• Fresh Views

    8 Tried and True Solution-focused Strategies for Eating Healthy Through the Holidays

    November 9, 2022

    With Thanksgiving celebrations and the holiday season at hand, today we’re sharing 8 tried and true strategies to enjoy the special foods that accompany holiday gatherings without compromising blood glucose. These 8 solution-focused strategies have worked for our clients and we hope are helpful for you.

    Strategy 1: Take a healthy dish or treat to share, or a healthier version of a favorite. Maybe it’s something like the caprese kabobs Tami made for an event that you see pictured below. Just a couple of grape tomatoes, fresh basil (or spinach) leaves, and a fresh mozzarella ball speared with a small skewer with a balsamic dressing to drizzle. Offering to bring something healthy can reduce stress by knowing that there’s at least one item to suit personal preferences and needs.(And chances are the host will welcome an addition to the party spread!)

    Strategy 2: Share a side dish that incorporates seasonal vegetables. Many of the food traditions associated with Thanksgiving and the winter holidays are laden with carbs and calories. One of our well-loved low carb favorites is roasted vegetables. Whether you choose to roast one type of vegetables (our vote is roasted Brussels sprouts) or a combination of winter vegetables (such as butternut squash, brussels sprouts, radishes (yes radishes!), parsnips, carrots, and red onion) they’re low in carbohydrate, high in flavor, and won’t keep you hanging out in the kitchen. Cut the vegetables into even size pieces/chunks for even cooking, then toss 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). These roasted carrots were delish!

    Strategy 3: Try the Two- to Three-Bite Taste Test 

    Many clients we’ve worked with over the years have shared success keeping their blood glucose in range by sticking with tiny tastings, or 2-3 bites, of foods they may not be sure of exactly what’s in them or foods that are rich in carbohydrate. They can still enjoy the experience without too much worry of sending blood glucose out of range.  This is also a great strategy when traveling over the holidays. You can read more about that here.

    A patient Tami’s worked with in the past  loved cheesecake. Prior to developing diabetes she’d eat an entire giant slice when she  dined at her favorite restaurant. Once diabetes entered her life, she still wanted to try to  work in cheesecake on occasion, and realized  that portion control was important. She agreed to try the two- to three-bite taste test. She reported back that she discovered she really  savored the first three bites of her cheesecake, but after that the pleasure decreased. Based  on her discovery, she decided to eat just three  bites of cheesecake at the meal, count and  incorporate the carbohydrate accordingly, 

    Strategy 4: Make a swap or two. Consider the foods that are often at holiday gatherings and determine where you can make a swap or two for health. One client who is planning ahead shared that she’s planning to swap in broccoli casserole (made with reduced fat ingredients) on her plate in place of mashed potatoes and a corn casserole to reduce carbs.

    Strategy 5: Eat off a smaller plate.  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). This strategy helps manage portions, and make those portions appear larger on the full small plate. 

    Strategy 6: Fill half of your plate with veggies of the non-starchy variety

    Aim to fill at least half of the plate with non-starchy veggies (such as veggie salads, green beans, broccoli, roasted vegetables from Strategy 2), one fourth of the plate with lean protein foods (such as a turkey), and one fourth with carbohydrate foods (this is mashed potatoes, stuffing, corn on the cob, or a sweet treat may fit). This simple strategy has brought success for many when navigating picnics and celebrations. 

    Strategy 7: Cruise by the foods that aren’t worth the carbohydrate or calories.  Before filling your plate with a little bit of everything, cruise the buffet or party spread to see what’s available, and then decide which foods you really want, and what portion of each works for you, We encourage asking yourself, “Is it worth the carbohydrate or calories?” If the answer is “no,” then it may be best to pass it by. If the answer is “yes,” then decide what portion fits your carbohydrate budget before adding it to your plate.

    Strategy 8: 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. Here we are embracing this strategy a few years back on holiday escape!

    Evaluate what went well. After each event, reflect on what went well and how you can repeat that at future gatherings. This is a helpful solution-focused strategy for anyone! Also think about what didn’t go as planned, and what changes can be made at future gatherings to keep blood glucose in range. You can read more in our blog post on Bright Spots and Landmines.

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

    Follow us on Twitter @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown Diabetes Center, but her words and opinions in this blog are her own.

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  • Fresh Views

    Transform Primary Care Encounters: Discovery Learning from Data

    July 27, 2022
    CGM tracing showing time in range (in green) and time out of range (in red)

    The real voyage of discovery consists not in seeking new landscapes, but in having new eyes. – Marcel Proust

    We kicked off 2022 with this series we’re wrapping up today:  Transforming primary care encounters by taking a solution-focused approach when managing type 2 diabetes in the primary care setting. Along the way we’ve shared a multitude of tips and tactics to add to your toolbox so speak. Today’s blog wraps up the series as we focus on discovery learning from  diabetes data in a solution-focused way.

    While there is a multitude of diabetes data that we can learn from, today we’re focusing on structured blood glucose monitoring (BGM) and professional continuous glucose monitoring (CGM).

    DISCOVERY LEARNING FROM  STRUCTURED BGM

    Both of us spent a large portion of our career in the  primary care setting where we routinely used structured BGM.There are 3 profiles that we have routinely used with clients/patients to help them to discover and learn about their blood glucose patterns and how favorite foods and physical activity affect them. We call this “discovery learning” because on their own, using “personal experiments” people are uncovering aspects of their diabetes themselves. And when people learn by doing, they are able to make health decisions that work for them. They are identifying “what’s working well” and are able to apply solution focused tactics to “do more of what’s working” and focus on successes instead of problems. Discovery learning is a great way to incorporate a solution-focused approach into practice. Let’s look at some examples

     When using BGM there are several profiles or checking patterns you can apply.

    7-point profile

    This one can be helpful to use for 3 days prior to a visit, for instance. This profile uses 21 strips, or 7 checks (before and after each meal and at bedtime) 3 days in a row. See the table below. The concentrated focus helps to measure the magnitude and frequency of short term fluctuation in blood glucose. It can be helpful in reducing the therapeutic inertia (Read more about therapeutic inertia in our blog here.) 

    5-point profile

    Similarly is the 5-point profile which requires fewer strips (15), if supply of adequate test strips is a concern. The 5-point profile includes 5 checks daily for 3 days, as you see in the table below – checking before and after breakfast and supper, as well as after lunch.

    Paired checking

    This is one of our favorite profiles for discovery learning. It can be used to focus on one thing, such as how a food/meal impacts blood glucose. We’ve had many clients/patients use paired checking to learn how their Friday night pizza affects their blood glucose. One example that stands out was an individual who routinely ate ½ of a medium hand-tossed pepperoni pizza (4 slices). After seeing the spike in his blood glucose, he decided to go with 2 slices and a side green salad, and saw his blood glucose fall back into range. We encourage patients to conduct their own “experiments”, if you will, to learn how food (type, portion) or adding in more physical activity affects them.

    Paired checking can also be used around 1 meal time each day, rotating amongst the meals over the course of the week, to give a good look at blood glucose patterns.

    Follow-up on personal experiments

    At the follow-up to see what the individual learned from structured BGM, ask solution-focused questions in a non-judgemental way, such as:

    I know you really like cheesecake and were planning to try paired checking to see how 3 bites satisfied you and affected your blood glucose, as compared to eating a whole piece. What did you learn? Did that change your plans? What are some options if your glucose spikes?

    What have you learned during your discovery? And follow up with, How can you do more of that?

    DISCOVERY LEARNING FROM PROFESSIONAL CGM

    Another tool available to support people with type 2 diabetes to engage in discovery learning is by using professional CGM. Professional CGM is owned by the clinic, not the person with diabetes, for intermittent CGM use. Similar to the personal experiments described with BGM, a person can choose to view their data before and after favorite foods, different activities, or even before and after sleep or a stressful event. The benefit of professional CGM is that the individual doesn’t have to do a fingerstick as the unblinded professional CGM can be connected to their smartphone and they are able to see their data in real time for up to 10 days. We’ve written about discovery learning and CGM previously. There is also a blinded professional CGM where the person reviews the data at the end of session retrospectively. While not as useful for discovery learning and personal experiments, if they keep good records of food and activity they can identify trends and patterns. 

    Examples of personal experiments:

    Favorite foods – While wearing the CGM your client might decide to eat different breakfasts each day of the week, and view their data on their smartphone before and again two hours later to see if they stayed in their target range (typically 70mg/dL-180mg/dL). They might choose their favorite high carb breakfast one day, and then a low carb version the second day, and then something in-between the next day.The beauty of personal experiments is that they can be anything that matters to the person.Through this personal discovery, they are able to learn what is working and make decisions.regarding their next steps.

    Physical activity – Similar to evaluating the impact of food on glucose values, the same can be done for physical activity. The client can check their smartphone to know their glucose value and their trend arrow direction (are they staying steady, trending up or down) and then choose a variety of physical activities to evaluate the impact. Some questions they may ask are: What happens when I start physical activity when I have a trend arrow going down but my glucose is in range? Or what happens when I complete my physical activity and my trend arrow is going up? Many people discover that their glucose values actually increase following physical activity, but then come down later and using CGM can help them to plan how they respond.

    Stress – Using CGM can really help clients understand the impact stress can have on their glucose. We’ve shared in our presentations about a friend who’s CGM values went straight up during a stressful event when she had nothing to eat or drink (the fire alarm went off, she ran out of her condo but forgot to get her cat …good news in the end it was a false alarm and the cat was fine!). Viewing data during stressful times can help people remove some of the guilt they experience with glucose fluctuations and help them to realize that diabetes is a challenging condition to manage.

    Follow-up on personal experiments

    Similar to BGM, use your solution-focused tools when discussing data. Focus on what went well, what the individual learned, and remember that all data are valuable.  Data are just numbers and not judgements and do not define a person as “good” or “bad.” Help your clients value data to support their learning and to modify their health behaviors, even when their choices may not be choices you would suggest. People need to be ready to make big changes, and over time, data can help them get there!

    I see you changed how much you walked after dinner, what did you learn? 

    You were in target range after these three meals, how did you do that? How can  you do more of that? And what else?

    We’ve written before about the 42 different factors that affect glucose (see Bright Spots and Landmines) and how Bright Spots are very similar to “exceptions” in a solution-focused approach, a time when things are going well. Author Adam Brown mentions that he would not have been able to identify these 42 factors without the use of CGM to guide him and reveal glucose changes that were unknown before. There is nothing more helpful for someone trying to make a challenging health behavior change than personal data to help them identify what they can do and what is reasonable for them.

    Stop back by in 2 weeks when we’ll share a sneak peek at our session we’ll be presenting at the ADCES22 conference in Baltimore, MD!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

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

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown Diabetes Center, but her words and opinions in this blog are her own.

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  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Applied to CGM

    March 24, 2021

     “The future depends on what we do in the present.” – Mahatma Gandhi

    Views of the Sierra Nevada Mountains from Folsom Lake, Granite Bay, CA

    In this week’s installment of Diabetes Technology and Solution-Focused Practice we’re discussing continuous glucose monitoring or CGM. If you’ve been reading our blog, you know we’ve written about CGM before in our posts about Exceptions and Possibilities and also in our series on “Flipping the Paradigm” when applying a solution focused approach to Monitoring. 

    Focus on “exceptions” rather than “problems”

    When we think about applying a solution-focused approach to CGM, Bright Spots and Landmines by Adam Brown comes to mind. It’s a framework for evaluating diabetes habits and decisions. (You can read our 2019 interview with him here.) As we were identifying our technology themed blog posts, Deb happened to watch a North Carolina JDRF Chapter presentation by Adam (see slides here) that really highlighted the approach we encourage  diabetes care and education specialists (DCES) to take when discussing CGM data. 

    When evaluating CGM data similar to that below, the typical first response may be to focus on the glucose spike and try to identify what went wrong.

    However, when taking a solution-focused approach, we want to turn focus to all of the things that are working well (rather than what went “wrong”). Similar to Adam’s “Bright Spots”, we call them “Exceptions” or times when the problem did NOT occur and when things were going well. Below you can see where Adam focuses on his Exceptions, instead of his “landmines” and identifies all of his successes during the day. If we only focus on times that are not working well, we miss identifying successes.

    CGM creates a great opportunity for discovery learning!

