Welcome to the Voice’s newest feature. If Blindness Comes is a special pull-out section on diabetes and vision loss, printed in a larger font. If you know someone living with diabetes and vision loss, please pull this section out and share it.
by Ed Bryant and Thomas Rivera Ley
If you have diabetes, you need to measure your blood glucose regularly. This is essential to your health. There are no exceptions. Even if you are blind or are losing vision, you still need to find a way to track your blood glucose.
Traditional blood glucose monitors display results on a screen. Sight is required. Sighted people have many types and brands from which to choose. However, if your vision is limited or fluctuates (your acuity changes by the hour) traditional meters won’t do.
All blind and visually impaired diabetics have a right to independence. Trying to make do with traditional blood glucose monitors forces dependence on others—but, thankfully, there are better options. A handful of monitors are designed with speech, either through an add-on voice synthesizer, or through built-in speech chips. These emit instructions and results aloud, enhancing safe, independent testing.
Progress in glucose testing has been rapid. The newer meters (talking or traditional) are more accurate, require smaller blood samples, are simpler to use, work across a greater range of blood glucose values, store more results, connect to computers, and come in smaller packages. Sometimes they even cost less.
A Tale of Two Types of Meters
Talking blood glucose monitors come in two varieties. The first uses a standard off the shelf, blood glucose monitor and adds a piece of hardware which converts the displayed text on the screen to audible speech. The newer varieties fall into the second group. They have speech built directly into the monitors; no additional mechanism is required. This makes them much more convenient to carry when you’re on the go.
The Classics—Meters with Add-on Talking Hardware
The oldest talking blood glucose monitors still available today have add-on voice boxes. The first LifeScan Profile monitors were introduced in the mid-1990s. You can still purchase these from Science Products and the LS&S Group (see Resources). They are accurate, but this is pretty outdated technology. They require a hanging drop of blood which can often be a challenge for those with low vision.
The LifeScan SureStep, introduced in 1996, is a great machine for someone with reduced vision or for a beginner at blood glucose monitoring. It does not require a hanging drop of blood. An add-on voice box is available for it as well (see Resources). Still, this is also decade-old technology.
Roche Diagnostics introduced the Accu-Chek VoiceMate in 1998, which is a combination of the older Accu-Chek Advantage meter and a box which enables the talking function. The system offers speech prompts. Many diabetics with vision loss have used this reliable talking meter successfully for the past eight years. In fact, close to 40,000 units have been sold.
Currently, it is the most readily accessible monitor for a blind user. The mechanical voice is loud, clear and understandable. Its Comfort Curve test strip allows quick, reliable, non-sighted placement of the blood sample. It does not require a hanging drop of blood, but you will need a relatively large 4 microliter sample; just smear or dab it on. The strip sticks well out of the meter, and you just find the tactile cutout on the side. Even if you have neuropathy in your hands, you should find it easy to place the blood. Once this is done, you will have a result in 30 seconds.
The VoiceMate includes a unique feature which, incidentally, dramatically adds to its bulk. It’s a talking insulin vial identifier. If you use Eli Lilly insulin, you can insert the vial into the special opening, follow the spoken prompts, and the machine will tell you what type of insulin you have there. If your insulin is not from Eli Lilly, the identifier is useless, but the meter is still completely useable.
The VoiceMate is not perfect, however. Sometimes it fails to distinguish between “not enough blood” and “low blood sugar” readings. It might report a low, when in fact you missed with part of your blood sample. Therefore, it is very important to retest if you get a “low blood sugar” reading you feel is unjustified.
Does a talking meter have to be so big?
Does it have to cost so much?
The Next Generation—Meters with Built-In Speech
From Diagnostic Devices Incorporated (DDI) come the Prodigy Audio and the Prodigy AutoCode Meters. These bilingual meters are smaller and more fully-featured than their talking predecessors. These meters fit in your pocket, they talk, and they’re very affordable, making them truly economical. (About $30 for the meter, $18 for 50 test strips.)
They offer many of the enhancements of the state-of-the-art blood glucose monitors on the market today including: smaller blood samples (only 0.6 micro liters), quicker results (only six seconds), and alternate site testing, all in a 3 oz., 3-7/8” x 1-3/4” x 15/16” package.
The brand new Prodigy AutoCode, which, incidentally, turns on when you insert the strip, adds a self-coding feature to the original Prodigy Audio. The code for each bottle of strips is automatically registered by the meter; no coding or button-pressing is required from the user. This is a welcome advance over the Prodigy Audio in terms of accessibility.
Still, these $30 meters have some accessibility limitations. They won’t do everything the $500+ VoiceMate does. They do not repeat test results audibly nor do they articulate the testing history which can be seen on the screen. If you miss the reading, you must repeat the test. A seemingly unrelated feature of the meter is its temperature reading, which actually announces the ambient room temperature.
But, if you need a talking blood glucose monitor, these are dramatically more affordable and have some great features. The Prodigy Audio and AutoCode are available right now. I’ve used the Prodigy Audio; it’s accurate, and I predict that its incredibly low price will re-make the market.
The latest addition to the talking glucose monitor market is the Advocate. Roughly the same size and price as the Prodigy Audio meter, the Advocate offers very similar features. It uses a small, 0.7 microliter blood sample and provides the test result in a quick 7 seconds.
It also suffers from similar inaccessibility issues, no way to repeat the result or review the history, and visually impaired users will require sighted assistance to set the code.
However, Frank Suess, at Diabetic Support Program, reports that when blind customers order the Advocate strips from them, they will send only strips with the same code as originally purchased. This way there is no need for the customer to reset the meter. This is a helpful service to the customer, but we recommend that users have someone verify the shipment to ensure the code for the new strips in fact have the matching code. If the code in the meter differs from the code for the strips, incorrect blood glucose readings may result!
Bright Things on the Horizon
We reviewed the SensoCard Plus in our spring 2006 issue. The SensoCard Plus is for sale now in England, but it is still awaiting final FDA approval. It is a higher-priced, more sophisticated product than the other new small talking meters. It may be somewhat easier for a blind individual to set up and use without sighted assistance. It uses a blood sample size of just 0.5 microliters and delivers the test result in only five seconds. It measures only 3-1/2” x 2-1/8” x 5/8”.
Spokespersons for BBI Healthcare in England tell us they anticipate FDA approval in the first quarter of 2007. They have not yet released prices for the US market.
Competition in the small, low-priced, talking meter market is surely heating up as Roche Diagnostics is discontinuing its popular VoiceMate. (*See accompanying article.) We expect revised versions of both the Prodigy and Advocate blood glucose monitors in the coming year. The companies’ leaders express commitment to correcting the accessibility flaws and expect we will approve of their planned accessibility enhancements. This is an exciting time indeed!
RESOURCES
The Accu-Chek VoiceMate talking glucose monitor:
Roche Diagnostics Corporation,
9115 Hague Road, Indianapolis, IN 46250-0100, 800-858-8072.
The NFB sells the VoiceMate for $475.
NFB Independence Market
1800 Johnson Street
Baltimore, MD 21230
410-659-9314
Note: 8:00 am to 5:00 pm, EST, weekdays.
LifeScan Meters: (Basic, Profile, and SureStep)
DigiVoice Module:
Science Products
Southeastern, PA; 800-888-7400.
Science Products carries several versions of the DigiVoice. Be sure to specify
which LifeScan meter you have!
LifeScan Profile LHS7 Module:
LS&S Group
Northbrook, IL; 800-468-4789
Prodigy AutoCode and Prodigy Audio meters:
Diagnostic Devices Inc. (DDI)
Customer Service: 800-366-5901
Technical Support: 800-243-2636
www.ProdigyMeter.com
Advocate Blood Glucose Monitor:
Diabetic Support Program
3381 Fairlane Farms Road
Wellington, FL 33414; 800-990-9826; www.prescriptionsplus.com
The SensoCard Plus:
BBI HealthCare, Gorseinon, Swansea, UK,
(01144) 1792 229333
WWW.SensoCard.com
(Site should be operational by January, 07)
Is Roche Abandoning Visually Impaired Consumers?
As of this writing, Roche Diagnostics has informed their sales outlets that they will stop producing the Accu-Chek VoiceMate after January 1, 2007. Roche states that they will continue to provide service and support for the VoiceMate, and that the Comfort Curve test strips required by the machine should be available for the next four to six years. Once current supplier inventories of the VoiceMate hardware are depleted, however, no more VoiceMate units will be available.
Roche is working on the replacement for the VoiceMate, but as of this writing has made no public announcements on the features of the next generation product nor have they announced when they expect to bring it to market. Any replacement will first need to pass the FDA approval process, which can take quite some time. We will keep you posted as Roche makes more information available.
How Can I Pay for my Talking Blood Glucose Monitor?
Many private health insurance plans will cover the cost of a prescription for a talking blood glucose monitor under the durable medical equipment benefit. Medicare part B also provides coverage for both categories of talking blood glucose monitors. Be sure you and your supplier follow all guidelines for reimbursement. Codes are: E0607, for traditional, “non-adaptive” meters, and (THIS IS A NEW NUMBER) E2100, for talking meters and/or add-on voice synthesizers, available to diabetics who are at least legally blind. For Medicare information (in English or Spanish), call 800-633-4227, and ask for “Durable Medical Equipment.”