• Fresh Views

    5 Solution-focused Strategies for Labor Day Gatherings

    Marblehead Harbor, Marblehead, MA

    Labor Day is just a few days away! This first Monday in September celebration often is heralded in with gatherings amongst family and friends. Sometimes it can be challenging to maintain healthy lifestyle habits around holiday gatherings, especially if everyone is not on the same page. It’s helpful to have strategies that work at the ready. Today we want to share with you 5 solution-focused strategies for navigating Labor Day gatherings so you feel satisfied and won’t feel that you missed out on a thing.

    5 Solution-focused Strategies for Labor Day Gatherings

    #1 – Bring something to share that incorporates seasonal produce. Many of the food traditions associated with Labor Day are filled with the best summer has to offer. Not only is flavor at its peak, seasonal produce is packed with nutrients (and lower in cost). Below you see a variety of beautiful tomatoes. 

    An easy, colorful, flavorful salad with Tami’s crew is simply chilled diced tomatoes and cucumbers tossed with light Italian dressing. The flavor intensifies if the salad is chilled 30-60 minutes before serving. (Stir it up and pop in the cooler. It will be good to go by the time you arrive at the gathering).

    Seasonal tomatoes and fresh berries

    Another well-loved side dish is roasted carrots. They’re low in carbohydrate, high in flavor, and won’t keep you hanging out in the kitchen. Toss sliced or diced carrots with some olive oil, kosher salt, and black pepper. Roast at 425 degrees in an even layer on a sheet pan until fork tender (about 20-25 minutes). 

    Roasted carrots

    #2 – Make a swap or two. Consider the foods that are often at Labor Day gatherings and determine where you can make a swap or two for health. One of our favorites is swapping lean turkey burgers in place of hamburgers. Maybe everyone doesn’t want a turkey burger, but having a few on the grill is a tasty option for those trying to be health conscious.

    Turkey burgers and zucchini

    Another delicious swap is spiralized zucchini salad in place of traditional macaroni or pasta salad. Raw fresh zucchini is crisp and delicious with little carbohydrate. A spiralizer  is a handy, inexpensive kitchen tool.  Here’s a simple way to make a zucchini salad with a Mediterranean flair (you can find more Mediterranean swaps and ideas in our July 17, 2019 blog here.) 

    #3 – Portion your plate by the healthy plate for diabetes. As we shared in our July 3, 2019 post, 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). Partitioned paper plates can do the portioning for you. Not sure partitioned paper plates still exist? Here you go, just a click away.  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. 

    Lobster salad with a light dressing, vegetables, healthy fat and 1/4 portion of potatoes

    #4- Go on a walk early in the day. We are believers in making a commitment to move even more when we know there is a weekend or vacation ahead filled with a few indulgences. Taking a walk early in the day (as you’ll see us doing with our husbands on a holiday escape to Chicago), makes sure that movement doesn’t get pushed out by other holiday activities. And if you find blood glucose out of range 1-2 hours after you eat, take another walk to help lower blood glucose.

    Mike, Tami, Deb & Mark, Walking along Lake Michigan, Chicago, IL

    #5 – Focus on fellowship and laughter. We believe that laughter is the best medicine, and we try very hard to practice what we preach. Scientists have shown that laughter is a great stress reliever and causes mental relaxation. Laughter can even improve blood pressure, pain, and immunity. Most importantly it strengthens human connections when we laugh together. There is now actually “laughter therapy” defined by the National Cancer Institute as therapy that uses humor to help people cope with medical conditions by relieving pain, stress and improving well-being. 

    Tami and Deb enjoying some “laughter therapy”

    You’ll find 4 more of our tried and true solution-focused strategies for picnics and celebrations in our July 3, 2019 post. 

    As you prepare for Labor Day gatherings, we challenge you to consider the following:

    • 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? 
    • Choose at least one of those to put into practice on Monday

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

    Tami and Deb, Highland Beach, FL

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  • Fresh Views

    The Miracle Question Applied to Diabetes at #AADE19

    You had the power all along, my dear – Glinda the Good Witch from the Wizard of Oz

    River pool at the Marriott shaped like the state of Texas!

    #AADE19 is a wrap! And what an exciting (and scorching) week we had in Houston, TX! The over 100 degree temperatures kept us from venturing outside much, but we enjoyed the view of the Texas shaped lazy river just outside our hotel window.

    Change is here!

