• Fresh Views

    Move to Mediterranean-style Eating: Tips, Swaps, and How-to’s that work

    View of the Mediterranean Sea from Eze Village, France

    In the quest to eat healthy (with or without diabetes), embracing a Mediterranean eating style can be a helpful approach. In fact, in our last blog post you’ll find the highlights from the new consensus report on nutrition therapy for adults with diabetes or prediabetes which confirms that the Mediterrannean eating pattern, along with a variety of others, can help people with or at risk for diabetes to eat healthier and be healthier.

    We are personal fans of the Mediterranean approach. We enjoy the flavors, variety and health benefits (of course)! So, we want to share a few practical tips that have worked for us, as well as clients we have coached over the years. But first… 

    What exactly is Mediterranean style eating? 

    Traditional Mediterranean meals feature foods grown all around the Mediterranean Sea, and emphasize foods that are minimally processed, seasonally fresh, and locally grown. Focus is on including the following:

    • Plant-based foods, including vegetables, beans, nuts and seeds, fruit, and whole grains. 
    • Fish and other seafood (small amounts and limited frequency of red meat)
    • Olive oil as the main dietary fat
    • Dairy products (mainly yogurt and cheese) in low to moderate amounts
    • Fewer than 4 eggs per week
    • Fresh herbs and spices for flavor
    • Wine in low to moderate amounts
    • Water as the go-to beverage
    • Infrequent use of concentrated sugars or honey

    Does this peak your interest? If so, are there some of these foods that you already like and eat, that you could swap in more often to begin eating “more” Mediterranean?

    There is no one “right way” to eat Mediterranean style. If you are interested in eating “more” Mediterranean, here are 6 small steps to get you started.

    6 steps to start eating more Mediterranean

    1. Eat fish at least twice each week. Fresh or water-packed tuna, salmon, trout, mackerel, and herring are good choices.
    2. Fill at least half of your plate with Mediterranean style non-starchy vegetables which include the following: artichokes, arugula, beets, broccoli, Brussels sprouts, cabbage, carrots, celery, celeriac, chicory, cucumbers, eggplant, fennel, greens, leeks, mushrooms, nettles, okra, onions, peas, peppers, potatoes, radishes, rutabaga, scallions, shallots, sweet potatoes, tomatoes, turnip, and zucchini.  Vegetables are a staple of the Mediterranean eating pattern. 
    3. Replace butter and margarine with healthful oils such as olive or canola oil. Use these oils for cooking, dip bread in flavored olive oil, or lightly spread olive oil on whole-grain breads.
    4. Choose whole-grain breads and cereals, as well as whole-grain pasta and rice products.
    5. Season meals with herbs and spices rather than salt.
    6. Snack on small servings of nuts or seeds instead of snack foods. Deb likes pistachios so has small zip-top bags of them on her desk at work, in her travel bag, and in her car for quick snacks! Perfect for plane travel too!

    The Mediterranean eating style is not low fat, but rather rich in heart healthy monounsaturated fat from plant sources such as olives and nuts. Here are some of our favorite swaps to make the switch to high quality Mediterranean fats…

    4 simple swaps to healthy Mediterranean-style fats

    • Top whole grain toast with almond butter or peanut butter rather than butter. Natural nut butter is preferred (rather than the kind with added fat). If you have trouble with the nut butter separating, screw the lid on tightly and store the jar upside down. That way when you turn it right side up to open it, the oil will be in the bottom rather than on the top.
    • Mash and spread avocado on a sandwich rather than mayonnaise.
    • Lightly dip crusty bread in olive oil rather than slathering with butter.
    • Try almond milk on your morning cereal rather than dairy.

    We’ve found that seeing how all of this could come together in the form of an actual meal is helpful too. Here are some ideas to spark your thinking on what might work for you:

    Like yogurt for breakfast? Try plain Greek yogurt topped with chopped figs, unsalted pistachios and a light drizzle of honey

    Savor a sandwich at lunch? What about  a whole wheat pita stuffed with hummus, salad greens, and tuna, dressed with olive oil and fresh lemon juice; and a date stuffed with almond butter for a sweet bite

    Trying to fit in more fish at dinner? Go for grilled trout; tomato, cucumber and arugula salad with lemon olive oil vinaigrette; steamed broccoli; couscous; watermelon; and a glass of red wine (if you choose to drink wine)

    Searching for a snack? Grab a nectarine or peach; or walnuts or almonds for a no carb option.

    The Mediterranean eating style is easily adaptable to today’s busy lifestyle. We hope you enjoy one of our favorite Mediterranean style recipes which follows. It’s super easy, colorful, and packed with flavor!  And only has 2 ingredients! (We confess that just talking about this for the blog made us hungry for it, and required a run to the market for dinner!)

    You can print our recipe card below for Two Ingredient Sun-Dried Tomato and Shrimp. (Deb likes the Bella Sun Luci brand of sun dried tomatoes that she buys at Costco or Amazon)

    Yield: One serving

    TWO INGREDIENT SUN-DRIED TOMATO AND SHRIMP

    TWO INGREDIENT SUN-DRIED TOMATO AND SHRIMP

    Quick and easy yet tasty 2 ingredient shrimp recipe

    Prep Time 2 minutes
    Cook Time 5 minutes
    Total Time 7 minutes

    Ingredients

    • ½ cup julienne cut sun dried tomatoes in olive oil and Italian herbs
    • 3 ounces (6-7 large) cooked shrimp (we buy the fully-cooked frozen version and thaw under cool running water or purchased pre-cooked shrimp in the deli area)

    Instructions

    1. Rinse shrimp (thaw if frozen).
    2. Heat 1/2 cup of sun dried tomatoes in olive oil in a sauce pan or skillet until warm.
    3. Add shrimp and stir until shrimp are warm.
    4. Serve and enjoy, that's it!