     When CGM was first incorporated as a management tool, the focus was typically on hypoglycemia, and preventing serious events from happening. As CGM has evolved and more individuals with type 2 diabetes are incorporating it into their diabetes care, the focus has broadened and now includes focus on making healthy behavior changes. CGM creates a great opportunity for discovery learning, where people can try different foods or activities and personally experiment to learn what works well for them. While Adam identifies 42 factors that can impact blood glucose, he stated that there are more likely more than 60-100 factors if you include mental health and other daily issues. There’s so much to learn!

    As DCES use CGM in practice with clients with type 2 diabetes, applying a solution-focused approach to CGM data can be motivating and help reinforce habits and choices that result in increased time in range (TIR) and overall quality of life. (The recommended goal for TIR is > 70% of glucose values between 70 and 180 mg/dL) Focusing on their “best day” pattern (the day with the greatest TIR) and working towards increasing TIR is a positive goal to strive for because they can “do more of what’s working” instead of giving up or stopping something they enjoy. Our “fresh view” photo today was taken by Deb on an easy hike near her home. Physical activity is one of many factors that can help one see more TIR. Applying a solution-focused mindset with CGM can help your clients want to learn to use their own data to learn about their diabetes and create a plan that works for them, where they can be successful.

    Do you use CGM in your practice and with your clients? If you do, try focusing on times when they are in their goal range and inquire about their actions and activities during that time. Help them identify what’s working well and what choices will move them towards more TIR. 

    • One mnemonic to facilitate conversation is MGLR, which stands for “more green, less red” when looking at the TIR bar. The goal is to see more green (time between 70-180 mg/dL) and less red (< 70 mg/dL). Talking about TIR can be a great way to have a solution-focused discussion and to help clients identify opportunities to succeed instead of focusing on past failures. 
    • A second mnemonic is FNIR, or “flat, narrow and in-range”, which is a goal for the trend graph. When viewing the trend graph the goal is to have the majority of the data fall within the target range, again typically 70-180 mg/dL without extreme variability swinging from below range to above range. CGM creates an opportunity to move towards a clients goals while providing constant, non-judgemental feedback on their progress.

    We plan to continue to write about a variety of other technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching. Stop back by in 2 weeks to see what’s up next!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

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

    Deb is employed by Dexcom but her words and opinions in this blog are her own.

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  • Fresh Views

    EXCEPTIONS: Today’s word to jump-start solution-focused practice

    June 24, 2020

    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:

    1. Are there times when this has been less of a problem?
    2. What is different about the times when this was less of a problem?
    3. What did you (or others) do that was helpful? 
    4. What’s gone better for you today or over the past week?
    5. What thoughts kept you on track?
    6. At a time when you feel more optimistic and satisfied, what will you be doing more of or more often?

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

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

    Follow us on Twitter and Instagram @AFreshPOVforYou

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  • Fresh Views

    Fresh Start in the Fall

    September 25, 2019

    All endings are also beginnings. We just don’t know it at the time. – Mitch Albom

    Autumn on the Saint Lawrence river in Quebec

    Monday September 23rd heralded in the official start to Fall! For many, Fall signals an ending…the end of carefree summer break for kids, and depending on where you live, the end of warm weather, the end of long sunny days, and the end of leisurely weekend afternoons on the lake or by the pool. 

    But with that “ending” comes striking new “beginnings”. The air takes on a crispness. The trees magnificently change colors and leaves begin to fall. And we enter a season of waiting. All necessary to make way for the new. 

    With the start of Fall, today we share 3 solution-focused fresh starts for Fall: 

    1 – Spend time in reflection. Fall is a great opportunity to take a look back at the past months and summarize your accomplishments in all aspects of life. And to remind yourself what’s gone well. This can help bring fresh perspectives, set priorities and inspire you to consider new possibilities. Life in general brings constant challenges, not even to mention life with diabetes. We encourage you to focus on what has worked. How can you make that happen more often?

    2 – Practice gratitude. Fall is a time of gratitude with Thanksgiving around the corner. Reflect on what you are grateful for and what brings  you joy, especially if life is seeming challenging and burdensome. Feeling thankful for the experiences and emotions they brought you. Read our gratitude blog to get some ideas on some gratitude practices. 