    It’s difficult to describe the thrill of being immersed in learning through cutting edge, high quality sessions with more than 3000 other people passionate about supporting individuals affected by diabetes to live long and happy lives. And to learn that our specialty (formerly Diabetes Educator) has a new name: Diabetes Care and Education Specialist! This repositioning and new title fully acknowledges us as trusted experts of the integrated care team that provide collaborative, comprehensive, and person-centered care and education to people with and at risk for diabetes. Woohoo! More to come!

    Taking a solution-focused approach to managing diabetes

    A description of our presentation “Applying the Miracle Question in Diabetes” at #AADE19 can be found in the online conference planner. We were honored to be one of the over 130 sessions attendees could choose from. Can you see the joy in our faces below at the crowd filling the room (late on a Friday afternoon nonetheless) to learn about taking a solution focused approach to managing diabetes rather than a “traditional problem-focused” approach? 

    Tami and Deb getting ready to present at #AADE19

    In quick illustration, here’s a comparison from one of our slides showing how a solution-focused approach differs from a traditional counseling approach. The traditional counseling approach tends to focus on what’s “wrong” and identifying how to “fix” it, whereas a solution focused approach focuses on those times when things are going well, and leveraging those past successes to do more of what’s going well. 

    What is the Miracle Question?

    The Miracle Question applied to diabetes is one tool or technique, if you will, that can be implemented as part of a solution-focused approach to help clients envision a future that is more problem-free. You can learn more about the Miracle Question applied to diabetes in a previous blog post here. The Miracle Question has powerful impact. It is creative, bold, healing, a bit mysterious sounding (and has a cool name!). It allows a person to step out of their current problem story to a time when the problem occurs less. It helps people identify “exceptions” or times when the problem doesn’t occur, but could have.  We think of exceptions as similar to “Bright Spots” (From Adam Brown’s Bright Spots and Landmines) or times and choices that work well for people. The Miracle Question challenges a person to look past their obstacles and feelings of hopelessness to focus on possibilities, opportunities and a vision for the future. (Hmmm sounds like the Mission of @AFreshPOVforYou!). The goal is to help one identify what they’ve actually known all along, and that they have the power to make choices and changes that can move them forward. 

    We value the voice of those that live with diabetes every day and listen intently to inform our work. We have some intriguing findings from a study we conducted that will be presented in September at an international diabetes conference, the European Association for the Study of Diabetes, in Barcelona, Spain. And other insightful learnings to guide our work from focus groups, surveys, and interviews we’ve conducted. Many have asked if we’ll share that information. Stay tuned!  We will soon reveal more through three peer-reviewed publications – one of those being an international publication.  

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, we invite you to subscribe to our blog, and we will send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

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  • Fresh Views

    Doing things differently: Using solution focused questions to build a therapeutic alliance

    Tami’s photos from the Chihuly glass sculptures exhibit at the Biltmore Estate in Asheville, NC. She did things differently by not only viewing the exhibit in the daylight, but also after dark, and got an entirely different perspective.

    Doing things differently leads to something exceptional. – Anonymous

    We’re just returning home from the fantastic #AADE19 Annual Meeting and look forward to sharing some new information next week. Today enjoy an encore post from this past march where we discussed the concept of a Therapeutic Alliance!

    The strength in a therapeutic alliance

    As you may know, we strongly believe in the concept of a “therapeutic alliance” (which you may also know as the “helping alliance” or the “working alliance”). This alliance refers to the relationship between a healthcare professional and the person with diabetes by which they engage with each other to bring about beneficial change for that person with diabetes. This relationship is a most important component.

    The power of language

    It’s near to impossible to create those connections and build that alliance without focusing on language. Language and word choice is one of the most powerful choices we have. Words can demonstrate respect, empowerment and support or words can shame and blame. Respecting the expertise and experience of the person living with diabetes is essential to develop a strong therapeutic alliance.

    Focusing on solutions, not problems

    You also probably know that we are using solutions focused brief therapy (SFBT) and coaching in our work. SFBT is a questioning approach with conversation focusing on the client’s vision and how he/she identifies potential solutions. The questions asked during the interaction focus on a desired future state, and on what is already working well for that individual in the present. We acknowledge that the client has all the skills necessary to achieve their goals. As we mentioned last week, our goal, through incorporating principles of SFBT and coaching in diabetes care and education, is to change the conversation, the interaction and the experience of the diabetes community to improve health.