    Notes

    If you prefer, and have time, you can make your own sun dried tomato sauce with fresh tomatoes, sun dried tomatoes, garlic, olive oil and herbs.

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    A favorite variation: With summer produce arriving, another favorite variation is to mix diced fresh tomatoes, diced sun dried tomatoes, and fresh garlic in a skillet with hot olive oil and toss until tender. Add a squeeze of fresh lemon juice to brighten the flavor, and coarse ground salt and black pepper to taste. If you have fresh parsley or basil, chop and stir in before serving.

    Fresh tomatoes, sun dried tomatoes, garlic and herbs

    Rounding out this Mediterranean-style meal: Enjoy the shrimp and tomatoes alone, over steamed spiralized zucchini, or with a side of green vegetables as a light low carb meal. Salad greens topped with Kalamata olives, a sprinkle of Feta cheese, and a drizzle of olive oil and Balsamic vinegar rounds out a quick meal. You can also serve the tomatoes and shrimp over quinoa, a whole grain pasta, or small cheese tortellini if you want a more hearty meal and carbs aren’t a concern for you.

    Shrimp and sun dried tomatoes served over tortellini

    The summer months are perfect timing to begin embracing a more Mediterranean eating approach with the bounty of fresh produce from summer gardens. What Mediterranean style foods are you already eating? How can you fit those in more often? 

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  • Fresh Views

    Highlights from American Diabetes Association Scientific Sessions (Part 2): Focus on New Nutrition Consensus Report

    Here is how Tami is getting more veggies this summer. A share from the CSA she joined!

    A couple of weeks ago we shared four highlights from ADA Scientific Sessions focused around behavioral health. This week our focus is on other exciting developments: Did you know that ADA has updated their nutrition guidance? The summary, Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report, was published in Diabetes Care, May 2019 and you can access it here.

    Since the last nutrition guidance was published five years ago, evidence has continued to evolve around the impact of food and nutrition on diabetes management and overall health. 

    Here’s what’s new…

    #1 – Enhanced focus and guidance around prediabetes and the impact of lifestyle change to prevent or delay type 2 diabetes.

    #2 – Evidence supporting that a variety of eating patterns and eating plans can help people with diabetes achieve metabolic goals and eat healthy. Individualization is important. There is not one “best” “one-size-fits all” approach. There are 8 different eating patterns acknowledged to be beneficial in managing type 2 diabetes:

    • Vegetarian or Vegan
    • Low fat
    • Very low-fat (such as Ornish or Pritikin)
    • Low carbohydrate
    • Very low carbohydrate
    • DASH (Dietary Approach to Stop Hypertension)
    • Mediterranean style
    • Paleo

    No one pattern has emerged as being superior to the others. The first six in particular are beneficial for weight loss. The low carbohydrate and very low carbohydrate patterns have demonstrated the most evidence for lowering blood glucose, so if blood glucose is above target or one desires to try to reduce diabetes medications, adopting a low or very low carbohydrate eating pattern is a helpful option.

    Four commonalities among all healthy eating plans include the following:

    • Emphasize non-starchy vegetables
    • Minimize added sugars and refined grains
    • Emphasize whole foods over highly processed foods
    • Replace sugar-sweetened beverages with water as often as possible. 

     #3 – Initial and ongoing support through individualized medical nutrition therapy (MNT) and diabetes self-management education and support (DSMES) make a difference. They are fundamental in diabetes management, not only at diagnosis, but during times of changing health status. Reported A1C reductions from MNT can be similar to or greater than what would be expected with treatment using currently available medication for type 2 diabetes. 

     #4 – The greater the weight loss, the greater the health benefits. In type 2 diabetes, 5% weight loss can help achieve health benefits, while 15% weight loss or more is the optimal goal when needed and can be feasibly and safely accomplished. For prediabetes the goal is 7-10% weight loss to prevent progression to type 2 diabetes. Keeping as much of the weight loss off over time is critical. Also noted is that more than 50% of people with type 1 diabetes have overweight or obesity. 

    One fun way we’re getting our fruit servings!

    6 solution-focused swaps to put the new nutrition guidance into practice and answer the question “What Do I Eat?” Nutrition has long been recognized as the cornerstone for successful diabetes management. One of the most commonly asked questions when receiving a diagnosis of diabetes is “What can I eat?” (In fact, Tami wrote a book addressing just that, entitled What Can I Eat Now?  (The 3rd edition will be released in early 2020). We are particularly excited to see acknowledgement that a variety of approaches can “work”. Personal preferences and maintaining the pleasure in eating as much as possible (while achieving health goals) are high priorities in our perspective. Here are 6 solution-focused swaps to help put the nutrition guidance into practice. 

    • Swap whole fruit in place of fruit juice.  Whole fruit has more fiber, is more satisfying, and will not raise blood glucose as quickly as the juice. A whole orange, for instance,has nearly three times more fiber than orange juice.      
    • Swap infused water (a zero calorie alternative) in place of a sugar-sweetened beverage. One favorite combination is sliced lemon, sliced cucumber, and fresh mint. Place in a large pitcher, fill with ice, add water to the top, and chill for 2-3 hours to allow flavors to infuse.The longer the water sits, the stronger the flavors become. Infused water bottles accomplish the same thing in a portable fashion. 
    • Swap unsweetened almond milk in place of dairy milk. Embrace a more plant-based option and save 10-11 grams carbohydrate per cup.
    • Swap cooked spaghetti squash or zucchini spirals in place of spaghetti noodles. Get extra non-starchy vegetables and save 35 grams of carbohydrate per cup.
    • Swap mashed avocado on a sandwich in place of mayonnaise. Get healthier fats, and embrace more plant-based and Mediterranean-style eating.  
    • Swap quinoa or brown rice instead of white rice. Get a whole grain, more fiber with a plant based and DASH friendly option.. 

