Note from Dr. V. Mohan :
We are proud to publish this blog written by Mr. Lakshminarayana Varimadugu who not only overcame type 1 diabetes but also visual impairment this shows his great courage and positive nature. I salute you, Mr. Lakshminarayana. We as Dr. Mohan’s Diabetes Specialities Centre are proud of you!
Introduction
Great thanks to Dr. V. Mohan for encouraging me to write a blog! Hope this would enable people with diabetes to develop a positive attitude towards diabetes management. I wrote my first blog on the Blue Circle Diabetes Foundation blog 2 years back. Can be accessed by clicking here.
I’m Lakshminarayana Varimadugu, currently living in Hyderabad. I am a native of Anantapuram district, Andhra Pradesh. I’m a person with both vision impairment (by birth) and Type-1 Diabetes. Please note that there is no connection between blindness and diabetes in my case. According to doctors, the reason behind my visual impairment is my parent’s consanguineous marriage.
I am currently working as a “Digital accessibility tester” at BarrierBreak Solutions Pvt. Ltd. I’m a postgraduate in political science from the University of Hyderabad.
I have the following professional skills:
- Certified digital accessibility tester (Vision Aid)
- Certified diabetes educator (LIHS Mumbai)
- Certified computer trainer (Enable India)
Childhood
I had an amazing childhood because of RDT (Rural Development Trust), NGO in Anantapuram working for marginalized communities such as people Below Poverty Line, women, SC, ST, disabilities, etc.
I am lucky to have a good school education. I joined the school 2 years late as my family was not aware that a child with vision impairment can also pursue education like other children……..In fact, in grade 2, I stopped going to school…If I was not educated, I would have been in a different position.
I am grateful to have access to quality education (inclusive) and I am thankful to my teachers……Until 7th standard, my education happened in braille script. RDT gave me a laptop in my 8th standard and this marked an entry of technology into my life which is the reason for my independence. Teachers Alba (who is also a visually impaired person) and Esther taught us computer and English skills. I can use computers and smartphones efficiently like everyone else.
My higher education material included E-copies such as Docx, PDF, PPT, XLS, etc. I got good support from my University friends. Whenever I had difficulty in finding the study material, they spent their time and helped me by giving either the text format or an audio recording of the same.
People with blindness use devices such as computers, tablets, and smartphones with the help of screen readers. Screen readers are pre-installed (comes with OS) apps in popular platforms such as Windows, Android, and apple.
My T1D Diagnosis story
I was diagnosed with Type 1 Diabetes on 13th August 2012 at the age of 17 in RDT Battalapalli Hospital. My blood sugars were on 646 mg/dl at the time of diagnosis and doctors immediately kept me on “mixtard” insulin.
I spent the initial 3 years after diagnosis in RDT Inclusive School where I studied my high school education. I was given a special diet and insulin-free of cost until I completed my +2 education. Director Mr. Dasarath and campus in charge sister Ritty gave me special attention and cared for me well. I still remember eating aloe vera and neem leaves every day at Sister Ritty’s home. With our little knowledge on T1D and not knowing that it may not show much impact for a T1D, we then thought it would help me better my blood sugars. Mr. Dasarath introduced me to my first glucometer which is glucocard 01 and I was excited to use this. My great thanks to the teaching and non-teaching staff of the campus for their love and support. During my higher education, I received a scholarship every month for my diabetes management even after leaving the campus.
My Travel
I can travel independently alone wherever I want. I use a White cane regularly. White cane gives real dignity and makes the visually impaired independent. I am also good at using google maps and identifying places. Mostly I use public transport such as trains and buses to travel. I found railway stations and train journeys are more accessible and comfortable for visually impaired people compared to buses. I use Uber, Ola uses it if I am going to a new place and if I’m in hurry. I do not hesitate to ask for help from others when I need help. my friends gifted me a Smart cane on my last birthday. It is an addition to the white cane, and it has a cool feature called an obstacle detector i.e., it vibrates if something comes on my way in 3 meters distance.
I also started learning to cook independently!
My volunteer activities
In the past 5 years, I trained nearly 500 school children and college students (both disabled and non-disabled) in using the devices such as computers, tablets, and smartphones. I volunteered as a computer instructor in Enable India and worked in NAB (national association for the blinds) Bangalore, Andhra Loyola during my summer holidays. I enjoyed teaching children and I was amazed by their enthusiasm for learning new things
Story of independence in Diabetes management
I’m managing my diabetes by myself and achieved this independence in diabetes management after plenty of challenges and self-research by combining all my professional skills mentioned above. Technology has been a key to my successful independent diabetes management. Being a visually impaired person; I use accessible and inclusive tools and technology to manage my diabetes on my own without depending on others. I strongly agree with this quote:
“For most people, technology makes things easier. For people with disabilities, technology makes things possible.” – Mary Pat Radabaugh
I used “Mixtard” insulin for nearly 4 years after diagnosis. I was using vials and syringes initially. I had to depend on someone to draw insulin from the vial as I cannot see the units on the syringe. There were days I had to skip insulin doses and meals when I could not find anyone to help me draw insulin from the vial. Even If I found someone, they were filling with a bubble. Many times I ended up taking the wrong dosages. I also used Insumen combo 30/70 for a year.