    10 questions practitioners can use to build a therapeutic alliance

    If you are a healthcare practitioner, we want to share 10 questions that you might find useful when engaging in discussions with patients or clients to acknowledge and build the therapeutic alliance. These questions reinforce the human side of both parties. They demonstrate that you care about the person sitting with you and that the relationship between you is important. Moreso, the word choices and body language during the interaction can go a long way towards creating a relationship of mutual respect.

    1. Thank you for coming in. Tell me what’s been going on. What can I help you with today?
    2. What do you wish to achieve or learn by the end of this session so that you can say you’re glad that you were here?
    3. What is the best way for me to work with you? (For example, do you prefer talking on the phone or text messages?)
    4. So that I can learn more about you, what do you consider your assets and strengths?
    5. Is there anything else you’d like to share that I should know?
    6. When you are at your best, what does that look like? How is that different from the way things are now?
    7. How can you do more of what is making things go well?
    8. If we created a plan, what would you consider a start to your being on the right track? And what else?
    9. What can you take from this session that can help you in the coming weeks?
    10. What will you be doing differently after the visit?

    Here are 3 additional questions that can be used to glean insight and feedback on the interaction:

    1. What feedback would you like to give me about today’s session?
    2. On a scale of 0-10, to what extent did you feel heard, understood, and respected during this session? 0 being you did not feel heard, understood or respected at all.
    3. On a scale of 0-10, to what extent did we talk about and work on the things that are important to you during this session? 0 being not at all.

    If you try incorporating some of these questions, we’d love to hear from you about your experiences and if you felt differently during your client visits. We leave you with 3 things to consider:  

    • Do you feel more present and “conscious” during the visit?
    • Do you feel like a “human” first and a practitioner second?
    • Do you notice that your clients are achieving their goals, and most importantly, are they feeling more confident in their ability to live well while managing diabetes?

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  • Fresh Views

    #AADE19 Sessions (Part 2)

    More Behavioral Health, Language, Peer Support, Tech & Social Media 

    The long awaited #AADE19 Annual Meeting in Houston August 9-12 is here! Tomorrow we’ll be on a plane headed to Houston to join more than 3700 diabetes educators and other healthcare professionals at the American Association of Diabetes Educators (AADE) Annual Conference. It is the premier educational and networking event for diabetes educators. Can you tell we’re excited??

    Tami and Deb at AADE a couple years back, with now AADE President Karen Kemmis

    Last week we shared the sessions that peaked our interest to catch on Friday. And today we’re sharing a look at the sessions we’ve highlighted in our online planner for Saturday-Monday.  As you will see, many overlap. So much great content, so little time to catch it all!. So, if you’re joining us in Houston and haven’t had a chance to look at sessions yet, here’s a glance at the top twelve we’re excited about and which again focus on behavioral health, how to impact behavior change, and the use of peer support. To keep it simple, we pulled out the session descriptions for you and reviewed uploaded slides when available. You can find all of this information in the Online Planner.  

    Saturday August 10, 2019

    S03 – 9:15-10:15 am AADE’s Practical Approach to Mental Health for the Diabetes Specialist by Shannon Eaves, Jasmine Gonzalvo, Jay Hamm, & Cynthia E. Muñoz

    Description:

    The AADE practice paper A Practical Approach to Mental Health for the Diabetes Educator describes common psychosocial considerations in people with diabetes (e.g. depression, anxiety, diabetes distress, disordered eating, etc.), the pharmacological impact of relevant medications, appropriate assessment and referral strategies, and effective communication practices. During this presentation, the authors of the paper will review the content of the paper and expand on specific aspects, including clinical scenarios to highlight real world implementation of the assessment and referral recommendations.

    Our take away:

    The dynamic duo of Jasmine Gonzalvo and Jay Hamm are two of the speakers on this panel who will review the practice paper findings and discuss medication therapy. We predict this session will be well attended. 

    S16A – 1:00pm-1:30pm Online and In-Person Peer Support for Underserved Populations by Michelle Litchman, Cherise Shockley and Heather Walker

    Description:

    Support for individuals with diabetes is recommended per the 2017 DSMES National Standards; however, it is not always easy to identify support resources, especially for underserved populations. In this session, online and in-person support specific to those with different ethnic, language, abilities and diabetes type will be discussed. This session will provide diabetes specialists with tools for identifying, creating, and referring to support resources.

    Our take away:

    This team is well known in the diabetes support space and we look forward to learning from them.