    Eating healthy is a journey shaped by many factors. All food and beverage choices count. We encourage finding what works for you, and doing more of it! 

    You can read our part 1 review of the ADA Scientific sessions focused on behavioral health here.

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  • Fresh Views

    Happy 4th of July! 5 Solution-focused Strategies for Picnics and Celebrations

    Celebrating with family and friends on the 4th of July is a highlight of the summer for many. Sometimes it can be challenging to maintain healthy habits during group gatherings, especially if everyone is not on the same page. It’s helpful to have strategies in your back pocket to pull out. Today we want to share with you 5 solution focused strategies for navigating picnics and celebrations. We put these into practice during our recent trip to France, with the goal of enjoying a special vacation together, yet keeping it healthy. We’ll share how they worked for us. And we invite you to consider how the strategies may work for you. 

    Here we are: Four diabetes educator AADE past and current presidents (with our husbands), getting ready to enjoy a Mediterranean-style dinner at a house we rented on the southern coast of France in Eze (We all traveled together to Ireland 4 years ago so we knew we would have a great time!) Learn more about that trip in our blog post, Going off the beaten path..

    5 Solution-focused Strategies for Picnics and Celebrations

    #1- Eat fresh and local. We are fans of supporting local farmers and enjoying local produce at the peak of ripeness. When trying to decide what to take to a gathering, think local and fresh. Picnics can be laden with rich casseroles and sides, so taking a fresh, low carbohydrate side that you know will work for you helps to insure there is something you can eat at the event. One of our favorite go-to’s that is ALWAYS the first dish to disappear is this (you may know it as Caprese salad): juicy ripe sliced tomatoes on a platter, topped with a slice of fresh mozzarella cheese, chopped fresh basil (or a dollop of pesto sauce), then drizzled with olive oil and balsamic vinegar. Sometimes we’ll layer sliced avocado on the tomatoes as well. Serve with  salt and pepper grinders alongside so everyone can manage what goes on their salad.  

    A version of the Caprese salad we enjoyed in France made with yellow tomatoes

    Deb shopping at the local market in Arles, France 

    Fresh herbs at a local market in France

    #2 – Portion your picnic plate by the healthy plate for diabetes. When you are ready to sample the celebration spread, if there’s a choice on plate size, go with a smaller plate (maybe the ones that are out for salads or desserts). Then fill half the plate with non-starchy vegetables (such as veggie salads, green beans, or sliced tomatoes), one fourth of the plate with lean protein foods (such as a grilled turkey burger or grilled chicken), and one fourth with carbohydrate foods (this is where potato salad, corn on the cob, or a sweet treat may fit). When asked how high one can “pile the plate”…try to keep it no higher than a deck of cards is thick. This simple strategy has brought success for many when navigating picnics and celebrations. And, Tami recalls one client she worked with that embraced this as a “year-round” strategy, purchasing the “old fashioned” partitioned 9-inch paper plates to use at home. He went on to lose over 30 pounds managing his portions and blood glucose in this manner. And he was thrilled that he didn’t have to wash dishes!

    We put the healthy picnic plate into practice on one of our outings to taste local Provence wine. We had a lovely outdoor picnic (on the perfect sized plate), including fresh salad, vegetable quiche, and fresh strawberries, all  served in baskets! We felt very French!

    #3 – Stick with small tastings. Maybe there are a number of things on the picnic table that you want to enjoy. And maybe you are not sure exactly what is in some of the dishes or how much carbohydrate they contain. One tried and true strategy is to stick with small tastings. You can sample a number of different items if you choose, fitting them within the plate sections reviewed above. And there’s a lesser chance of sending your blood glucose out of range with small tastings versus a serving spoon portion. This is a great strategy for travel as well discussed in our blog on Traveling with Diabetes.

    We put this strategy into practice during our trip too as we embraced a Mediterranean eating style.. And while we had such fun sampling many delectable foods and treats, we came home without gaining any weight.

    #4 – Fit in fitness. With the eating and celebrating, fitting in fitness can help manage blood glucose and spend more time in range. Whether it’s participating in a local walk/run, swimming, playing cornhole, or joining the kids in a water balloon toss. How can you fit in fitness on the 4th?

    Fitness was a part of our daily routine while in France. Our days were filled with sightseeing and tons of walking, with most days averaging 15,000 steps or more. We came back in the afternoons and and swam in the pool.Then in the evenings we played games, laughed, and laughed some more as we de-stressed and regrouped. Below you can see part of our group walking down to our street to catch the train.

    Daily short walk to the train station

    5- Stay hydrated. No matter where you are at this time of year, it’s likely to be warm (or hot)! Keep a calorie-free beverage at your side to sip on. We are fans of the Yeti cups and water bottles (we’re not paid by Yeti to say this, just fans) which have kept our iced drinks cold for over 12-hours in the summer heat! Another favorite trick is to freeze bottled water and use it as ice packs in the cooler, then drink it as it thaws.

    In France, while the temperature was only 72, the sun was intense and felt more like 92. Hydration was important. We all brought our water bottles to sip on and stay hydrated in the heat.

     We had such a great trip that we are all hoping to gather together again in another 2 years and maybe this time explore the Greek Islands! 

