• Fresh Views

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

    June 26, 2019

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

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

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

    Highlight #1

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

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

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

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

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

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

    Highlight #2

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

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

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

    What deadlines look like on vacation!

    Highlight #3

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

    Highlight #4

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

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

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

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  • Fresh Views

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

    June 12, 2019

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


    From a peak overlooking the harbor in Monaco


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

    Historic fortress in Cannes, France

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

    Valley below Eze Village, France

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

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

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

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

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  • Fresh Views

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

    June 5, 2019

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

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

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

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

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

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

    How can you get started with gratitude?

    Here are 5 strategies to help develop daily gratitude habits:

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

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

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

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

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

    Maybe you employ one of these strategies. Or several.

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

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

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  • Fresh Views

    Hello world! A Fresh POV may change your life

    May 29, 2019

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

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

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

    Who are we?

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

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

    What is our focus?

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

    Why did we start this blog?

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

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

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

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

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

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  • Fresh Views

    Peaks and valleys in life

    May 22, 2019


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


    Hilltop village of Eze, France

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

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

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

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

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

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

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

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

    Activity tracker report of steps taken over 2 different weeks

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

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

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

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  • Fresh Views

    Decision Fatigue: Tips to decrease the burden

    May 15, 2019

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

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

    What is decision fatigue?

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

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

    Embrace a minimally disruptive approach

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

    4 Solution- Focused Tips to decrease the burden:

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

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

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

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

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

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

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

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  • Fresh Views

    Bringing order to chaos: A solution focused approach

    May 8, 2019

    Photo from the home-front. Yes that’s a metal hanger in the washing machine!

    Does your life ever feel like this? This was what Tami found when she opened the washer after her son did his first ever load of laundry a few years back! (And don’t worry, he knows this is out there).  How often does life feel the way this picture looks? Things are all mixed up. Things are happening that shouldn’t. Things are where they shouldn’t be, or we don’t want them to be. It’s easy to let our minds dwell on those things.

    However, what if instead of focusing on the problem at hand and stressing, we focus on what actually is going well. In this scenario, Tami confesses when she happened upon this sight, at first she was mad. Then she had to laugh. Then she realized, there are actually some things going well here: He did his first load of laundry on his own! He knows how to operate the washer, and measure the detergent (there aren’t bubbles everywhere!). It’s all dark clothes – there are no white items in there. And nothing got torn by the hanger. In the end, it worked! The laundry got done. Now he can repeat (minus the hanger!)

    Applying this to life with diabetes, do you ever look at your blood glucose and feel like everything is in chaos? This reminds us of “John”…. a few years back he brought his blood glucose log into his appointment. When asked how are things going? What’s been going well this past month? He immediately pulled out his log and proclaimed with excitement…”Look at this one week!” All blood glucose checks were in range that one week, as compared to the other three weeks where he was overall significantly above range. Rather than focusing on those values out of range, instead the focus turned to that one week in range. How did he achieve that? What was going on? He realized that was the week he was on vacation! His stress level was much lower. He made the connection that stress raises his blood glucose and less stress means lower blood glucose for him. It was a moment of realization for him! And a driver of change to incorporate more self-care and mindful focus on stress management when he is not on vacation. He decided to use his Fitbit to track his sleep to ensure he slept 7 hours every night.  He also used a mindfulness app to take 5-10 minutes every day to clear his head during the most stressful time of the day at work. While vacation may be an easier time to take good care of himself, he knew there were small changes he could make to move more in the direction he wanted to go. He was successful in bringing order to chaos with a solution focused approach.


    A beautiful, and orderly, row of painted houses, Isle of Skye, Scotland

    Now we know what you might be thinking…….if only my healthcare provider (HCP) would do the same and focus on those “exceptions” or things that are going well too. Maybe you can lead your next medical conversation in a similar style to John’s? Before you mention a problem you may be having, start by telling your HCP what you’re happy about and something positive about your diabetes management. You can tell him or her that you’ve learned about a solutions focused approach that resonates with you and you’d like to try to do more things that are going well for you. (You could share our blog post about building a therapeutic alliance with your team!) When you focus more things that ARE working well, there is less time to engage in habits or practices that are not working so well.