    S16B – 1:30-2:00 pm Create Lasting Behavioral Change in African Americans with Diabetes by Sharon Evette

    Description:

    African Americans have one of the highest rates of diabetes in the US. Diabetes specialists play a significant role in addressing cultural barriers which enable diabetes self-care. The Change Model addresses the person’s level of growth by helping them identify goals and develop strategies for long term self-care behavior change.

    Our take away:

    We’re interested in learning about their process. In the 7-step process of change they describe, step 2 is establishing a “vision” which is in alignment with what we are trying to do here @AFreshPOVforYou , and aligns with the Miracle Question exercise we’ll present on Friday.  If you’d like to read more about the Miracle Question, we are fans of this book

    S21A – 3:15-3:45 pm Making Space for Lurkers in Peer Support: A Community-Supported Approach to Engagement by Anna Norton and Heather Walker

    Description:

    Peer support in diabetes has been shown to positively impact the health of those who actively participate; however, only one recent study points to the power of a lurker. In this session, the role of the lurker will be introduced and highlighted in the context of diverse populations. The session will conclude with strategies to include underserved and low-income adults generally not reached through traditional peer support programs.

    Our take away:

    These powerhouse women are strong advocates of peer support and are fantastic speakers. We love the concept of lurkers as being truly a part of the community, learning and engaging in a way that works for them. Not everyone has the same needs, desires and abilities. We support all.

    S28-4:30-5:30 Beyond Coping: Raise Your Spirits, Not Your Blood Sugar, by Maggie Hunts

    Description:

    This interactive and musical presentation incorporates key methodologies to improving diabetes care for the specialists and the person with diabetes. Be uplifted by musical parodies about living with diabetes, as you learn key ways to reach individuals.

    Our take away:

    While this presentation seems like it will be a lot of fun, we were attracted to the solution focused approach described in the slide deck. She emphasizes starting with “wins” to build on what’s working and to teach seeing “victories” no matter how small. Love this! Tami will catch this one since Deb will be presenting another session at the same time.

    S25 – 4:30-5:30 pm Use of Social Media and Peer Support in Diabetes Care: A Panel from AADE Project Leaders by Deborah Greenwood, Ashley Ng, Michelle Litchman and Hope Warshaw

    Description:

    This panel presentation will share findings, tools, tips and practice pearls from publications in a special edition of the Journal of Diabetes Science and Technology focusing on social media and peer support in diabetes. Three projects, which will be highlighted, had support from AADE. These include the online peer support community scoping review, the peer support communities initiative and iDOCr council. Join us to learn how to incorporate a variety of peer support and social media components to improve outcomes.

    Our take away:

    Deb was a special section editor for these journal issues and will share with other authors on the panel some learnings about the benefits of social media in diabetes care and education.

    Sunday August 11, 2019

    D01 – 9:15-10:15 am Tic-Tac-Tech: An Expert Panel on the Game of Integrating Technology into Practice by Crystal Broj, Kelly Close, Jasmine Gonzalvo and Deborah Greenwood

    Description:

    The panel discussion will focus on technology and its evolution in diabetes care. Real world case studies will demonstrate how educators can integrate new technologies into practice and work flow to ultimately produce improved outcomes.

    Our take away:

    Deb will be speaking on a panel with other tech savvy individuals in the diabetes space. The team hopes to generate a lot of discussion and conversation with the audience. So please join us if you would like to talk tech!

    D11 – 10:30-11:30 am No One Understands Me!; Helping People Live Well with Diabetes by Ann Constance and Cecelia Sauter

    Description:

    Only 32% of people with diabetes reported recently being asked about their emotional well-being by a member of their health care team.This interactive session will discuss new evidence about the negative effects of diabetes-related distress. It will explore effective and practical strategies diabetes specialists can incorporate into care delivery models to address emotional well being.

    Our take away:

    The Empowerment model will be employed in this presentation, helping people use their “own innate ability to gain mastery over their chronic disease.” Their slides describe very solution focused approaches to practice including focusing on goals and NOT solving problems for the individual, but listening to them and supporting them in their efforts.

    Next is a description of a two-session series on diabetes distress in the afternoon.

    D15A – 1:30-2pm Interventions to Help Overcome the Impact of Diabetes Distress by Eliot LeBow

    Description:

    Diabetes distress can impact a person’s life and diabetes self-management.This presentation orients educators to the underlying causes of diabetes distress, the symptoms, and the impact on peoples’ lives. Validated resources will be provided to help attendees understand and decipher the differences between diabetes distress and clinical depression. Interventions to help overcome the impact of diabetes distress will be reviewed.