    As you prepare for 4th of July celebrations, we encourage you to consider:

    • What strategies have worked well for you in the past to navigate picnics and gatherings? 
    • Which of the strategies that we’ve shared might help you? 

    We’d love to hear from you on strategies that worked for you! Happy Independence Day!

    Enjoying good food, good friends and Fresh Views near Marseilles, France!

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  • Fresh Views

    Highlights from American Diabetes Association Scientific Sessions (Part 1): Focus on Behavioral Health

    “Wellness is the complete integration of body, mind and spirit – the realization that everything we do, think, feel and believe has an effect on our state of well-being.” ~ Greg Anderson

    Tami, Mike, Deb and Mark enjoying the “Fresh Views” in Marseilles, France

    We’ve just returned from a relaxing vacation in the South of France where we imprinted enough “fresh views” to last us quite a while! But we are quickly back to work, with the first stop post vacation at The American Diabetes Association Scientific Sessions in San Francisco. A Fresh POV for You attended some inspiring sessions, particularly those focused around behavioral health. (If you’ve been following our blog, you know that’s a special interest of ours.) We thought we’d share highlights from several that were particularly impactful.

    Highlight #1

    One of the most rewarding presentations was the Richard R. Rubin Award lecture, presented by Dr. Frank J. Snoek, PhD. The award recognizes an individual who has contributed to the science of the behavioral aspects of living with diabetes. Dr. Snoek’s talk  #DiabetesPsychologyMatters focused on the important connection between behavior change and mental health. As one of his slides depicted…they are two sides of the same coin!

    Dr. Snoek noted that one goal is to shift the burden of diabetes distress, so that higher distress can be moved down to moderate, and moderate moved down to low. He also indicated that a single high score on a distress scale does not mean that an individual needs professional help, or is in a maladaptive situation. Everyone with diabetes experiences diabetes distress at some point and at some level.

    Additionally, he discussed the correlation between mood and behavior, an area of significant interest to us at A Fresh POV for You. He described that when someone actually feels good, they are able to shift their priorities towards less pleasant activities that might help them achieve more long term goals. However, when someone has a low mood, they tend to seek short term rewards to help them feel better in the present.

    Overall he emphasized the need to enhance access to care and specifically called out what he described as “indirect interventions” –  including Diabetes Self Management Education and Support (DSMES), psycho-education as well as internet/mobile interventions. Specifically, he called for incorporating behavioral techniques along with existing pure “education” practices.

    Photo of Frank Snoek’s slide at ADA Scientific Sessions showing the indirect psychological support that can be provided by nurses, diabetes educators, etc.

    We believe that by incorporating Solution-Focused Brief Therapy (SFBT) techniques and counseling approaches, diabetes educators can address the needs of people living with diabetes, incorporating “two sides of the same coin”. Addressing both the self-management education and support needed for behavior change, while at the same time, addressing mental health concerns, such as diabetes distress. In essence, we can “fill the gap” that exists in access to psychological care. Overall this lecture solidified our efforts in moving this approach forward within the diabetes community.

    Highlight #2

    Another impactful session focused on complications associated with diabetes. The emotional toll of diabetes complications-What have we done for them lately.  The panel was moderated by Dr. Korey Hood, a behavioral scientist. Panelists included Chris Aldred (aka The Grumpy Pumper), Kerri Sparling (Six Until Me), Matthew Heywood, and Ina Mendoza. They spoke frankly and candidly about their experiences living with diabetes complications. Managing diabetes is tiring enough, then add a complication, and it becomes so much more complex. Much of the discussion addressed the stigma associated with diabetes complications and how the panelists were/are often told that they “should have done better”. Ouch.  #LanguageMatters when talking about complications. Making people often feel “less than” when they have a complication.  Where is the compassion in care?

    One question from the audience was, “What can we do to make this better?” So, A Fresh POV for You posed an answer to consider….”How about incorporating a more solution-focused approach into practice?  With focus on the solutions and strengths an individual has to help move them forward, rather than focusing on past problems and trying to identify why they occurred.” We know that no matter how much effort goes into managing diabetes, sometimes people still get complications. We also referred to Adam Brown’s Book, Bright Spots and Landmines,, featured in one of our  April blog posts. Focusing on “bright spots” are similar to focusing on the “exceptions” or the things that are going well used in a solution-focused approach.  

    We look forward to sharing more of these concepts in our presentation at the American Diabetes Association Annual Meeting in Houston in August,  Applying the Miracle Question in Diabetes Care.. In fact, here we are finalizing our slides before the deadline while in Marseilles, France.

    What deadlines look like on vacation!

    Highlight #3

    Stigma was a theme common through many of the behavioral health sessions. As recipient of the Outstanding Educator in Diabetes Award, Virginia Valentine, shared a moving presentation, The most important thing we give to people is…Hope: Overcoming stigma in diabetes and obesity,. She explained that the stigma associated with diabetes causes blame and shame, and that “Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of being loved or belonging.”-Brene Brown. She reminded the audience that “the only thing people with diabetes did wrong is when they picked their grandparents.”  She ended her presentation with a review of the language guidelines that foster person-first, strength based language.

    Highlight #4

    Finally, there was the session on #LanguageMatters- Strategies to Improve Communications in Diabetes Care. Jane K Dickinson, and Joe Solowiejczyk, both healthcare providers and people living with diabetes, gave their perspectives on the use of language. Notably, Jane was the lead author on the publication , The Use of Language in Diabetes Care and Education (we’ve written about #languageMatters in the past here). Then Kevin Joiner connected the dots between the stigma associated with language when engaging in a healthcare discussion. Finally, Dr. Jane Speight, lead author of the Australian Position Paper, A New Language for Diabetes, helped to identify strategies for healthcare providers to communicate more effectively with people living with diabetes. We were excited to see them show the Telly Award Winning #LanguageMatters video that was co-designed with the #DOC and released last year at the AADE meeting, Changing the Conversation.

