Type 1 Diabetes: Complications
Software
Animas has diabetes-management software for your personal computer that can be used to upload data from the pumps and to create reports of insulin delivery over time. The software can also help you calculate the correct insulin-delivery amounts. However, the software was not accessible using either JAWS or Window-Eyes. The MiniMed 512, the Deltec Cozmo, and the Disetronic D-TRONplus have software that performs the same diabetes-management functions, but their software can also be used to program the pumps. Although the Deltec and MiniMed software programs were not accessible using JAWS or Window-Eyes, the Disetronic software was accessible. We were able to set basal profiles and send them to the pump via the infrared ports. The software warns the user to confirm that the settings were properly transferred to the pump, but a person who is blind or has low vision cannot do so. SOOIL has not introduced software yet, but it plans to do so in 2004.
Battery Replacement
Most of the pumps have simple battery-replacement procedures. You simply remove the battery cap with a coin or screwdriver and replace a standard AAA battery or battery pack, and the whole process can be done tactilely. However, the MiniMed 508 and Animas use 357 silver oxide batteries that are used in many wrist watches. Because there is only a slight difference to the feel of the positive and negative ends of these batteries, it is difficult to orient the batteries in their housings properly. All the pumps have low battery warnings, but as with the low reservoir warnings, they are inaccessible.
Can People Who Are Blind or Have Low Vision Use Insulin Pumps?
Insulin pumps are relatively inaccessible devices without any speech output. They are also complex medical instruments, and improper use can be dangerous. Unlike the inconvenience experienced when an inaccessible cell phone cannot be used properly, the results of improper insulin delivery can be lethal. However, we do know that there some people who are blind or have low vision who are successfully using insulin pumps, and we assume that they are doing so in close contact with a certified diabetes educator or other health care provider and with some sighted assistance.
The Bottom Line
If you have diabetes and a visual impairment, and you think that you may be a candidate for insulin-pump therapy, we encourage you to consult extensively with your endocrinologist and certified diabetes educator to learn as much as possible about the pumps. Although none of the pumps can be programmed and operated entirely nonvisually, the MiniMed 511 and 512 pumps provide a bit more accessibility than do the others on the market. The reservoir-filling guides, insertion devices, and accessible priming feature on the 511 and 512 make these pumps the easiest and most accessible to get insulin flowing into your body. The audio bolus, easy-to-identify buttons, and easy battery replacement are other positive features of the MiniMed 511 and 512. The Disetronic pumps also have some accessible features, and they are the only pumps with prefilled reservoir cartridges, but they are no longer on the market because of FDA violations.
Insulin pumps are revolutionary in the advancement of diabetes management, and their use is spreading rapidly. From 1990 to 2001, their usage increased from less than 9,000 to over 160,000 persons, but because they are so inaccessible, many people with diabetes who are blind or have low vision are missing out on the benefits they provide. Manufacturers must realize this shortcoming and design the next generation of insulin pumps with more accessibility in mind. Adding speech output is the most important step toward full accessibility, so that people who are blind or have low vision can safely and independently use insulin pumps.
Funding for this product evaluation was provided by the Teubert Foundation, Huntington, West Virginia. The authors thank Steven Taylor of Marshall University for his research assistance and the Marshall Diabetes Center of Cabell Huntington Hospital, Huntington, West Virginia, for providing insulin pumps to evaluate.
Product Information
Products: 508, Paradigm 511, and Paradigm 512
Manufacturer: Medtronic MiniMed, 18000 Devonshire Street, Northridge, CA 91325; phone: 1-800-MINIMED; web site: http://www.minimed.com.
Product: DANA Diabecare II
Manufacturer: SOOIL Development Co., DANA Diabecare USA, 2601 North Hullen Street, Suite 100, Metairie, LA 70002; phone: 866-Diabecare (342-2327); web site:http://www.danapumps.com/.
Products: H-TRONplus and D-TRONplus
Manufacturer: Disetronic Medical Systems, 5151 Program Avenue, St. Paul, MN 55112; phone: 800-280-7801; e-mail: info@disetronic-usa.com; web site:http://www.disetronic-usa.com.
Product: IR 1000
Manufacturer: Animas Corporation, 590 Lancaster Avenue, Frazer, PA 19355; phone: 877-767-7373; web site: http://www.animascorp.com.
Product: Cozmo
Manufacturer: Deltec, 1265 Grey Fox Road, St. Paul, MN 55112; phone: 800-826-9703; web site:http://www.delteccozmo.com.
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