    Our take away:

    We’re interested in the concept of “micro-trauma” as a factor in diabetes distress and look forward to learning more.

    D15B – 2:00-2:30 pm Diabetes Distress and Burnout: Helping Youth and Families Live Well with Diabetes by Rebecca Butler, Katherine Gallagher and Amber Smith

    Description:

    Most people with diabetes will experience diabetes distress at some points during their life. The emotional side of diabetes is often the area where providers spend the least amount of time, but it is one of the most important things to address to help people succeed. The goal of this presentation is to help diabetes specialists learn to recognize when people may be exhibiting diabetes distress and to provide tools to empower them to provide emotional support.

    Our take away:

    There are some great solution focused approaches to practice in this slide deck, including providing 3 behavior praises for every one correction and for parents and providers to notice what the kids did WELL!  Also, there’s great inclusion of using empowering language.

    D22 – 2:45-3:45 pm Mind, Body, History: Listening, Eliciting, Responding to the Whole Story of the Person with Diabetes by Marina Tsaplina

    Description:

    Behind the complexities of diabetes management, is a human being with a lived history that shapes their diabetes story. Narrative medicine understands that illness unfolds in stories and that a competent diabetes specialist must be trained in the physiology of the body and appropriate treatments, but also in narrative competence, humility and mind-body practice to serve people with diabetes across cultural, racial, and economic inequities. We invite you to participate in a workshop that incorporates theater, narrative medicine, and mindfulness to strengthen your practice of delivering compassionate, whole-person diabetes care.

    Our take away:

    While there were no slides to review, this interactive session by Marina Tsaplina will discuss building a therapeutic relationship with clients, an important concept to us, and in any solution focused approach.  

    Monday August 12, 2019

    M12 – 10:45-11:45 AM Not the Word Police: What the Language Movement is Really About by Jane K. Dickinson

    Description:

    The 2019 Diabetes Educator of the Year will present a deeper dive into the language movement in diabetes. Why are we trying to change the language around diabetes, why does it matter, and how can we do it effectively? We will discuss what the language movement is not, and have some hands on practice with replacing unhelpful messages.

    Our take away:

    Dr. Jane K. Dickinson will work through some examples of how to change practice and use person first, empowering language that does not stigmatize, shame and blame. Hooray! 

    So many fabulous speakers, topics, panels and presentations are ahead of us! Not to mention all of the great posters that will be presented as well. Join us in tweeting using the #AADE19 hashtag – share what you are learning along with others in your network. While we love the learning, we are also excited to connect with dear friends and colleagues, laugh a little (or maybe a lot), enjoy an adult beverage (or two) and dance at Sunday night’s classic celebration!  

    Please find us and say hello at the meeting! We love meeting our “online friends” when we are at in-person at conferences! We plan to share our highlights in a future blog, so stay tuned!  Hope to see you in Houston! 

    2019 AADE President, Karen Kemmis and Past President Donna Ryan at last year’s AADE Celebration!

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  • Fresh Views

    Highlights of #AADE19: Behavioral Health, Language, Peer Support and Social Media

    We’re getting excited for the #AADE19 Annual Meeting in Houston August 9-12!  For us, a little  advance planning and mapping out a schedule with the online planner helps us to successfully navigate the packed meeting, get to the sessions that peak our interest, and catch-up with friends! 

    Deb, Karen, Joan and Tami at #AADE18 President’s Reception

    As always, this meeting offers a multitude of cutting edge topics and excellent presenters. So, if you’ll be joining us in (hot) Houston at #AADE19 but haven’t had a chance to check out the sessions, here is the scoop on the 8 we’re excited about on Friday which focus on behavioral health, how to impact behavior change, and the use of peer support. To keep it simple, we pulled out the session descriptions for you and reviewed uploaded slides when available. You can find all of this information in the Online Planner.  

    F06-Friday 9:45-10:45 AM Shame and Diabetes: Practicing Resilience in a Culture of Weight Stigma, Disordered Eating, and Healthism by Nikki Estep 

    Description:

    Nearly 3/4 of people with type 2 diabetes report feeling shame about having diabetes, and shame-based self-talk and behaviors have been correlated with all types of diabetes. Presenters will define shame and how it is exacerbated in a culture of weight stigma and healthism, which can lead to disordered eating and other barriers to diabetes management.