    Deb watching the Changing the Conversation #LanguageMatters video at the #ADA2019 meeting (Photo credit Renza Scibilia)

    Check back July 10th as we share another big highlight from ADA Scientific Sessions,  discussion of the recently published “Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report”.

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  • Fresh Views

    November 27, 1996, 7:10 AM

    While our A Fresh POV for You blog only began in November of 2018, Deb has been blogging about travel adventures and experiences for some time. She wanted to share a story, along with some special travel blog posts from the past, today, on this special day for their family.

    Adoption Day, June 19, 1997 Yangzhou, Jiangsu, China

    Today, June 19th, is the adoption day of Deb’s amazing and talented daughter, Diana. Diana was adopted when she was 6 months old from Yangzhou, Jiangsu, China and for the first 21 years, they celebrated adoption day with a small gift, one from today along with a cherished gift they bought in China.  They brought home 21 gifts, one for each year. Some were simple, like a stuffed panda, and some were more meaningful, including pearls for her 16th birthday (matching pears like the ones Deb is wearing in the photo above). Now that Diana is 22 and there are no more gifts from China, Deb remembered the biggest gift of all, and wanted to share the story today on this very special day.

    Here’s a little bit of Deb’s story and links to 2 previous travel blog posts.

    As with many children adopted from China we don’t have any information about Diana’s life before she entered the orphanage, and simple things we all take for granted, like knowing the time and date of your birth are not always known.  We knew the date of Diana’s birthday, but were never certain it was accurate, but it really didn’t matter, it was her birthday. (And interestingly the same birthday as my dad and step mother, but my dad passed away before we adopted Diana).

    When Diana was in grade school she had a project that required her to enter the time of the day she was born.  It was hard to tell her that I didn’t know. So we looked at the clock (We lived in Chicago on Central time) and it was 9:10 am, so I said, “Let’s just say you were born at 9:10 in the morning. No one else needs to know anything different.”  So, life went on. We moved to California (now Pacific time, so two hours earlier) and we were fortunate to take a special trip back to the orphanage in China in 2009 with a group of moms and daughters that we originally traveled with to adopt Diana in 1997.  

    Four of the mom’s and daughters, from our original 1997 trip, who returned to Yangzhou as part of a larger group trip.

    If you are interested in the whole, amazing, incredible trip you can read all of the blogging I did that week here.  I titled this particular blog, on Wednesday March 18, 2009, November 27, 1996, 7:10 am  because we found a miracle and a most amazing gift. You can read all of the details of that special day if you are interested, but the short story is this.  We found a “red note” while looking through Diana’s medical records. A mythical and elusive thing we heard other families talking about, often written by birth families, and attached to babies before being taken to the orphanage, since the Chinese Zodiac is an important concept in China and birth information is needed.

    We never knew Diana had a note. We were not told it came with her.  I immediately started crying, unsure of what it said and secretly hoping that November 27th was her real birthday.  And when they read to us that it indeed said November 27, 1996 AND 7:10 AM we were stunned, amazed and now really crying.  On that day in Chicago, when we looked at the clock it was 9:10 am BUT it was 7:10 am in California, where we live now. Surreal!

    Discovering the “Red Note” and learning Diana was born at 7:10 AM

    Unfortunately they would not let us take the note home. We were crushed, …..we cried, …..we begged, …..we pleaded and I think to get us to stop talking, they told us she could come back when she was 18 and get it.  So when she turned 18 I emailed and asked if she could have the note and they said no. When she turned 19, I asked again, and they said no. And Finally when she was 20 I asked again, and I told them how happy she was and how she was living her dreams at UCLA and marching in the band and loving life, and the only gift she really wanted was to have that one small piece of her past that connected her to her birth family in China and I didn’t understand why she couldn’t have it.  Finally, they relented, and said, “Okay, you can come and get it!” That was one of the happiest emails of my life. We were already planning a holiday trip to Asia that December, so Mark, Diana and I left a few days earlier and went back to her orphanage to meet everyone there, and most importantly to get the note. You can read about our whole trip here.

    We also decided to retrace our trip that we made 20 years ago, remaking photos and having so much fun sharing that special time with Diana.

    All of our photo remakes. My favorite is Mark carrying Diana up the steps of Dr. Sun Yat Sen’s Mausoleum in Nanjing.

    How do I tie any of this to using solution focused methods?  Well we had a vision for the future that would not let us stop working towards our goal (getting that red note). We kept trying and used all the strengths we had and told a story, full of possibilities and opportunities, that finally moved someone enough to make things happen.  Sometimes life is messy and sometimes it’s hard and then, one day it happens to be really, really beautiful.

    The red note, still in the medical record
    Diana, Deb and Mark touring Yangzhou

    On this very special day, a day that changed our family’s life forever, I want to tell our daughter how much we love her and how proud we are of her and most importantly that our lives would be so less without her in it. Happy Adoption Day, Diana!

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  • Fresh Views

    European Association for the Study of Diabetes (EASD)…here we come!

    Dreams don’t work unless you take action. The surest way to make your dreams come true is to live them. ― Roy T. Bennett


    From a peak overlooking the harbor in Monaco


    The last couple of weeks have taken us on the road for work, followed by a few days of relaxation with friends while taking in the astoundingly beautiful French Riviera. Throughout our travels we explored many historic sites, hundreds of years old, nestled high up on peaks among bustling cities below.

    Historic fortress in Cannes, France

    We explored countless peaks and valleys. In fact, our home for the week was nestled in the valley below the ancient village of Eze, France.

