[Diabetes-talk] questions from a fairly new list subscriber

Sat Mar 14 19:12:15 UTC 2009

Hello Chanelle and everyone, 
Unfortunately, I found that you cannot even get the Paradigm Pal software
installed without sighted assistance. To me, this is totally unacceptable
and I will be talking to the contacts I once had with the software
development team.  If memory serves me correctly, the software is developed
using JAVA. Java alone can be made to be accessible provided the developers
know this and include it in the Java objects they use within the
application.  However, this is a big "if" as most developers still don't
understand the term "accessible" or how it applies to software as it is
developed. Hopefully, the contact info I have is still good and the 2
developers I have contacted in the past are still with Minimed. If this
software can be made accessible, then it would allow blind pumpers using
Paradigm pumps all kinds of access to the settings of their pumps. We would
no longer have to worry about having an accessible pump because the software
would allow us to control the pump, including setting those all important
basal rates.

On a somewhat different note, someone at work asked me how the folks at
Minimed get away with making an inaccessible pump when they sell to the
government through the veterans administration. I told him I didn't know and
would check into it. Does anyone know, or have a way to confirm, that the VA
does actually purchase Minimed or any other brand of insulin pump for those
veterans who become insulin dependent diabetics? If this is the case and
pumps are purchased, does this fall into one of those situations where the
device being sold to the government must be accessible? This might give us a
little more oomph if we were to find out this is indeed the case as we might
be able to get the government involved somehow. But then again, it cold
wreck everything too <lol>.

-----Original Message-----
From: diabetes-talk-bounces at nfbnet.org
[mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of Chanelle Hill
Sent: Thursday, March 05, 2009 11:02 AM
To: 'Diabetes Talk for the Blind'
Subject: Re: [Diabetes-talk] questions from a fairly new list subscriber

Hello Dave,
Thank you for explaining your process for using the bolis wizzard. I see my
diabetes educator in a few weeks so I will talk to her about it.
For the past several years, I have been meaning to use the Paradigm Pal
Software. Now that I finally got the right cable a few weeks ago, I should
try it. Unfortunately, the people atMinimed didn't know what I meant at
first. They sent me the meter to work with the Personal Care or whatever it
is called where people upload their pump readings online.
I have memorized the button pushing sequence for setting a temporary basal
rate, so if anyone needs the steps, please let me know. Of course, go
through the process with someone sighted first (smile).
I would definitely be interested in having the Paradigm Pal software made
more accessible with Jaws. I have always wanted to learn Jaws scripting.
Maybe someday when I get around to it, I can help with the Paradigm Pal
Software (smile).
Speaking of carbs, what ways have you or anyone on this list found to be
effective for reading nutrition labels or getting access to that
information. I have sighted friends read labels for me, but it is easy to
forget in keeping track of so many things. Since I am getting set up with
Services for the Blind, I am hoping to get a portable scanner or something
similar that would read barcodes. Does the K NFB reader do this? I also know
that there are websites that give nutritional information for certain foods,
but I have forgotten what those are.
I have been using my pump for five years, but I am feeling more hopeful
about using it more effectively since I have gotten responses to my
questions on this list.

Chanelle

-----Original Message-----
From: diabetes-talk-bounces at nfbnet.org
[mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of David Anspach
Sent: Wednesday, March 04, 2009 9:36 PM
To: 'Diabetes Talk for the Blind'
Subject: Re: [Diabetes-talk] questions from a fairly new list subscriber