    Our take away:

    Their slides are intriguing, sharing the work of Dr. Brene Brown on shame and vulnerability (love her books). From their slides: “Healthism is a belief system that sees health as the property and responsibility of an individual and ranks the personal pursuit of health above everything else, like world peace or being kind. It ignores the impact of poverty, oppression, war, violence, luck, historical atrocities, abuse and then environment from traffic, pollution to clean water and nuclear contamination and so on. It protects the status quo, leads to victim blaming and privilege, increases health inequalities and fosters internalized oppression.” – Lucy Aphramor

    The concept of “healthism” is new to us and yet the impact on stigma is so clear.  We also love the concept of Weight-Neutral Diabetes Care (WNDC) that “Focuses on establishing self-care behaviors. It DOES NOT promote restriction, endorse unsustainable exercise, or encourage disordered eating as a way to ‘get healthy’.”Looking forward to this one. 

    F07- Friday 11:00-12:00 Bright Spots & Landmines: A Diabetes Toolkit for Meaningful Behavior Change by Adam Brown

    Description:

    Why is changing behavior so difficult in diabetes? Why aren’t more people motivated? Why is there so much negativity in diabetes? Can we do better? Adam Brown will discuss the concepts of Bright Spots & Landmines as a toolkit for diabetes specialists to assist individuals to change behaviors, including specific food, mindset, exercise and sleep strategies. Attendees will learn how to apply “Bright Spots” and “Landmines” thinking to different individuals and scenarios, including easy-to-implement question guides.

    Our take away:

    While there were no slides to review, we are big fans of Bright Spots & Landmines and interviewed Adam Brown in our blog post on April 3, 2019.  Adam’s “Bright Spots” are very similar to “Exceptions” in a solution-focused approach (where one evaluates what’s going well and what they can “do more of” instead of focusing on the problems). Of course, there are obstacles that people face every day, and those are the “landmines” where things are not working as well.  You won’t want to miss his PDF handout of the 42 Factors that Affect Blood Glucose.

    F12-11:00 am-12:00 pm Reducing Stigma to Improve Outcomes: How to Reduce Stigma Effects by Laurie Klipfel , Eileen Rivera and Ann Williams

    Description:

    Health care professionals work with people who experience stigma, such as stigmatized racial/ethnic identities and other stigmatizing conditions. Recently stigma itself has been recognized as a fundamental cause of health disparities, that is, persistently associated with health inequalities across different times, diseases, risk factors, and health interventions. In other words, stigma affects outcomes. This panel presentation will explore what stigma is, how it produces health disparities, and what diabetes specialists can do to decrease its effects. It will include discussion by people from three stigmatized groups: People who are legally blind, transgender individuals, and those experiencing weight stigma.

    Our take away:

    The slide deck revels a presentation on how stigma affects health and how we can decrease the effects of stigma.  Looks like some powerful personal stories will be shared. Unfortunately, this session is the same time as Adam’s Brown’s. So many decisions!

    F23 Friday 3:15-4:15 pm Peer Support Communities for Self-Management Support: Research Trends by Perry Gee

    Description:

    The “S” on the end of DSMES is for support. Peer support is a resource being used by millions of people with diabetes. In this session, you’ll learn the latest research on the impact of social media and peer support communities on the promotion of self-management of diabetes.

    Our take away:

    The slides for this presentation show a historical look at past AADE presentations as well as published research supporting the #DOC or Diabetes Online Communities.Happy to see iDOCr research council mentioned in the presentation. This is at the same time as the Language  presentation below.

    F24A -3:15 pm-3:45 pm How Language Affects Person and Provider Communication by Jana Wardian

    Description:

    Communication between people with diabetes and providers plays an important role in engagement, conceptualization of diabetes management, treatment outcomes and behavior. Healthcare teams can be more effective through respectful, strengths-based communication. Empowering language can enhance motivation and well-being for people with diabetes. While this skill may take time, it is well worth the effort.

    Our take away:

    The slides are available for this presentation. Jana states she has lived with diabetes for 26 years and wears a pump and CGM. It’s always good to hear the language perspective from a person living with diabetes. If you follow us you know we often speak about person centered, strengths based language, so we’re happy to see several sessions on language at this conference. There was one slide that we would challenge however around the use of “bad vs. unhealthy blood sugar”. We don’t see “unhealthy” as a positive word choice or a biological factor. We’d go with “in range” or “out of range”. 

