someone they love. I can't blame them for that. Many of us never thought about diabetes until it barged into our lives. But this is my cause, this is my passion—to make people aware of and think about accessibility issues surrounding diabetes.
This is not my only area of advocacy, but as something that affects me and about 4 million other people in North America,* it's a cause I chip at a little each day. I write e-mails to companies when I hear about the next great pump (the Cellnovo, for example) asking if it will include accessibility features and offering to help in any way that I can. I take part in as many product surveys as I can, always making sure to mention accessibility as a major feature concern of mine. I speak to product representatives at conferences about the challenges (or impossibility) of using their product with little to no vision and possible solutions. I bring accessibility up in forums and blogs, often with a bunch of barriers thrown back at me about why designing an accessible pump or CGM wouldn't be possible—cost, aesthetic, functionality, technology, and so on.
It's easy to think of barriers. What I want to think of, and hope others will think of, are solutions. If I spent my life thinking of barriers I would go nowhere. I've lived my entire life thinking of solutions, and I want more than anything for the companies who manufacture diabetes products and provide diabetes services—and for the diabetes community who use those products and services—to shift their thinking in the same direction. I realize for many who are not familiar with accessible technologies it may be difficult to picture how some of these things could be accessible. So let me give some examples of possible solutions.
Picture a glucose meter that had a setting to enable a speech output feature, which would otherwise not interfere with the functionality of the device at all (like iOS devices). Picture an insulin pump with a meter-remote or PDM where consumers had a choice of whether to purchase a standard unit or one with a user interface designed specifically to be accessible. Imagine a CGM that used sound cues to render a trend graph on a musical scale and a series of ascending or descending tones to indicate arrow direction and intensity after announcing a blood sugar reading. Imagine diabetes publications were made available in fully accessible electronic copies at the same time they were published in print—including all tables, graphs, and pictures being accessible. Imagine all food packages, everywhere, had tiny bar codes that contained the nutritional information and ingredients and could be scanned and read aloud by an app on a smartphone. Imagine the breakthrough products of tomorrow—which are being developed today, as you read this—had accessibility considered as a top consideration as the product was designed from the ground up.
Imagine I and others with impaired vision could await the release of the artificial pancreas with boundless enthusiasm, rather than wondering whether it will be a tool we will be able to access and use safely and effectively.
The issue of accessibility, of course, encompasses a far wider field than simply diabetes. In order to deliver accessible online diabetes learning, the platform on which the content is delivered has to be accessible. In order to have an accessible insulin pump, the cost needs to be reasonable. In order to have an accessible nutritional database linked through bar codes and a mobile app, food companies need to be on board. Yet, accessible products and services do exist in other areas of life, but diabetes is lagging seriously behind. The most important factor is that in order for any of this to even be imagined, it has to be in demand. And currently, there is no demand. There is no outspoken disability cohort of the diabetes online community, as there is with parents and people with LADA and athletes with diabetes. There is no one writing letters and e-mails, flooding companies with questions and requests for accessibility. For the most part, championing accessibility in the diabetes arena is a very lonely battle.
Perhaps I am just ahead of my time. I realize that many of the solutions I've brainstormed here (and they really are just brainstorms—I'm no engineer) rely heavily on the advent of technologies such as the explosion in mobile apps and services. But there is a trend in accessible devices: they tend to be one or two generations behind the most recent devices, so that by the time there's an accessible insulin pump we will have moved on to something newer and better and, like the pumps of old, just as inaccessible, albeit in a novel and different way.
I realize that I live in, and will always live in, a sighted world. Those of us with visual impairments will always be the minority, and we will always have to find ways to cope and adapt in a world that wasn't designed for us. I hope, though, that someday I will live in a world where at least one product of each type is accessible. I'm not asking for a selection of 20 glucose meters or 5 insulin pumps to choose from; even just one would be a great stride in the right direction. First, companies need to decide that they are willing to design a product from the ground up with the idea that, just possibly, 20%* of their users will have impaired vision—and that those customers are just as important as the other 80% with near-perfect vision. And, for that, there needs to be a much louder voice than there currently is.
* Statistics from the American Foundation for the Blind.