Premixed insulin such as Mixtard, Novomix, Insumen combo, Ryzodeg, etc are not recommended for T1Ds. I was unhappy and worried with Mixtard insulin as I had to eat a small quantity of food multiple times at fixed timings. I was feeling like I was living to eat all day long. Dr. Kalyan Chakravarthi, citizens specialty hospital, Hyderabad, introduced me to the Basal bolus regime in 2017 and taught me to inject insulin using an insulin pen on my own. That was when independence in diabetes management started. The great advantage of the basal-bolus method is flexibility i.e. I need not eat multiple times and I need not follow fixed timings. Dr. Kalyan is friendly and treats me like a student.
Lakshmi demonstrating taking insulin shot using insulin pen
Insulin needs refrigeration and it has to be stored between 2 to 8°C temperature. I did not have a fridge and my insulin lost its potency and spoiled many times which led to a rise in glucose levels. My university being a huge campus, I had to travel 3 km from my hostel to the health center whenever I had to change insulin pen fill. Dr. Sheetal from Hyderabad, understanding my challenge, gifted me a new mini-fridge to store my insulin. She is very friendly and I feel comfortable asking for help if I need any medical help. I also use a Frio bag to keep my insulin cool whenever I travel.
Every person with diabetes should own a glucometer and should check his/her glucose levels regularly to maintain BG levels in a normal range. I used glucometers such as Glucocard 01, Alereg1, and Beato with the help of a nearby person available. None of them were accessible for visually impaired person and it was very challenging whenever I had to check my blood sugar during fluctuations i.e. during lows and highs, especially in midnights. Sweet souls gifted me a Prodigy voice glucometer which is completely audible from initial settings to testing and announcing the glucose results. After my self-research online, I found this beautiful glucometer and shared the info with Nalini.
I also started using the libre pro (FGM) sensor from last year whenever possible. Sensor readings can be checked using Libre pro reader or through mobile (only NFC enabled) and it provides continuous glucose readings for 14 days.
For most of my life, I stayed in hostels before and after diagnosis of T1D. Living in a hostel is challenging because of diet, insulin storage, etc. As I always say challenges make life special and interesting, we have to find solutions to adjust and live happily in hostels. My education happened from KG to PG in hostels.
Being a central university student, I received advanced insulins free of cost. I didn’t know this earlier and missed this advantage in my first year of campus days.
My post in the “beyond Type1” app introduced me to an amazing T1 world. Nupur is my first T1 friend and she connected me to Sweet souls foundation Hyderabad.
My diabetes education
I manage my diabetes as best as I can and I enjoy learning more about diabetes treatment, diet, technology, etc. My last HBA1C (3 months average blood sugar) was 6.5 and I stay nearly 60% in TIR (time in range) on a libre pro sensor. My target is 70-130 MG/DL.
My proper diabetes education started with the help of T1 parents Sirisha, Nalini, Ramesh, and Sunil. Nupur is always there whenever I want to speak. I always receive great encouragement and support from Prashanth, Harsh, Bheemakka, etc. I’m thankful to T1 parent Praveen for helping me in finding room in Hyderabad and for providing initial support.
My family supports me in whichever they can and I’m sure if they were educated, they would have supported me even better. They want to give their best whenever I visit my home but their limited knowledge of T1D and unavailability of resources in the village is limiting it. It motivated me to educate more and more T1 parents on T1D in such a way that children with T1D can enjoy their life to the full extent in their homes. My family proudly says that I can lead my life on my own with full confidence!
My great thanks to Dr. Bernstein for explaining medical knowledge in simple language. I watch his videos and teleseminars without missing one.
Becoming a certified diabetes educator was my dream but I was a little worried and disappointed as I was from a different science background but the course admits people with BSC or from a similar science background. I expressed my desire with Sheryl Salis ma’am on the T1D foundation of India launching day. She responded positively and immediately promised me that she will admit me into the CDE (certified diabetes educator) course. I was excited and felt very happy after her assurance. I, along with many T1D friends and some parents having children with Type 1 Diabetes have completed the diabetes educator course successfully, virtually with the help of Sheryl ma’am. She always encourages me and now has helped me fulfill my dream to become a CDE.