    F26A-4:30-5:00 pm Applying the Miracle Question in Diabetes Care by Tami Ross and Deborah Greenwood

    Description:

    Managing diabetes is complex and the constant focus on problems can erode confidence. Presenters will introduce “The Miracle Question,” a step-by-step solution-focused approach to work with people with diabetes. Participants will learn to use “exceptions,” the times when life works better or when problems are less likely to take over, to guide them toward attaining a personal action plan and goals. By focusing on abilities and possibilities, there are ready-to-use solutions. This approach assists diabetes specialists to help people strengthen their resilience and confidence.

    Our take away:

    Of course we are really looking forward to our presentation and hope you will join us! We will share one solution-focused tool called “The Miracle Question” as an exercise to move people forward in their thinking and actions when living with diabetes – to create a sense of hope and acknowledge possibilities. You can read our past blog post about the Miracle Question to learn more. If you’d like to further explore the Miracle Question, check out this book we’re fans of! 

    F29-4:30-5:00 F29 – Impact of Diabetes Self-management Education and Support on Psychological Distress among African Americans and Hispanic/Latinos with Diabetes by Ninfa Pena-Purcell

    While it conflicts with our session, this is another interesting topic.

    Description:

    Attention to the emotional side of diabetes is necessary in the delivery of DSMES. This has been found to be particularly critical for diverse racial and ethnic groups that have unique lived experiences. Two culturally appropriate community-based DSMES programs responded to this need, one aimed at African Americans and the other at Hispanic/Latinos with type 2 diabetes. Findings suggest that for both groups psychological distress was reduced and diabetes-related outcomes improved. Participate in this interactive session to dive deep into an exploration of the complexities of culturally appropriate diabetes interventions.

    Our take away:

    The slides for this presentation address the ADA guidelines for psychosocial care, how and when to assess people for diabetes distress, and describes a culturally tailored program to address these issues.

    F26B-5:00-5:30 Peer Support Communities: Data, Resources, Tips and Tricks, Ashley Ng 

    Description:

    People with diabetes and caregivers are increasingly turning towards online peer support communities to share and exchange information and experiences that impacts health behavior outcomes and emotional health. While the popularity of online communities continues to grow, it is crucial that diabetes specialists start to integrate evidence based online peer support networks as part of mainstream diabetes care. This presentation will discuss current challenges that surround people with diabetes and healthcare providers with the widespread sharing of personal data.

    Our take away:

    Ashley a dietitian, researcher, person living with diabetes, and colleague will discuss the privacy, security, and safety concerns of sharing personal data online, along with the role of the healthcare provider in helping people stay safe while online. 

    Wow, Friday is going to be a jam packed day! We’re thinking it may be Saturday before we make it to the Exhibit Hall this year!

    Deb, Tami and our good friend Lorena as we explored the exhibit hall at #AADE18

    We can’t wait to get to Houston to learn and re-energize! We are thrilled to see so many presentations addressing the behavioral side of living with diabetes and the essential component of peer support. Join us in tweeting using the #AADE19 hashtag – share what you are learning along with others in your network. Drop back by next week when we’ll share other  sessions of interest throughout the rest of the conference.

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  • Fresh Views

    Reducing Carbohydrate: Tips and Swaps That Work

    View over the Mediterranean Sea where we enjoyed some delicious low carb meals on recent travels

    Is managing carbohydrate something you think about? Carbohydrate gets a lot of attention when it comes to managing diabetes because it is most directly responsible for the rise in blood glucose after eating. (It’s also the body’s preferred fuel. The other two sources are protein and fat). 

    Having diabetes does NOT mean totally avoiding carbohydrate foods, though many find blood glucose easier to manage and keep in range when eating less carbohydrate. In fact, in our July 10 blog post you’ll find the highlights from the new consensus report on nutrition therapy for adults with diabetes or prediabetes. The report confirms that reducing carbohydrate through a low or very low carbohydrate eating pattern has demonstrated glucose lowering power, and can reduce the need for glucose lowering medication! Low and very low carbohydrate eating are among the most studied eating patterns for type 2 diabetes.

    What exactly is a low carbohydrate or very low carbohydrate eating pattern?

