FUDiabetes

CGM, visually impaired

My brother is T1 since about 3. He is also legally blind. He has had some pretty close calls with getting very low and basically becoming unconscious. Luckily someone has found him in each case and got him help/treatment. I’m trying to find a solution that would warn him of this before he becomes incapacitated. Through research a CGM seems to be the best solution and the dexcom G6 seems to be the best CGM. The problem is his visual impairment, are there any good solutions? I’m at my wit’s end and really want to help him but there seems to be few CGM solutions for the visually impaired.
Thanks in advance,
Rick

Hi Rick, welcome to FUD!

I also have T1D and have been legally blind my entire life. I have used several CGMs over the years, including the Dexcom G4, Dexcom G5, and FreeStyle Libre.

Since legal blindness covers such a wide spectrum of vision, it might help to know a little more about your brother. Is he able to read large print? Does he use any assistive technology? Does he use a smartphone?

While Dexcom G6 is the best system in terms of features, what matters most is that your brother is able to use the device he gets. The best device is useless if it’s not fully accessible and can’t be used effectively.

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Thank you for your quick response. He has something called wolfram’s syndrome which is what caused his diabetes and his loss of vision. Basically he has no center vision, it’s just a dark blob according to him. He has some outer vision which he can see shapes and shadows with. He uses screen reader software on his computer and uses something called a visual tech to magnify print to the point that there is 4 to 6 letters filling the screen which he can just make out. The only phone he has ever had is just a little flip phone that he carries for emergencies. I am an IT guy and I have remote software setup on his computer to assist him and plan to do the same on whatever smartphone we settle on. I’m just looking for suggestions for possible solutions, smart phones, CGM devices and software or apps. Thanks for any assistance you might provide. :blush:

If he’s good with a screen reader on the computer, I’d highly recommend he look into getting an iPhone or Android phone. Both of these have built-in screen readers (VoiceOver on iOS devices, TalkBack or similar on Android devices). While none of the CGMs have accessible readers/receivers, all CGMs have apps that work on iOS and Android devices, and at least the Dexcom G5 app and LibreLink apps are accessible.

The Dexcom does have an ID on the transmitter that needs to be entered into the app for pairing. There is a function of the app where you can take a picture of the ID, but this part of the app isn’t accessible, so it must be entered manually, which would mean your brother would have to use his CCTV (“visual tech”) to magnify the ID on the back of the transmitter or have someone read it to him. The transmitter needs to be replaced every 90 or so days, unless you use open-source software to extend its life.

The FreeStyle Libre is completely accessible and I have totally blind friends who use it independently. Here’s a review of the Libre from a blindness perspective. There is no transmitter to pair, so no ID to read. While the Libre by itself is not a full-fledged CGM, it can be paired with open-source apps and a device such as the MiaoMiao to create a full-fledged CGM with alarms.

By the way, I used to call CCTVs a “visual tech” as well back in the '80s! That was a popular brand of CCTV back then. Or, these days, some use the term “video magnifier” to distinguish from security CCTV systems. I hadn’t heard the term “visual tech” in years, so thanks for bringing back fond memories! :slight_smile:

Thanks Jen, glad to put a smile on your face. I think that Visual Tech was the name of the company that made the device, he has had it forever. Take care and thanks again.

Hi Rick - Dexcom (with their G5 and G6 CGMs) transmit all the blood glucose data in realtime to cloud-based servers.

There are 3rd party apps that can share this (near-live) data, and the Sugarmate app has the option to automatically call your cell phone in the event your sugars fall below a user-adjustable threshold while you’re sleeping.

Perhaps it’s possible to adjust the sleep period to notify a cell phone 24 hours a day?

https://beyondtype1.org/using-sugarmate/

Thanks Jim

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I’m always wary of setting up a system that has one single accessible feature but where the rest of the system remains totally inaccessible.

If using something like SugarMate (which may or may not be accessible with a screen reader), I’d just use an app that provides full screen reader accessibility to all the normal features and alarms that every other user has access to.

The problem with setting up a single accessible feature in otherwise inaccessible system is that the moment something goes wrong, not only will the person with a visual impairment not be able to fix it without help, but they won’t even realize something’s gone wrong or be alerted to seek help, which is not good.