Hello Chanelle,
I have successfully used the bolus wizard on the Paradigm series of insulin
pumps. It was much easier than I expected and requires just a few things be
set up in the pump itself first. Afterwards, it is just a matter of pressing
the button furthest to the left followed by pressing the far right button,
or activate, button. I haven't used this feature of my pump in quite a
while, but am planning on getting back into the habit once an insulin pump
trainer comes out to my home and helps me adjust my basal rates. From what I
remember, these are the steps:
1. Press the button furthest to the left. I think this tells the pump you
are ready to begin entering information into the bolus wizard.
2. Using the arrow keys, you enter the value of your blood sugar reading
that is over your target value. For example, my target value is 100. If I
check my blood sugar and I get a reading of 130, then I would press the up
arrow key 30 times.
3. You then press the far right, activate, button on your pump.
4. Using the arrow keys again, you enter the value of your carbs you are
about to eat. So for example, if you are going to eat 30 grams in carbs, you
would enter this value using the arrow keys. In my case, I chose to set the
up arrow to enter 1 gram per arrow press as it was easier and provided much
more control than setting it to 5 grams per press. So, I would press the up
arrow 30 times to enter the carb value.
5. Finally, you press the activate button, I think, twice to tell the pump
you are finished. The first press causes the pump to display the number of
units of insulin the pump has calculated you will need based on your blood
sugar reading and the carbs you will be eating. The second press causes the
bolus wizard to begin administering the insulin.

As I stated above, I'm not 100% sure my steps are accurate, but, I think
they are close. So, don't try this at home <smile>. In any event, you will
need to have someone sighted give you a hand in the initial set up of the
bolus wizard. You will need to set your target blood sugar value, the number
of carbs each press of the up arrow key represents and I think that's it.
The nice thing about using the bolus wizard is that it shows your health
care provider what your blood sugars have been running and your average carb
intake. 

Someone also mentioned the software that you can purchase that allows you to
adjust various settings on your pump, including basal rates. I believe this
software is called something like Paradigm Pal, but I'm not totally sure.
When I first got my pump back in 2004,  I took a look at this software.
Unfortunately, it was written totally in Java and was basically inaccessible
using a screen reader, such as JAWS. I tried working with their software
developers to get it to be more accessible, but, my efforts didn't pan out
as I had a lot of trouble getting the Java run-time environment and access
bridge set up correctly on my PC. Once I did, I lost their contact info and
sort of gave up. I have a newer copy of this software around somewhere that
I received after getting my new 722 last spring. I have been looking for it
as I want to see if it is any better now than it was nearly 5 years ago.
Since I also work for Freedom Scientific, I may end up taking it into our
development team and asking them to see what might be done on the JAWS side
of things to help access the software. I think that in order to  actually
get changes made to JAWS, I will have to show project management that there
is enough need for changes in JAWS. If you or anyone else, for that matter
is interested, then please let me know. The more interest in the use of this
software by blind diabetics who use Minimed pumps, then the better the
chances we will have in getting changes made. I also have a contact at
Minimed that I am going to try and use to see if I can get back in touch
with their software development team. I truly think that if we cannot get an
accessible pump, then having software that is accessible that allows us to
manage our pumps will be just about as good.

Sorry for the long post, but, I am very passionate about making life for
blind pumpers  that much easier.

Have a great Thursday,

Dave

-----Original Message-----
From: diabetes-talk-bounces at nfbnet.org
[mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of Chanelle Hill
Sent: Wednesday, March 04, 2009 12:04 PM
To: 'Diabetes Talk for the Blind'
Subject: Re: [Diabetes-talk] questions from a fairly new list subscriber

Dear Mike,
Thanks for replying to my message. I will check out the Braille Monitor. I
subscribed to Voice of the Diabetic about a month ago and haven't received
an issue yet. I opted to receive the publication via email.
The CD I received from Blind Inc., seems to be a few years old since some of
the articles date back to 2004, 2001, and those reprinted from the 90's.
I would like to get connected with diabetes educators who have had
experience working with the blind.
That would be great if Prodigy made a talking pump!
Minimed pumps have software that allows one to make changes to basal rates,
the increment for easy bolis, time and date, and other items that are set
through the pump menus. It would be nice if one could also use the software
to program a bolis that would be delivered as soon as the pump was
disconnected from the computer. For example, I think that the pump has bolis
wizzard--a feature to calculate insulin needed for carbs eaten and high
blood sugars. These calculations can easily be made manually, but I think
the pump also keeps track of active insulin.
I will figure out who I could speak to at Minimed about this or pump
accessibility. I appreciate your efforts to advocate accessibility with the
insulin pump companies.