    Well, there doesn’t seem to be a consistent definition. Generally, “low carbohydrate” means 26-45% of calories come from carbohydrate. And “very low carbohydrate” is less than 26% of calories coming from carbohydrate, or around 20-50 grams of non-fiber carbohydrate over the day. Don’t get caught up in the math. Just know that for many, this generally translates into eating less carbohydrate.
    Here is a low-carb meal we enjoyed on our recent trip to France. Crisp fresh salad greens, juicy yellow tomatoes (nope they’re not peaches), topped with fresh grated Parmesan cheese, olive oil and balsamic vinegar. Easy and delicious!

    Fresh Tomato Salad

    Low- and very low-carbohydrate eating means focusing on the following: 

    • Non-starchy vegetables that are low in carbohydrate (think broccoli, tomatoes, carrots, and salad greens). 
    • Foods higher in protein (like meat, chicken, turkey, fish, seafood, nuts, and seeds)
    • Healthy fats (like olive oil and avocado)

    Fruit and higher-carbohydrate vegetables can be worked in; however, added sugar-containing foods and grain products are often very limited or altogether avoided.

    How do you portion your plate?

    So if you think about how you might actually fill your plate to embrace lower-carbohydrate eating, aim for at least half of the plate filled with the vegetables that are not starchy. About one-fourth of your plate would be lean meat or other proteins. And the remaining one-fourth of the plate portioned with carbohydrate foods…dairy, fruit, or maybe a small portion of a starchy vegetable or beans. For very low carb eating, actually the majority of the plate may be filled with non-starchy vegetables and lean protein.

    Deb’s low carb portioned plate (that’s riced cauliflower) with a peach from her peach tree to balance it out

    Individualization is important

    The consensus report acknowledges that there’s no one size fits all carbohydrate goals for those with diabetes. Figuring out how much carbohydrate and which carbohydrate foods to eat are important every day decisions. 

    Monitoring what and how much carbohydrate is eaten (or drunk) and noting the blood glucose response are key to keep blood glucose in range after eating. While we are fans of using a continuous glucose monitor (CGM), a blood glucose meter can do the work as well. Check blood glucose 1 ½ -2 hours after eating. If blood glucose is above target, reducing carbohydrate at the next meal may help bring blood glucose into range. We encourage trying it and noting the impact. Taking a solution focused approach – if it works, do more of that. 

    If you are managing carbohydrate choices and blood glucose is still out of range after eating, a diabetes medication may need to be added, or a dose or timing tweak made with guidance from your healthcare team.

    Small swaps can reduce carbohydrate in a big way

    We’re all about being practical and keeping it real. If you’ve followed our blog for awhile, you may remember the swap Deb shared in our blog Making New Years Solutions which helped her swap a tall Starbucks Latte instead of a grande Mocha, a habit she still follows.

    So if you are trying to make some swaps to reduce carbohydrate, here are 7 small swaps to get you started. Make them all, and you’ve reduced your carbohydrate by over 100 grams!

    7 swaps to reduce carbohydrate

    1. Swap in unsweetened almond milk instead of dairy milk. Save 10-11 grams carbohydrate per cup.
    2. Swap in plain Greek yogurt for plain traditional yogurt. Save 6 grams carbohydrate per 6 oz container.
    3. Swap in cooked spaghetti squash or zucchini spirals for spaghetti noodles. Save 35 grams of carbohydrate per cup.
    4. Swap in quinoa for rice. Save 7 grams carbohydrate for each cooked ½ cup serving.
    5. Swap in tomato or vegetable juice for fruit juice at breakfast. Save 8 grams for every 4 ounces. 
    6. Swap in nuts for pretzels. Save 17 grams carbohydrate for each ounce.
    7. Swap in water or tea sweetened with a low calorie sweetener for a 16-ounce sweet tea. Save 20 grams carbohydrate.

    Making it a low carbohydrate day

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

    Begin with breakfast. Veggie omelet or scramble with low fat cheese and  topped with diced avocado; fresh blackberries and raspberries with a dollop of Greek yogurt

    Leverage veggies at lunch. Green salad w/ tuna or salmon (foil pack for ease), sliced almonds, vinaigrette dressing

    Swap spiralized veggies for spaghetti at supper. Turkey meatballs and marinara over zucchini spirals or sauteed kale sprinkled with parmesan cheese; chopped romaine with light Caesar salad dressing;

    Seeks some satisfying snacks. string cheese; peanuts; cucumber slices with salsa for dipping

    What low carbohydrate foods are you already eating? How can you swap those in more often? What is do-able for you?

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  • 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.

    Recommended Products

    As an Amazon Associate and member of other affiliate programs, we earn from qualifying purchases.

    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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