Just something to think about in your considerations. :slight_smile: Since your brother uses a screen reader already, it sounds to me like he’s technically inclined enough to learn how to access a smartphone using a screen reader.

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I don’t depend on Sugarmate calls Jen, rather I was only suggesting alternatives for Rick to consider for his brother.

Hopefully none of us is depending solely on a CGM as the only preventative measure we’ve taken to prevent hypo events.

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I’ll admit, I’ve never fully understood the advantage of calls over a normal alarm. Are they just louder? Or do people tend to respond more if they think someone is calling?

My apologizes if I misinterpreted your comment. I just see so many people (not here, just in general) say things like, “Why not set up XYZ in this special way so this one feature will work for this person with a disability…” when, in reality, XYZ could be make 100% accessible fairly easily. So that was my only point. All the CGM apps I’ve tried are fully accessible when using a screen reader, with the exception of the trend graph (but the trend arrows are accessible).

And yes, no one should be relying solely on a CGM alarm for hypos. I’d also be looking into the circumstances surrounding any severe hypos (or any hypos, for that matter) to see what may have caused them and how they may be prevented in future.

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With a Dexcom G6 and an iPhone, you can say out loud, “hey Siri, what’s my blood sugar” and it will tell you. Mine just said, “it’s 176 and slowly rising”. (My [limited] unlimited lifestyle meant pizza and beer for dinner :slight_smile: )

It takes about 20 seconds to set up, but I’m not sure if the setup part is accessible.

(Other CGMs and other types of phones might also have similar capabilities.)

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I’m baffled. Can you clarify? I got a CGM after my first severe low, and the CGM has protected me so that I haven’t had another. I depend on the CGM to keep me out of trouble. Why is this a wrong thing to do?

My guess is that “solely” is the key word here. A CGM has saved lots of us. But, ideally, it alone isn’t going to prevent lows. Ideally, we’re working to get on insulin regimens and take actions that prevent those lows from happenign as much as possible…then the CGM picks up the few that will always happen.

This is exactly how VoiceOver reads the BG value and trend arrow in the app, too.

For those who have no idea what VoiceOver is, it’s a screen reader that’s built into all iOS devices that reads aloud, or displays in braille if a refreshable braille display is connected, everything that’s displayed visually on the screen. It makes an app completely accessible, regardless of specific audio-based features the app may have. A screen reader is, in part (I also use magnification), how I used all features on the Dexcom app and how I use xDrip on my iPhone, the app that pairs with my insulin pump, write emails, read websites, browse social media, read ebooks, edit documents, and of course, read and respond to these posts. :slight_smile:

Android, Windows, and macOS all have their own built-in screen readers.

The one thing screen readers can’t read are images, such as memes or animated GIFs. Or, sometimes an app or website is designed in a way that prevents information from being accessed by the screen reader, in which case it is inaccessible. But, for the most part, a screen reader user is able to use all the same programs and apps a sighted person uses.

Thanks for the tips Jen :heart:

Thanks again Jim, all info is greatly appreciated.

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Hey Jen, another question please. As my brother has never used or has a smart phone and you do, for the visually impaired do you prefer a small phone or larger one for screen reading etc. I was looking at the iPhone 5S as it was about the same size as his current flip phone and it’s also one of the cheaper choices. But then I got to thinking when adding screen reading in to the equation bigger might be better. Any thoughts from your point of view would be greatly appreciated. :blush:

I have an iPhone SE and love it. One thing to keep in mind is that, if you’re going for the Libre, the LibreLink app requires an iPhone 7 or newer (I just switched to the Libre and am wishing I had a newer phone). In general, I prefer smaller phones because they fit in my pocket better, and I don’t really benefit much from the larger screen. AppleVis is a great site that covers everything imaginable related to iOS and Mac accessibility. They have a forum where you could probably post and get a broader spectrum of opinions, if you wanted to.

Jen, thank you so much for all your help, your awesome. :heart:

You’re most weIcome @Rick, I hope you can find some tools to help your brother.

There are new ones coming out all the time, tech has improved T1’s lives vastly, and they’re moving forward in leaps and bounds :+1:t3: