By the National AgrAbility Project (Wisconsin)
A variety of assistive technology solutions can be used to help with the control of diabetes and secondary complications that may result from the disease. Diet, medications, and physical activity are important in controlling the disease and preventing potential complications. * The following assistive technology solutions may be useful in helping individuals achieve their treatment goals and remain as independent as possible on their farms or ranches.
Dietary Planning and Diabetes Monitoring
Meal Planning Sheets
The American Diabetic Association and the American Dietetic Association have developed six food exchange lists for individuals with diabetes. Meal planning sheets can be used when shopping for and preparing foods. For individuals who are always on the go, meals can be prepared ahead of time and stored in the freezer or refrigerator.
Electronic Prompting Aids
Eating meals or a snack at the right time can be challenging for individuals who do not have the same work routine each day. Working long hours, over lunch, or into the night can result in missed snacks or meals, which can result in extreme variations in the blood-glucose levels.
Electronic prompting aids can be very useful in reminding someone when and what to eat. Several of these prompting devices are on the market.
(1) The Timex Data Link Watch or electronic Voice Organizer allows an individual to record, in his or her own voice, reminders of snacks or meals to be eaten, medications to be taken, or insulin levels to be checked. Commands can be programmed to reoccur daily at the same time. The device is the size of a pager and can be worn on a belt or placed in a pocket. When the device goes off, the individual simply pushes the play button and listens to the reminder.
(2) Personal Digital Assistants (PDA's), such as the Palm Pilot or Visor Handspring, can also be programmed with auditory prompts that can reoccur at the same time each day. These devices require the individual to read the prompt on an LCD screen.
(3) "Day-Timer" has developed another simple prompting aid that makes a series of auditory beeps that can be programmed for up to 22 reminders per day by simply turning a tiny switch on over the hour or half-hour. The device measures 1" x 5" x _ " and can be purchased at many office supply stores. The limitation of this simple prompting device is that when the alarm goes off, the user must remember what the alarm is about.
(4) Electronic watches can also be programmed with beeping prompts throughout the day.
Several glucose-monitoring devices are currently on the market. Although each device requires checking the glucose content of a small drop of blood, there are variations in the way this sample is obtained. The majority of the glucose monitoring systems requires the use of lancets, test strips, and a monitor that reads the blood-glucose level. Another type of system, the "AT LAST" Blood Glucose System, creates a small break in the skin of the arm or thigh, capillary action delivers a tiny blood sample to the test strip, which can then provide an automatic reading in 15 seconds. Glucose monitors can be purchased at most pharmacies. Medicare and other health insurance usually pay for these monitors.
Insulin can be taken in pill form; however, many individuals with diabetes require insulin injections. Newer technologies available to inject insulin include insulin pens that allow the user to dial a selected dosage, insulin jet injectors, and external insulin pumps. Additional technologies under development include an implantable insulin pump and the insulin patch to give continuous insulin.
Low Vision or Blindness
Thousands of assistive technology solutions are available to help individuals accommodate low vision or blindness. Technologies include voice/talking output devices, magnification devices or systems, mobility canes, tactile overlays or materials, large print items, lighting solutions, and handwriting guides.
In addition, there are devices with auditory outputs like talking watches, color identifiers, calculators, scales, clocks, note takers, pagers, organizational aids, text-to-speech computer software (e.g., JAWS or Kurzweil), books on tape, and 4-track recorders/players.
An updated version of The PARROT Voice Mate is now available. This is a small hand-held electronic talking organizer that uses voice recognition technology with the following features: a phone book, a voice note pad, an appointment book, a talking alarm clock, and a calculator. I.D. Mate, manufactured by En-Vision AMERICA, incorporates bar-code scanning technology and digital voice-recording technology. Bar code identifiers can be generated and placed on virtually any object or material. With a small portable scanner and digitized voice output device, the user can quickly identify objects in the workplace. This technology could, for example, be used to identify a cow that is being milked in a milking parlor. This same manufacturer also sells Script Talk, a portable hand-held electronic device used to identify prescription information that is stored on a microchip imbedded in the paper label of a pill bottle.
Magnification aids include magnifying mirrors, monoculars, video magnification systems for closed circuit TVs, and computer magnification software programs that magnify whatever is on the computer screen (e.g., Zoom Text and Kurzweil).
Mobility canes for individuals with visual impairments may be either folding or ridged and are usually made of aluminum, fiberglass, or graphite. Graphite canes are lighter and more resistant to bending than the others. Less commonly used are laser canes, which emit laser beams that bounce off obstacles.
Solutions Made at Home (Low-Tech)
Many individuals who have lost their eyesight as a result of diabetes have developed their own low-cost, low-tech solutions to help accommodate their condition.
Protective clothing, such as a wide-brimmed hat, can prevent potential bumps or cuts to one’s head. Usually, the brim of the hat will hit a protruding or overhanging object, which will alert the individual to stop before his/her head hits the object.
Padding applied to protruding objects can be a simple solution to preventing a potential cut or bruise. If the protruding object cannot be adequately padded, applying padding to the individual might be the next best solution. Padding can include bump hats, construction hats, kneepads, shin guards, or elbow pads. When working in cluttered environments or around wagon tongues, a person can use hockey shin guards to help prevent injuries to his or her ankles and shins.
Use of contrasting colors on the edges of objects, doorways, and steps make edges easier to see. Glass doors can be marked with black and yellow tape. Areas around the farm site can be identified more easily with tactile ground markers like rocks, fencing, pavers, and paths of #2 crushed-rock with fines. "Puffy paint" and "High Mark" can be used to place markings on dials or scales to identify various measurement increments. Colors or textures of tags, ropes with knots, and chains around the calves’ necks will make it easy to identify them quickly.
Wind chimes or radios set to different music stations and in various farm buildings can help an individual orient him or herself when performing work tasks. Motion detectors with prerecorded messages can be placed in hazardous areas to alert a person to a potential danger or hazard.
Dogs can also be trained to alert the worker of a potential hazard in the area. Farmers who experienced blindness as a result of diabetes have reported that trained farm dogs can help keep livestock and other animals at a safer distance.
Tool caddies and shop organizers can be useful. Organizing the farm site and workshop so that there is a specific place for everything is an invaluable practice for a farmer with blindness or low vision.
Proper Foot Care
Custom shoes are often required to avoid sores or risk of infections. If comfortable, well-fitting shoes cannot be commercially purchased, a podiatrist should be consulted for assistance in obtaining customized footwear. A pedicurist or podiatrist can assist with proper foot care for a person with diabetic neuropathy by, for example, preventing nicks or cuts when trimming toenails.
Foot or Leg Amputations (See Amputation Section)
Advances are continually being made to improve comfort, energy storing capacity, and function of lower extremity prosthetic devices. Specific lower extremity prosthetic devices are recommended to individuals according to their level of activity.
Today, manufacturers sell single-axis and multi-axis prosthetic feet. "Multi-axis" feet allow the ankle to twist for uneven terrain. This feature can be useful for farmers and ranchers with well-healed amputations who work on uneven surfaces and constantly climb up and down tractors.
The two primary types of prosthetic feet are energy-storing and energy-saving. The heavier and more active people are more likely to benefit from an energy-storing foot. These feet act like a spring in the toe. The spring compresses (storing energy) and springs back (releasing energy) at toe-off, thus conserving energy that otherwise would be wasted. Examples of energy-storing prosthetic feet include The FlexFoot, The STEN (STored ENergy) foot, The Otto Bock Dynamic Foot, The S.A.F.E. (StationaryAttachment, Flexible Endoskeletal) foot, and The Carbon Copy II.
On an energy-saving foot the toe (lever) of the prosthesis is soft rubber and the wood keel is not too long so that little energy will be required to go over the toe of the prosthesis. The lighter and less active people are the more likely they are to benefit from an energy-saving foot. Examples of energy-saving prosthetic feet include the SACH (Solid Action Cushion Heel) and the Seattle Foot.
Individuals with foot or leg amputations should consider the benefits of using a mobility aid to save energy and prevent potential risks of slip or fall injuries. Mobility aids can be used both indoors and outdoors. These aids include power scooters, utility vehicles, powered wheelchairs, golf carts, or even modified lawn mowers with the blades removed.
Non-slip materials, such as grip strut, non-slip ladder rung material, and strips of non-slip material with self-adhesive can be used to prevent slips and falls. Ice grippers can be applied to the bottom of shoes to prevent potential slips or falls on the ice. Special ice gripping cane and crutch tips are also available.
The latest comfort technology available for those who use crutches is The Absorber Crutch Enhancer. This device absorbs up to 90% of the shock transferred to the wrist, elbow, and shoulder each time the crutch strikes the ground. It can be retrofitted into existing metal forearm and axillary crutches.
Timex Ironman Data Link Watch
E-Pill Organizer and Medication Alarm
Low Vision Solution - Talking Alarm Clock
Low Vision Solution - Bumper Dots can be used on keyboards, phones and more for tactual identification