A healthy outside starts from the inside – Robert Urich
As these crazy and unsettled days wear on, June has silently snuck upon us, bringing with it the first day of summer. Did you know June is also National Fresh Fruits and Vegetables month? We hope you enjoy the picture above of juicy lemons harvested from Deb’s backyard. We are big advocates of finding ways to fit in more fresh fruit (over processed fruit and juice) and fresh vegetables, particularly of the non-starchy variety (which means little impact on blood glucose)! In our experience, many people are challenged with fitting in non-starchy vegetables. And when they’re successful, we’re always curious: How were you able to do that?
Today’s word is: EXCEPTIONS
Today in our series on words to jump-start a solution-focused approach when managing diabetes, we’re focusing on EXCEPTIONS. Exceptions are those times when one’s able to deal with a problem (such as blood glucose out of range, too many carbs) in a way that makes it less burdensome. Exceptions are times when the presenting situation could have happened, but somehow did not. It’s a time when things could have gone wrong, but didn’t. Most all problems have exceptions. However, some people have difficulty even identifying exceptions because they stay so focused on their problems. Identifying exceptions is essential in order to build future solutions. Exceptions are the tools that help people achieve the life they want. Exceptions are a core tool in solution-focused practice.
Exceptions are addressed in the book by Adam Brown, Bright Spots and Landmines, which we’ve written about here. There are more than 42 factors that impact blood glucose, and that makes it challenging to stay in range all of the time. Focusing on what is going well, instead of what is wrong, changes the conversation and allows the client to identify strengths and successes, and feel there are those “bright spots” in their life that they can call upon and focus on to know they’ll be successful.
Here is an example of how you can use exceptions when reviewing continuous glucose monitor (CGM) data
Meet J.T. She has been experiencing glucose values above range after dinner quite frequently, while the rest of the day has been in-target most of the time. She’s shared CGM graphs similar to the one below, where you can see after dinner at 6pm her glucose rises above target.
Today when you meet with J.T. she shares her most recent CGM graph, and you notice that her after meal glucose values are all within her target range. You specifically call this out during your conversation. You might say, “J.T. I notice that your after dinner glucose values are within your target range, how did you manage to do that?” J.T. tells you that she has been focusing on swapping out starchy vegetables for non-starchy vegetables, like broccoli, squash, tomatoes, and mushrooms, cooking them in a Wok at home with just a small amount of olive oil. She notes that when she eats these non-starchy vegetables she stays in range.
This is known as an “exception”, or a time when her typical problem (post-meal above target blood glucose) did not happen. This is when we see “positive differences.” We now want to amplify and intensify these differences. This is the time to focus on the healthy changes being made and time to support and encourage MORE of these choices.
So you might follow up with, “How was it helpful for you? Or What else was different for you?”
You might use a scaling question. “ On a scale of 1-10 where 10 is you are confident you could do this again and 1 is the opposite, where would you say you are now?”
A fave tomato and cucumber salad that Tami enjoys in the summer. She makes it ahead and has it ready in the refrigerator to help her easily fit in more non-starchy veggies at meal time.
THIS WEEK’S SOLUTION-FOCUSED CHALLENGE
Each week we’re including a solution-focused challenge that can help evolve care and education in a solution-focused manner. Here’s this week’s challenge: Try incorporating some/all of the following guiding questions into conversations with clients to help elicit exceptions:
- Are there times when this has been less of a problem?
- What is different about the times when this was less of a problem?
- What did you (or others) do that was helpful?
- What’s gone better for you today or over the past week?
- What thoughts kept you on track?
- At a time when you feel more optimistic and satisfied, what will you be doing more of or more often?
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