    We know nothing is ever perfect and that chaos will sometimes rear its ugly head. That’s life with diabetes. So, when you’re feeling like you need to re-focus and reframe, call on those tried and true solutions that work for you.  Keep a list of 3 things to do every time you feel that you need more order in your life. (Re-read our post on making lists here!) Or try to see things from a new perspective. Learn what works for you!

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  • Fresh Views

    How to apply our solution-focused “Triple Crown”

    May 1, 2019

    Deb and Tami at the Kentucky Derby a few years back
    (Look closely in the background and you may see a celebrity you recognize!)

    “It’s Breeding

    And it’s training

    And it’s something unknown

    That drives you and carries you home

    And it’s run for the roses

    As fast as you can

    Your fate is delivered

    Your moment’s at hand

    It’s the chance of a lifetime

    In a lifetime of chance

    And it’s high time

    You joined in the dance”

    -Dan Folgelberg’s Run for the Roses

    This Saturday May 4 is the 145th running of the Kentucky Derby! An event near and dear to Tami’s heart since she lives in Kentucky. If you are not familiar with the Kentucky Derby, it is a thoroughbred horse race held annually in Louisville, KY on the first Saturday in May. Three-year-old thoroughbred horses race for a distance of one and a quarter miles at Churchill Downs thoroughbred racetrack. The race has been run every single year since 1875. It is known in the United States as “The Fastest Two Minutes in Sports” (in reference to its approximate duration). And the race is often called “The Run for the Roses” because a blanket of roses is draped over the winner. It is the first leg of the American Triple Crown, followed by the Preakness Stakes and then the Belmont Stakes. A horse must win all three races to win the Triple Crown.

    While, it is very difficult to get tickets to the Kentucky Derby,  2016 was our year! We thought you might enjoy this picture of us in our Derby hats alongside the red carpet. Look closely behind us and you may spot a celebrity. Attending the Derby definitely “sparked joy” for us!

    Carrying through the theme of the Triple Crown, we want to share with you our solution-focused “Triple Crown” so to speak. (If you’ve been following our blog, you know that we embrace a solution-focused approach to living well with diabetes). We believe in focusing on solutions rather than analyzing the “problem”.  When faced with a scenario that you’re trying to sort out, the three key questions to ask yourself (the three legs of the Triple Crown if you will) are:  

    1. What’s going well?
    1. How did I accomplish that?
    1. How can I do more of that?

    Let’s put that into practice with an example around eating breakfast:

    1. What’s going well? Maybe you’ve noticed that when you eat breakfast, your energy and concentration are better. You feel better. And maybe you’ve noticed that when you eat a breakfast that has more protein and less carbohydrate (such as a boiled egg and a slice of whole grain toast with almond butter, instead of cereal with milk), you feel even better.
    2. How did you accomplish that? Maybe it was that you did your grocery shopping before the busy work week started, getting foods in the house that fit your preferences and needs. And you boiled a few eggs to pop in the refrigerator to have on hand to grab in the morning. And you set the bread and almond butter by the toaster so it’s ready to toast in the morning while you’re brewing coffee.
    3. How can you do more of that? It sounds like it’s related to taking a few moments to plan ahead. For example, Deb buys pre-packaged, ready-to-eat hard boiled eggs at Costco so she can save time.  In the end, these decisions help you achieve your goal to feel better and see blood glucose in range.

    How can you put our solution focused “Triple Crown” into practice now?

    When we hear the above lyrics from Dan Fogelberg’s Run for the Roses, we think of a solutions focused approach. In our interpretation, breeding is your “built- in resilience,” and training is needed to gain skills and foster strength, while something unknown is the solutions you can identify, with a little support, to carry you through life.

    Run for the roses is living your best life. You have one life to live. We want it to be full of possibilities, opportunities and for you to live out YOUR vision of your best life, fitting diabetes in along the way.

    In closing, we knew our “Run for the Roses” adventure was a once in a lifetime experience. But we enjoyed celebrating so much, that we put our solution focused approach into practice. How could we repeat the experience? In the end, it wasn’t going back to Churchill Downs, but it was joining the festivities and live simulcast from Keeneland racetrack in Lexington, KY the following year. Here we are with our husbands. Happy Derby Day!