    3 – Sum up the results and start something new. Building on fresh starts 1 and 2, that “something new” may be self-improvement activities, setting new goals, or devoting more time to the things in life that bring you joy and contentment. Read our past blog on finding joy in life and diabetes education services.  Many programs, workshops and events start in September and October, so it’s the perfect time to enroll. Or it maybe time to take up reading a new book to nourish your soul and help you know yourself better. If you live with diabetes and have not read Adam Brown’s book, Bright Spots and Land Mines, we encourage you to put this on your reading list. The bright spots discussed in his book are very similar to “exceptions” in a solution focused approach. You can read our interview with Adam here.

    Rather than think of Fall as ending, think of it as a beginning of something fresh and new.

    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. 

    Subscribe to our blog and we’ll email you when a new post is published!

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Disclaimer: A Fresh POV for You is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com. 

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  • Fresh Views

    The Miracle Question Applied to Diabetes at #AADE19

    August 21, 2019

    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. 

    Subscribe to our blog and we’ll email you when a new post is published!

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Disclaimer: A Fresh POV for You is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.

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  • Fresh Views

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

    July 31, 2019

    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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    Disclaimer: A Fresh POV for You is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.

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  • Fresh Views

    Diabetes Bright Spots & Landmines: Insights from author Adam Brown

    April 3, 2019

    Finding Bright Spots puts wind in the sails, rather than constantly tearing them down. -Adam Brown

    Adam Brown  is almost a household name in the diabetes community! He is the Senior Editor of diaTribe.org and author of acclaimed diaTribe column, Adam’s Corner as well as Head, Diabetes Technology + Connected Care, for Close Concerns.  He’s the author of the incredible book, Bright Spots & Landmines: The Diabetes Guide I Wish Someone Had Handed Me,

    His practical guide aligns with our thinking at A Fresh POV for You and our desire to educate the community about solutions focused therapy and coaching approach. We appreciate Adam taking time to share insights around finding and focusing more on what he calls diabetes “Bright Spots,” while setting up safeguards to steer away from stumbling upon diabetes “Landmines”.

    Q1: What are “Bright Spots” and “Landmines”?

    Adam: “Bright Spots” and “Landmines” is a framework for evaluating diabetes habits and decisions.

    The goal with “Bright Spots” is to identify what works and focus on doing those things more often. In other words, “What’s going well in my diabetes that I should keep doing? What happens on my best days? What foods and decisions keep my blood glucose in the tight range of 70-140 mg/dL? What puts me in a positive frame of mind? How can I do more of these things each day?” Examples from my own life:

    • Eat less than 30 grams of carbohydrates at one time.
    • Remember why in-range blood sugars benefit me TODAY (I’m happier, more productive, in a better mood, and a kinder person to loved ones).
    • Walk after I eat and to correct high blood sugars.
    • Get at least seven hours of sleep.

    Conversely, the point of Diabetes Landmines is to uncover what doesn’t work and find ways to do those things less often. “What decisions do I make repeatedly that explode into out-of-range blood sugars values over 180 mg/dl or less than 70 mg/dl? What happens on my most challenging days with diabetes? What choices do I always regret? What repeatedly brings on negative feelings? How can I do fewer of these things each day?” Examples from my own life:

    • Hypoglycemia binge: overeating to correct a low, only to go high afterwards.
    • Eating white bread, crackers, and sugary foods
    • Asking unproductive questions like “How is this this possible?” or “Why am I so terrible at this?”
    • Using all-or-nothing thinking: “Well, I don’t have an hour, so I can’t exercise.”

    Clarifying Landmines upfront helps develop a plan of attack: What safeguards can I set up to avoid them? How can I build routines that reduce the chances of stumbling onto them?

    Most of us are very good at identifying Diabetes Landmines (mistakes), but we rarely ask the opposite (Bright Spots) question: “What is working and how can I do more of it?” Diabetes requires both modes of thinking! And since Bright Spots are often overlooked and undervalued, we must actively cultivate this kind of thinking.

    Q2: How does this framework fit into your book, Bright Spots & Landmines?

    Adam: The book discusses my own “Bright Spots” and “Landmines” in four areas: Food, Mindset, Exercise, and Sleep. I consider these key pillars of living well with diabetes. My #1 goal was to make this book actionable, meaning anyone can pick it up and immediately improve some aspect of his or her life: more time in an ideal blood glucose range; less time managing and worrying about diabetes; less stress and guilt; better relationships and energy and sleep; and a happier mental state. Everything in Bright Spots & Landmines has made a positive difference in my life, and most things include a small step that can be taken immediately. The advice has resonated with people who are newly diagnosed all the way to those with 50+ years of diabetes.