Chanelle
-----Original Message-----
From: diabetes-talk-bounces at nfbnet.org
[mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of Mike Freeman
Sent: Tuesday, March 03, 2009 9:58 PM
To: Diabetes Talk for the Blind
Subject: Re: [Diabetes-talk] questions from a fairly new list subscriber

Chanelle:

With respect to BLIND, Inc., it's a great rehab center. I know some of the
personnel who teach there and they're great folks and know what they're
about. If you go to http://www.nfb.org, thence to the "Publications" link
and thence to "The Braille Monitor", you can read a review and description
of the BLIND, Inc. program in a recent issue. 
Just do a search for "Blind, INC." and you'll find it or just peruse the
tables of contents for the past few issues.

BLIND, Inc. had someone who specialized in diabetes management but don't
think there's one there now. However, there are a number of persons there
who have diabetes and who can probably put you in touch with blindness-savvy
CDEs. Additionally, there's a lot of practical expertise on this list.

Insofar as pump accessibility is concerned, I and several others from the
Diabetes Action Network are working on the problem. However, the situation
isn't much different than that which you described from an article several
years ago. Although at first blush it would seem that it would be easy to
make an insulin pump talk, it isn't quite as simple as one might suppose.
One has to determine what must be spoken when and in what form (for example,
if one is using a pump with a CGMS system, often the information is
graphically displayed, not numerically displayed and one must figure out how
to convey this verbally). WE have had some communication with one pump
manufacturer which has showed a bit of interest. However, if truth be told,
despite what we might think, the blind (and yes, I mean the visually
impaired also) are a pretty small segment of the market so pump
manufacturers have to be shown a good reason for making the investment in
access technology. AS I say, we're working on it. I doubt anything is in the
immediate offing.

AS to the Clevercheck, I've not seen one but suspect that it is like the
Prodigy Autocode or the Advocate in that it would speak a bg reading -- once
-- but that all other functions would be inaccessible. But I emphasize that
I'm going on a hunch, not on knowledge.

We'll keep working on the pump problem, though!

Mike Freeman, President
Diabetes Action Network
National Federation of the Blind

----- Original Message -----
From: "Chanelle Hill" <chanellemh at gmail.com>
To: <diabetes-talk at nfbnet.org>
Sent: Tuesday, March 03, 2009 1:27 PM
Subject: [Diabetes-talk] questions from a fairly new list subscriber

Dear List Members,

I read an article about insulin pumps that someone from NFB wrote several
years ago, and so I thought I would join this list to see if anyone has had
improved accessibility with the pump and for other diabetes issues. I am a
Type I diabetic, and I have been using the Minimed Paradigm 512 insulin pump
and the Prodigy Voice meter. I know that NFB is heavily involved in
advocacy, but what has been done to inform insulin pump companies of the
need for more accessible pumps? Is there any way to become involved in
advocating for better accessibility? It would be wonderful to use the new
Minimed Continuous Glucose Monitoring system, but the meter needed to
calibrate the pump doesn't talk. It seems like that could easily be fixed
since there are already talking glucometers. I spoke with a rep from Minimed
about upgrading my pump and asked if Minimed was working on a pump that
would be more accessible. She thought that the company was, but no one has
gotten back to me.

It sounds like someone is having problems with the Prodigy Voice meter on
this list? After calling and waiting a few weeks to get some more strips, I
found out that Homecare Solutions is no longer carrying the strips for
Prodigy Voice and that they are carrying a new meter that is supposedly like
the Prodigy called the Clever Check. Have any of you heard of this new
meter? Hopefully it has all of the audible features and more accessible
software (that's almost too much to ask :-) ).

Finally my last question. I am checking out state rehabilitation centers in
Minnesota-one of which is Blind Inc. On the CD that SSB sent me containing a
BLIND cyber brochure, a class for diabetes management was mentioned. Do you
know if that is still taught? Apart from that, have any of you had
experience with the training programs at Blind Inc.?

Thanks in advance for answering my questions.

Chanelle

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