    Deb, Mark, Tami and Mike at Keeneland Racecourse, Lexington, KY
    Celebrating the Derby via simulcast

    Deb and Tami at Keeneland, Racecourse, Lexington, KY

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  • Fresh Views

    Co-design: How we are engaging people living with diabetes in designing diabetes education services

    April 24, 2019

    A new day dawning

    Please, let patients help improve healthcare. Let patients help steer our decisions, strategic and practical. Let patients help define what value in medicine is. –Dave deBronkart, Let Patients Help

    Imagine with us…… a square table. On one side sits the healthcare team. On the other sits their patient living with diabetes. The healthcare team has created a plan and program of great things for their patient that they think their patient needs…without once asking for any input or perspective of that patient – the one who actually lives with diabetes 24/7/365. What if instead, at that same table, everyone is sitting on the same side. The individual living with diabetes was included in the discussion and decision making from the very beginning. The plan and program was crafted around their input. That’s an illustration of co-design. And that is something we strongly believe in. What if relatable individualized solution-focused education services for people with diabetes were co-designed with people living with diabetes?

    What exactly is co-design?

    The Institute for Healthcare Improvement defines co-design in the following way: “Co-design involves the patients in the design process and works with them to understand their met and unmet needs…..This enables us to incorporate the patient perspective directly and immediately.”   In theory it doesn’t sound complicated, but it doesn’t seem to happen very often. The healthcare profession has a long history of the clinician being the “expert” and the patient being the one to “follow orders”. Often, programs and services are designed by the medical staff, independent of patient input. Some more evolved health systems are adding patient and family advisory councils to get feedback and input. However well meaning, they’re often not facilitated to the full potential.With co-design, everyone has an equal say in creating the solution. It is not spending time just getting feedback about programs you’ve already designed….it’s about including people in the decisions from the very beginning.  

    So instead of the healthcare team solving problems they think exist, co-design allows a multi-stakeholder team to first identify the problem that really exists and then develop solutions together. People living with diabetes know what’s worked for them and what hasn’t, and how they would create a program if they had the chance. This is truly a person centered approach to care.

    How has @AFreshPOVforYou been engaged in co-design?

    Supported by a three-year PCORI award, the Intercultural Diabetes Online Community Research Council, affectionately known as, iDOCr, was born (which Deb is a part of). The goal of PCORI is to help patients make more informed healthcare decisions by supporting research that compares the effectiveness of existing, known and proven treatments. All PCORI projects involve patients from the very beginning of every research study or community engagement project. With the iDOCr funding, a stakeholder group was created that represented researchers, clinicians, people working in industry, non-profit organizations and people affected by diabetes (people living with type 1 and type 2 diabetes and caregivers). Both English and Spanish-speaking individuals were included.Together, over the three-year award, this team developed a research question that was important to the group with the goal of eventually receiving funding to conduct the study. One of the main outcomes of this award was very interesting to us….although the majority of the iDOCr patient representatives lived with type 1 diabetes, the team decided to develop a research study focused on type 2 diabetes in the Hispanic community, because that is where they saw the need. This is the essence of co-design; preconceived ideas might have encouraged a completely different research question. The team is about to embark on the research study very soon, so stay tuned for more information. You can learn more about iDOCr via Facebook, Twitter and read the Blogs here.

    We also led the development of two videos to educate about the use of person first language in diabetes.  These 2 videos “Why Language Matters” and “Changing the Conversation” were written and produced using co-design principles. The background and supporting information was first taken from the 2017 paper, The Use of Language in Diabetes Care and Education jointly published by AADE and the ADA. We wanted to understand how language has directly impacted people living with diabetes by learning about real world experiences. We also wanted to learn from healthcare providers how they used empowering, person first language in their practices. So, we developed questions and asked the diabetes community to answer them. We were so overwhelmed with responses that we knew people really wanted to share their stories about why #LanguageMatters to them. From these stories we crafted the scripts for the two films and then we sent the scripts back out to the diabetes community to make sure we got it right. Finally, the videos were filmed with those same individuals, not actors, but people living in the diabetes community. The amazing, talented and Telly award winning creative director from Mytonomy, Mr. Kevin Kuchar created videos that we are so proud of and really reflect the true emotion that language can create and why the language we use in healthcare has a direct impact on outcomes and well being. Read our November, 2018 blog Language can change your POV!

    How are we using co-design now?