    Q3: How can people get Bright Spots & Landmines?

    Adam:

    1.     Download a free PDF version at diaTribe.org/BrightSpots

    2.     Get it in paperback ($5.78) or on Kindle ($1.99)

    3.     Listen to it for free at diaTribe.org/BrightSpotsAudio or buy it on Audible or iTunes

    Q4: The work we @AFreshPOVforYou are doing is centered around the solutions focused brief therapy approach. How does that align with Bright Spots?

    Adam: It’s easy to come up with a vague list of things I “should” and “should not” do, but Bright Spots and Landmines need to be useful. That means hitting three criteria:

    1. Specific and actionable: “Eat healthy” does not count as a Food Bright Spot – it’s too vague. “Fill half my plate with vegetables” is much clearer.
    2. Realistic and sustainable: “Not eating” does not count as a Food Bright Spot either – it’s impossible to sustain. “Eat slowly and stop before I’m 100% full” is more realistic.
    3. In my control and changeable: “Bad weather” is not an Exercise Landmine – it’s out of my control. On the other hand, “overeating after exercise” is a Landmine that is changeable – I can find ways to avoid it.

    Q5: Tell us about the 42 factors that affect blood glucose.

    Adam: Over the past ten years, I have worn continuous glucose monitoring for over 60,000 hours, run thousands of personal experiments, and learned from some of the smartest minds in diabetes. One of my biggest takeaways is how absurdly complex diabetes is; it’s not as simple as “eat healthy, take your medications, and exercise and you’ll have on-target blood sugars.”

    In reality, there are at least 42 factors that affect blood sugar – food, medication, activity, environmental, biological, and decision-making factors. Many of these factors are barely talked about (e.g., sleep), others are impossible to measure in any given moment (e.g., stress, infusion set function), and we never know what factors are in play in a given moment. Most of Bright Spots & Landmines is about minimizing the impact of those 42 factors. But perfectionism is impossible, given the tools we have and the environment we live in. CGM, coupled with experimentation and reflection, is an amazing diabetes tool to cope with this complexity. Get a full downloadable PDF explaining all 42 Factors here.

    Q6: Would you share an impactful story/experience surrounding Bright Spots that might resonate with people living with either type 1 or type 2 diabetes?

    Adam: The Amazon reviews tell some remarkable stories – people who have dropped their A1c by multiple points, who spend significantly more time-in-range each day, who have renewed motivation to manage diabetes, etc.

    Q7: What guidance would you offer for DEs / HCPs to focus on bright spots?

    Adam: When someone is struggling, the temptation is to focus on what’s going wrong and brainstorm solutions. This “Diabetes Landmines” thinking has value, but it cannot be 100% of the focus!

    A “Bright Spots” orientation – what is working and how can I do more of it? – is just as valuable (and in many cases, far more valuable). Finding Bright Spots puts wind in the sails, rather than constantly tearing them down.

    Here are some questions to help Find Diabetes Bright Spots:

    1. What is going well in my diabetes? What am I doing well that I should try to do more often?
    2. What happens on my best days with diabetes?
      • What do I eat?
      • What does my diabetes self-talk sound like?
      • When and how do I exercise?
      • How did I sleep the night before?
      • What do loved ones do that is helpful?
    3. If I wanted to have one of these Bright Spot days today, what would I do to make it happen?
    4. What times of day or days of the week is my glucose consistently staying in range (70-140 mg/dl or 70-180 mg/dl, depending on your preferences)? What choices might be enabling that to happen?
    5. What is one Bright Spot decision from the past week that – if repeated consistently – would really improve my quality of my life?
    6. What are some small steps that I could take this week to increase my Diabetes Bright Spots? What am I willing to try?

    Thank you Adam for your enlightening solutions focused approach and sharing your first-hand understanding and experience about how to live well with diabetes!  We agree with you that “Bright Spots are often overlooked and undervalued, (and) we must actively cultivate this kind of thinking.” At A Fresh POV for you our goal is to do things differently and encourage building a strong therapeutic alliance by focusing on strengths, solutions, and yes, Bright Spots!

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    Disclaimer: A Fresh POV for You is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.

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