    Valley below Eze Village, France

    Red rock mountains by the sea near Saint-Raphael, France

    In our recent blog Peaks and Valleys in Life, we discussed that peaks and valleys are catalysts for positive change, both in life with diabetes and life in general. And on that note, we have some sensational news to share with you – a definite “peak” we experienced while on our travels!  We received notification that an abstract we submitted to the 55th Annual Meeting of the European Association for the Study of Diabetes (EASD) has been accepted for an oral podium presentation! This Annual Meeting, held in a different European city each year, draws more than 15,000 delegates from over 130 countries and includes more than 1,200 talks and presentations on the latest results in diabetes research by leading experts in the field. We will be presenting the findings from our research on “Perceptions of life with diabetes revealed through a solution-focused brief therapy exercise via Twitter”. If you plan to attend this conference, we invite you to join us at our presentation. More information to come.

    Many of our readers participated in this Twitter Chat and provided important and insightful perspectives that led to the fascinating findings we will present. Here is a sneak peek that we shared a few months back, Let’s Learn from the DOC!  Our goal, as we present at conferences this coming year, is to bring attention to the concepts of solution focused brief therapy and coaching.  To focus on “exceptions” or situations that are going well, instead of always focusing on the problems that need to be fixed. If we spend our time using a strengths based approach we can envision possibilities and opportunities to help people move forward towards their unique vision of their future.

    We made it back from France just in time for the start of the American Diabetes Association’s Scientific Sessions meeting. Stop back by over the next couple of weeks as we focus on some of the highlights from that meeting.

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  • Fresh Views

    What are you grateful for today? 5 strategies to develop daily gratitude habits

    We are grateful that we are taking some time off and seeing some fresh views! We’ll be back next week with some new perspectives to share! Enjoy this re-posting of an earlier blog that seemed to resonate with many!

    Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow – Melody Beattie

    Do you think about gratitude during your daily routine? Is it a habit you practice? Deb was recently on vacation and needed some self-care so decided to get a massage.  When she was checking into the spa they showed her three smooth stones, each with one of these words on it: Hope, Love and Gratitude.When asked to choose one emotion that she wanted to focus on during the massage, she chose Gratitude. While laying face down during the massage, a smaller stone was placed below her face so she could see and reflect on the word “Gratitude” during the massage, and to help her think about being grateful. (You see that stone in the photo above) This fresh view and experience created a new desire to be more thoughtful and intentional about being grateful for what is and what she has.

    What do you think about when you see or hear the word ‘gratitude”? The simple definition is “a feeling of thankful appreciation for favors or benefits received; thankfulness.”  But the practice of gratitude means so much more.

    According to the American Heart Association several clinical trials show that engaging in a practice of gratitude can lower blood pressure and help the immune system. “Grateful people engage in more exercise, have better dietary behaviors, are less likely to smoke and abuse alcohol, and have higher rates of medication (taking)”. Several studies suggest that gratitude can decrease stress and anxiety by activating the areas in the brain that the release feel-good hormones serotonin and dopamine.

    Research discussed in the Jan/Feb, 2019 issue of Diabetes Self-Management also shows that positive psychological states such as gratitude are associated with improved physical health in people with diabetes, improved sleep, and increased self esteem. While the relationship is not fully understood, positive emotions such as expressing gratitude, are linked to healthier lifestyle choices. And healthy lifestyle choices including healthy eating and being active are in turn linked to overall health.

    How can you get started with gratitude?

    Here are 5 strategies to help develop daily gratitude habits:

    1. Have gratitude reminders. These are simple cues to remind you to focus on gratitude daily. Maybe it’s an alarm on your phone, a bracelet or wristband, a photo, a magnet even a post it note. And with that reminder, pause, take a breath and focus on being grateful in that moment.
    2. Keep a gratitude journal. We both have found this to be a good personal practice to express gratitude more readily and find things to be more grateful for. Some log entries in their journal weekly, and others daily. Our personal goal is to identify at least 3 things daily for which we’re grateful. Tami numbers her entries and is working toward 1000 things for which she’s grateful. Some things are big (Entry #622 – Protection through a tornadic storm). Some things are small (Entry #1- Sun and warmth on my shoulders). While the goal is to write in the journal daily, sometimes life happens and weeks may go by without an entry, but we pick right back up with our entries.
    3. Start a gratitude box. Keeping a box (jar, album, folder, or whatever works for you) filled with notes, pictures, and moments you are grateful for can bring a boost when needed. Tami keeps a folder on her desk and a file on her computer filled with nice notes and photos, as well as  an album on her phone of messages and moments she’s grateful for to refer back to when she needs a reminder. Deb has a bulletin board in her office that displays happy memories in photos, ticket stubs, quotes, flyers etc. that she can look at during working at any time.
    4. Voice or write down one (two, or three) good things that happened in your day. On the homefront, this is a gratitude practice Tami has used with her son over the years. In the days when she would take and pick him up from school, she found that the drive time was a good time to learn about his day. That conversation always began with these words, “Tell me something good that happened today.” He knew he needed to answer that, acknowledging something good, before talking about the challenges of the day.
    5. Use gratitude apps. There are a number of apps with a range of capabilities including sending reminders, sharing uplifting thoughts, and organizing memories for which you are grateful. Deb has been struggling with back pain from a chronic disc problem and was at a place where no position brought relief, not sitting, standing or lying down. It was getting challenging to think clearly and work. She began using the Calm app, decided to take the Calm masterclass in gratitude, and use their 7 days of gratitude meditation. The process has helped her to find daily items to be grateful for during a time when it was challenging to not be engrossed in the pain.