    Currently, we are using co-design to help us create diabetes services that resonate with people living with diabetes. Our efforts began with a #DSMA Twitter Chat with the diabetes online community. Questions for the group focused around how diabetes education could bring them joy (read our blog to learn about this discussion). From this information we developed a survey to dive deeper and learn more. One finding from the survey was that most people with diabetes are not familiar with the concept of co-design, which told us that it’s not happening much in the healthcare space where diabetes is being managed. We’d like to change this practice and share with others how its done!  Our next step is to hold a focus group. Each step along the way, we are learning new things.

    We’ll be excited to share out focus group outcomes and learnings later this year. Stay tuned!

    As e-patient Dave said, we want to “let patients help” us move diabetes education services forward in partnership with the real experts, those living with diabetes 24/7/365.

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  • Fresh Views

    Traveling with diabetes: Focus on diabetes management successes to feel your best and enjoy the trip

    April 10, 2019

    Coastal view in Makaiwa Bay, Kamuela, Hawaii

    Traveling is an important part of our lives @A Fresh POV for you and we live for new experiences, opportunities to learn something new, and, of course, that ever spectacular fresh view!  It’s the time of year when many are on spring break, heading out for spring break, or have just returned from spring break. In fact, Deb just returned from spring break on the Big Island of Hawaii while Tami had a “stay-cation” this year. And so we thought it might be interesting and good timing to ask others living with diabetes how they incorporate travel successfully into life with diabetes.

    As you read on, you will hear from two amazing women living well with type 1 diabetes for over 55 years between them! They are both diabetes advocates and volunteer for the diabetes community. Diane Bajalia is a PODS leader in Jacksonville, FL for Diabetes Sisters (for which Deb serves on the board of directors) and Fran Damian is a volunteer nurse on the medical team for Diabetes Training Camp. Both find inspiration in their volunteer commitments, but also like to take a break and do a little traveling. They shared some tried and true tips for travelling with diabetes with success.

    What works well for you when you travel to stay on track with diabetes management?

    Diane:

    I suppose the first words of wisdom for traveling with diabetes would be to expect the unexpected and try to be as prepared as possible.  When I fly, my carry-on consists of extra CGM supplies, pump supplies, insulin pens, and a full bottle of glucose tablets, as well as protein bars and nuts. Of course, my Kindle, a toothbrush and some makeup are in there, somewhere, as well.  I also put a few glucose tablets in my pockets when I travel. This allows for quick access to treat a low blood sugar while either dashing through an airport terminal dragging a heavy carry-on bag or sitting in an airplane middle seat.

    I love traveling because it is a change of scenery that involves family, friends and fun new experiences! However, what I don’t change is my relationship with my diabetes and my CGM. I have found that I feel better and enjoy my travels more if I remain engaged with my diabetes. There are so many variables that come into play when traveling with diabetes. Many of them, such as flight delays, restaurant meals, and even airport security issues, are out of my control. However, I can be as prepared as possible and continue to use my CGM to “Sugar Surf” my way through a vacation. I can continue to walk or workout everyday. And I can splurge with foods and drinks and enjoy myself.

    Fran:

    If traveling by plane, I bring low carb snacks on the plane and carry all my diabetes supplies with me. I don’t check them. I wear a pump so I bring a backup of syringes and long acting insulin in case of pump failure.

    What do you try to do more of because you know it works for you?

    Diane:

    I know, for me, that it is easier to manage my blood sugars with smaller quantities of food at each meal. When I travel, I eat foods that I don’t usually eat so mini portions with mini boluses work best. I know that I have a better chance of an “in range” post prandial blood sugar by starting to eat at 80 and using sugar surfing techniques such as smaller frequent boluses or injections.  

    I also walk or go to a gym as much as possible. The residual effects of this are twofold: I feel great and I know that my blood sugars are going to have an extra boost to stay in range that day.

    Fran:  

    Exercise – walk! Find a gym – hotels usually have fitness centers. If traveling for work, I always make time for the gym. My vacations are usually exercise oriented. I don’t ever think being on vacation means I can take a break from exercise.

    Do you have any tips you can share with us?  

    Diane:

    • Easy access to low blood sugar treatment at all times. I leave tablets in my wallet, in my pockets and by my hotel nightstand.
    • Stay calm with airport security … even if it is time consuming, humiliating and frustrating.
    • Walk as much as possible during the vacation.
    • Try new foods and drinks … while keeping an eye on the blood sugar levels.
    • Splurging in moderation is the key for me.

    Fran:  

    I’m fortunate my friends all know I have T1d [type 1 diabetes] and respect my need to take care of it. If they don’t understand, they usually are interested in learning. I think it’s important for travel partners to know enough to help if needed, and also to understand there aren’t many foods ” I can’t have”. Enjoy foods and beverages in moderation, exercise, and check blood glucose often, especially if trying new things.  I really love having a CGM and really appreciate it when away from home.

    Do you stay with your routine or do you give yourself a pass and let go?

    Diane:

    I feel better if I stay with my routine. I think it is hard after 30 years to give myself a diabetes care pass because I physically don’t feel good when my sugars are too high or too low. It certainly happens, especially when traveling, but the less often it happens, the better I feel.  

    When I travel, I usually wear my insulin pump. It makes life with diabetes on the road a bit easier for me. However, on my most recent spring break vacation to Mexico, I took a “pass” on my insulin pump. It sat in a drawer at home and I went MDI (multiple daily injections) . Most of the vacation was going to be spent at the pool or beach and I didn’t want to deal with it. I used a combination of Fiasp, Humalog and Tresiba to combat my tacos and tequila. And it worked! DexCom Clarity gave me a “passing” grade of an average blood sugar of 116 for the week.

    Fran:  

    I like to feel well, and have energy, so I don’t push the limits too much. It’s important to consider high altitudes and time zone changes as both can affect blood sugar. Check to see how your body is responding.

    Do you find travel good for diabetes mental health and diabetes distress?

    Diane:  

    I find any type of vacation good for mental health in general. It is a break from the routines, and stresses, of daily life; it is a break from work, from laundry and cooking, and it is an opportunity to enjoy new experiences with family and friends. However, traveling is not really a break from diabetes. I have been in many situations where I have been unprepared for a low blood sugar (think top of a mountain in Spain), I have forgotten my blood glucose meter (luckily you can purchase those without a prescription), and I have forgotten a syringe to get the insulin out of the vial and into my pump (thank you to the kind Walgreens pharmacist in Milwaukee).  The exception to that is traveling to a diabetes event, a diabetes camp, or some type of workshop filled with people who also have diabetes. I have friends that live all over the US that I have met when traveling to diabetes events. Everyone understands the ins and outs of diabetes care and if you forget something, someone else has it. To me, this is the best way to reduce diabetes distress!

    Fran:

    Yes! Sometimes my diabetes management is even better when traveling. Having time to exercise, menus to choose from, and being away from stressful jobs and other pressure.

    Any suggestions for others?

    Diane:  

    Don’t let diabetes stop you from going anywhere – just be prepared! And perhaps expect a little of the unknown.

    5 Tips for Successful Travel with Diabetes from@aFreshPOVforYou

    We thank Fran and Diane for taking the time to chat with us and share their insights with you. Here are 5 travel tips that have helped clients with diabetes that we’ve worked with over the years to have successful travel:

    Tip #1: Wear a medical identification (bracelet, necklace, etc.) that says you have diabetes and notes if you take insulin. Carry a note from your doctor explaining your diabetes supplies, medicines, devices, and any allergies, along with the information for an emergency contact.

    Tip #2: Carry your medical insurance card (and travel medical coverage).

    Tip #3: Keep a closer check on blood glucose. New foods, increased activity, and different time zones can throw your blood glucose off, so check your blood glucose or CGM more frequently, especially before and after meals, alcohol consumption, or physical activity.

    Tip #4: Crossing time zones. If you take insulin and will be crossing time zones, talk with your health­care team before your trip so they can help you plan the timing of your insulin and meals. Keep in mind that westward travel means a longer day (so possibly more insulin will be needed), and eastward travel means a shorter day (so possibly less insulin will be needed).

    Tip #5: If traveling outside the US, make plans for temporary health insurance coverage if your plan is not effective outside the U.S.

    We embrace focus on strengths and things that have gone well, or “Bright Spots” as our previous blog post discussed. The next time you travel, whether it’s a short weekend or a long international flight, think back to your previous travel experiences and identify what worked well for you and times when you were successful. Start your next journey with that in mind. Try to spend more time doing things that make diabetes easier to manage, while still having fun and enjoying your experience. You might want to even consider writing down your diabetes travel successes in your gratitude journal, so you can go back and recall them the next time you travel. We’d love to see your vacation photos so we can enjoy your fresh views! Please share them with us on our Instagram page

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