    Here are 3 other things Deb has learned  through this experience:

    Learning #1 – When you have a chronic condition that is challenging you, think about ways to appreciate and focus on what you do have and what is working for you.

    Learning #2 – Try not to compare yourself and what you may be dealing with to others. While the grass might look greener on the other side of the fence, we never truly know what others are going through.  

    Learning #3 – Trying to simply look at what is right in front of you and be present in the moment.

    Maybe you employ one of these strategies. Or several.

    Here are 3 tips to help maintain your gratitude practice once you get started:

    • Find a daily time to practice gratitude and try to be consistent. Maybe it’s when you get up in the morning. Maybe it’s before you go to bed at night. Maybe it’s when you’re exercising.
    • Write what you feel. Don’t censor it.  
    • Refrain from making the list repetitive. Be specific finding new ways to approach gratitude.

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  • Fresh Views

    Hello world! A Fresh POV may change your life

    While we are on the road a few days, we’re re-posting our original blog so that new followers can learn a little about us. Have a great week!

    Deb and Tami in Italy a couple years back enjoying some Fresh Views!

    Thanks for checking out our new blog “A Fresh POV for You”!  Join us as we focus on Possibilities, Opportunities and creating a Vision (POV) for the future, based on strengths and leveraging positive learnings from past experiences.

    Who are we?

    We are healthcare professionals and diabetes specialists passionate about positivity and empowering people with diabetes to live life to the fullest! Deborah is a nurse. Tami is a dietitian. We both have spent our entire careers partnering with those living with diabetes to leave a positive imprint.

    We are also speakers, authors, wives, moms, adventurers, and avid travelers always in search of the next fresh and magnificent view. (You see one of those stunning views in this photo, looking out over a vineyard in Italy). You’ll learn more about us and some of our adventures over time.

    What is our focus?

    Simply put, our goal is to inspire those living with diabetes, or at risk for diabetes to design a life that has a personal sense of balance, is realistic and fun. A life that works for them. It goes without saying that managing diabetes is complex and burdensome. The constant focus on problems can make it even harder. We are passionate about turning the focus to abilities and possibilities. What will be different and new instead of what will NOT happen anymore?  What is desired instead of what is NOT wanted? Let’s learn from each other!  

    Why did we start this blog?

    Since November is Diabetes Awareness month there’s no better time than now to let you in on our new adventure in diabetes that’s been in the works behind the scenes for some time.  

    Getting to know us personally, beyond professionally is important. We believe in the concept of a “therapeutic alliance”- which means that the relationship between health care professionals and people with diabetes is the most important component.  

    Awhile back, we discovered an approach called Solutions Focused Brief Therapy. It resonated with us because of the focus on possibilities, opportunities, and creating a vision for the future.  How about applying this to diabetes?  We  look forward to sharing with you as we learn more!

    Then we joined together to craft content for two recently released brief videos focusing on the use of empowering language in diabetes. Language that puts the person with diabetes, their needs and their values first, thus moving away from language that judges, blames and shames. These videos are based on the language position paper published by the American Diabetes Association and American Association of Diabetes Educators. (You can check out the paper and the videos here and on our blog homepage). Over the months that we worked on the video project we had many soul searching discussions about how diabetes care and education needs to evolve and innovate.

    And thus was born A Fresh POV for You! If you are someone who feels challenged and overwhelmed with aspects of life with diabetes – or someone who just wants to learn more about our creative approach – follow our blog as we begin to share more about our exciting new adventure over the next few months. We have lots of creative ideas and ways we hope to engage in innovative diabetes services! Our goal is to create programs and services that resonate and make sense for people living with diabetes.

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  • Fresh Views

    Peaks and valleys in life


    “The Path Out Of The Valley Appears When You Choose To See Things Differently.” ― Spencer Johnson, Peaks and Valleys: Making good and bad times work for you–at work and in life


    Hilltop village of Eze, France

    Provence and the southern coast of France have long been on Tami and Deb’s travel to-do list.  From the beautiful Luberon valley and it’s fields of lavender to the hilltop town of Eze in the French Riviera. We look forward to sharing with you some photos and experiences from the peaks and valleys we encounter on this upcoming journey. There will be many amazing views and lots of time spent soaking up and “imprinting” those views.  As you may know, we use the practice of imprinting (described here in our blog) as a mindfulness exercise. When you are in the moment and enjoying a special view, feeling, experience etc., take a moment and a breath, to capture everything and imprint it in your mind forever.  Not only does it help you appreciate what you have and acknowledge gratitude in the moment, it also creates an opportunity for you later when life may be more challenging.  You can recall your imprinted memories when you feel overwhelmed.

    On the theme of peaks and valleys, peaks and valleys are a routine part of life. And part of life with diabetes without a doubt. However, when life feels like a rollercoaster and the peaks and valleys are constant, that may signal it’s time for a new approach. Peaks and valleys are opportunities for change.

    Let’s use continuous glucose monitoring (CGM) as an example that’s part of life with diabetes for many. When looking at CGM tracings, such as the one below, it’s not uncommon to see peaks and valleys. It’s easy to see those peaks (or time above range) as negative and a “problem.” And as for the valleys “below sea level” – that plunge into an uncomfortable low blood glucose – you don’t care for those either. Rather than thinking about these peaks and valleys as “problems” to be “fixed”, is it possible to take a step back and think differently?

    Continuous Glucose Monitoring (CGM) tracing for a 24 hour period

    While  the many peaks and valleys on this CGM report might create a sense of frustration and fatigue, how might we use a solutions focused approach to manage thinking?

    We know from Adam Brown, interviewed in our recent blog on Diabetes Bright Spots and Landmines, that there are 42 factors that impact blood sugar.  Some of these factors are much easier to measure and manage than others. Maybe you’ve been sick or struggling with a very stressful life event. You need to give yourself permission to just say, “Some days diabetes is like this.  Some days I don’t know why I’m not in range, and I’ll see what happens tomorrow,” without feeling guilt, blame or shame. Sometimes it’s hard to really know what’s happening, and a “problem-focused” approach isn’t going to help.

    In looking at the tracing above, you see blood glucose in range between 10:00 am and 1:00 pm. That’s where to start. What was going on then? What can you learn from this time in range to repeat and help see more time in range in the future?  

    Let’s look at an activity tracker record as another example.

    Activity tracker report of steps taken over 2 different weeks

    In taking a quick glance we see definite peaks and valleys in activity. Rather than focusing on the “problem” of the day there’s only 22 steps tracked, (maybe the activity tracker battery died??), instead let’s focus on the day where there were over 13,000 steps! And the day where there’s over 10,000 steps. What was going on those days? How did this individual successfully fit that many steps in? How can that occur more often to help achieve physical activity goals?

    As you look to the next week, month, or year. We challenge you to consider peaks and valleys as catalysts for positive change.

    And check back over the next few weeks as we share some peaks and valleys that we encounter on our journey.

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  • Fresh Views

    Decision Fatigue: Tips to decrease the burden


    Photo from the gardens at Bed and Breakfast on Tiffany Hill near Asheville, NC

    When was the last time you packed for a trip? It can seem like a million decisions to make: How many days do I need to pack for? What will the weather and temperature be like? What type of scenarios do I need to plan for? What shoes? And the list goes on and on. Now, factor in all of the extra supplies that living with diabetes requires. It may leave you with decision fatigue and mentally exhausted from making so many decisions. We now find ourselves experiencing this first hand, wrapping up a million loose ends in the office and packing our own suitcases to hit the road for work, then for a few days of relaxation and beautiful new views.

    What is decision fatigue?

    If you are not familiar with the term “decision fatigue”, it basically means deteriorating energy and focus following a long session of decision making. It can result in making less than optimal decisions.

    Just day to day life may leave you experiencing decision fatigue…what to eat, how much to eat, when to eat, when to exercise, how much to exercise, how to remember to take any medicines  at the right time and in the right dose, when to check blood glucose, when to go to bed, what to do for self-care and stress management…and the list goes on and on. Various sources estimate that an adult makes about 35,000 conscious decisions each day. That number of decisions may sound unreal, but in fact over 225 of those decisions each day focus on food alone. We also know that if you follow all of the diabetes self-care guidelines and incorporate all of the related action items into your daily routine, it consumers over 2.5 hours a day! And that leads to more decisions. How many of the recommendations do you or can you incorporate? How realistic is it to try to do “everything”?

    Embrace a minimally disruptive approach

    You may have heard of the concept of minimally disruptive medicine or MDM.  If it’s new to you, it’s a very interesting approach to managing diabetes, focusing on balancing workload and capacity with the ultimate goal of reducing the burden of treatment of having a chronic condition. The idea is to customize clinical recommendations and guidelines and create true person-centered care. So medicine is not one size fits all. Making the conscious choice to individualize guidelines may help decrease decision fatigue. (This is just the tip of the iceberg of MDM, we hope to write more about it in a later blog)  Having to weigh all of the options regarding care, and making daily decisions increases the burden of living with diabetes.

    4 Solution- Focused Tips to decrease the burden:

    When there are many decisions to be made, sometimes it is challenging to know what should come first, what is essential to your health and well being, and what can you postpone, delay or decide not to do. You can prioritize your issues and concerns in order to design solutions that work for you.

    1. Simplify the choices you need to make throughout the day. Maybe it’s mapping out a 1 mile or 2 mile path so that you can go on “autopilot” when you go out to walk or jog and don’t have to decide where to go. Maybe it’s pre-portioning out a mix of healthy nuts (or other snack) into zip top bags or small airtight containers in amounts that work for you. Then when it’s time for a snack you don’t have to decide what to eat.

    2. Do hard work early in the day. This is a tip we’ve shared before [read it here]. The mind is fresher and more creative in the morning. Plus,it can help you feel accomplished to get hard things done and out of the way. Maybe it’s planning meals and making a shopping list. Maybe it’s fitting in exercise before noon so it doesn’t get pushed out of the way by other things that pop up during the day..

    3. Schedule similar tasks together. Take running errands for instance. Maybe you need to swing by the pharmacy to pick up a prescription. The pharmacy is next to the grocery store. You know you need to pick up a few things to have on hand for breakfast, so you knock out both errands at once and you don’t have to decide when to fit in the grocery run.

    4. Make the decision to get started. Maybe you’ve been off track with eating and realize you need to renew your focus on portions and associated carbohydrate content but just can’t seem to get started. Make the decision to start by downloading an app to help you get focused. Or start by making a list of foods you eat frequently. You’ll have that at your fingertips to fill in carb count for the amounts that work for you.

    No matter how rational or sensible you are, you simply can’t make decision after decision without paying a mental price. And unlike physical fatigue—which we are consciously aware of—decision fatigue often happens without us knowing. By reducing the amount of decisions you make every day, you free up space for the ones that really matter!

    Since May is Mental Health Awareness Month we wanted to share these resources about Diabetes and Mental Health. As we write and develop our blog and content we actively seek to focus on the need for tools and strategies to support positive mental health. Both diabetes and mental health carry a stigma which may lead to silence and not seeking help or support. Reach out to someone today, you might just be the one thing they need!

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