• Fresh Views

    Diabetes Technology and Solution-Focused Practice: Applied to Activity Tracker Conversations

    Tami walked the length of the Sahara Desert!

    Just keep taking the next step and keep having excellence in the ordinary. – Dave Ramsey

    In this week’s Diabetes Technology and Solution-Focused Practice post we’re discussing taking a solution-focused approach to activity tracker and physical activity conversations. We are both huge advocates of activity trackers, and have used several different versions ourselves over the years. Currently, Deb relies on her Apple Watch, while Tami likes her Fitbit (although it’s on it’s last leg…so something new will be coming soon!)  Recent estimates are that about 1 in 5 Americans use a smartwatch or fitness tracker. Whether a smart watch, wrist band, clip on pedometer, smartphone app, or other variety, activity trackers can give extra incentive to get active. They also provide a wealth of statistics on workouts and general health to have the data needed to achieve fitness goals. Many track not only steps and movement, but distance, activity intensity, calories burned, mindfulness, sleep, heart rate, and more. There are even fitness trackers for children with a variety of fun functions beyond tracking activity.

    A Facebook memory popped up the day we were posting the blog – Tami and Deb walking 10,000 steps along the Chicago lakefront with their husbands!

    Focus on “exceptions”, rather than gaps

    When reviewing physical activity frequency, duration, step counts etc with clients, there is  opportunity to implement a solution-focused approach (rather than focusing on “gaps” in activity). For example, when reviewing fitness tracker logs such as the one below, where this individual’s goal was to get 10,000 steps each day – rather than focusing on 3/10, 3/11, and 3/12 where step counts were far below their goal, turn instead to focus on 3/7 where they achieved 7016 steps, and 3/13 where they got 8681 steps. If we focus on the days where activity was low, we miss out on identifying successes

    4 questions we could ask when acknowledging those “successful” days are:

    1. How did you work that many steps into your day? 
    2. What were you doing differently than on 3/10-3/12, for instance?
    3. How can you do that more often? 
    4. What are some other ways you can be more active?   

    A case example from Tami…

    Years back, I worked with a client that was a dentist, and as such was fairly sedentary most of the day. When I began seeing her, she had recently learned that she had type 2 diabetes and was trying to increase her activity, in addition to managing her weight and blood glucose. Over the course of several visits we talked about the huge benefits of physical activity and the value of activity trackers in raising awareness around physical activity. While initially resistant to “exercising”, she eventually agreed to purchase a wrist band activity tracker with an initial goal of wearing it for 2 weeks to learn what her average movement and step count was during the day. She learned that she averaged 1200-1500 steps/day. She found that information enlightening, and immediately started considering how she could be more intentional to increase her movement. When she returned a month later for her follow-up visit with me, she had already increased her average step count to 5000-6000 steps each day. Wow! 

    I acknowledged her mindfulness, intentionality, time, and hard work. In applying the 4 questions above with her, I learned that to increase her activity, she was getting up between appointments and walking around the office. Then, she decided that at home in the evenings while watching TV and knitting, she would get up and walk around the house during commercials. From there, she went on to take-up swimming laps, then added doing a circuit work out at a local gym. She built upon her successes and leveraged those. 

    She was one of those special people you never forget. She had a fantastic sense of humor! She  enjoyed traveling and I frequently would have photos show up in my email of her swimming in a pool on a cruise, swimming in the lake at her lake house, or getting a “hydro massage” after working out at her local gym.  Applying a solution-focused approach to activity and activity tracker conversations assisted her in self-discovery and leveraging her successes in moving more for even greater successes.

    While activity tracking apps can help motivate individuals to make health behavior changes, just like anything else, if we focus on the negatives, success will be more difficult to achieve. When working with clients, help them set realistic goals to achieve to set them up for success, then build upon their achievements in a slow and steady process.

    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.

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

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Applied to Mobile Apps

    “You`re only as weak as you let yourself become, and you`re only as strong as you allow yourself to be.”

    Daniel Hansen

    Beautiful bougainvillea, Palm Desert, CA

    In this week’s installment of Diabetes Technology and Solution-Focused Practice we’re discussing mobile apps. In our last blog we focused on using a solution-focused approach to interpreting and discussing continuous glucose monitor (CGM) data. This week’s blog we’ll focus on a new discovery for us – the WW mobile app. We will share insights on other apps in future blogs. We believe that using solution-focused language within mobile applications can improve user engagement with the app, as well as encourage individuals to make progress towards their health behavior goals.

    WW App: Deb’s experience…

    As you may know, Weight Watchers is now known as WW. I have been using their app, the WW app, to help  stay on track during the COVID-19 lockdown. You can learn about the different WW programs and pricing here. There are several options to choose from, I only use the app for logging and motivation.  I was encouraged to continue using the app because of the nature of the messaging. Then I began to wonder if they were incorporating a solution-focused approach? 

    From a weekly in-App push a few weeks ago, the headline was “Why you should do what works: You might already have more tools in your toolbox than you think.” If that doesn’t sound like solution-focused messaging, I’m not sure what does! The post reminds us that people typically focus on what isn’t working well and how to deal with challenges. Of course, that is not motivating, and not helpful when trying to make hard health behavior changes.

    But, what if you “Flip the switch” so to speak? (See our many blog posts from 2019 about “Flipping the paradigm” –  here’s one on healthy eating, and here’s one on healthy coping). The WW message goes on to encourage focusing on the things that come naturally and leverage strengths or what’s worked in the past! Wow! We’ve written about strengths in this blog multiple times (you can read about strengths here), and so believe in focusing on what one does well,  building confidence, and increasing happiness by doing so. 

    Make Strengths your Secret Weapon. According to WW, leveraging your strengths will help you be successful. They suggest asking 3 questions to uncover strengths:

    1. When do I feel like my best self?
    2. What makes me unique?
    3. What comes most naturally to me?

    Those are questions that diabetes care and education specialists (DCES) can easily incorporate into diabetes-related conversations with clients as well. Once those questions are answered, WW suggests creating an “affirmation” to help remember to focus on personal strengths. You can read their post here. One exercise that helps people think through writing their own affirmation includes showing a word cloud to help direct thinking about potential ideas of strengths (including humor, cleverness, bravery, creative etc.). What a powerful visual tool, that would be so easy to employ in any diabetes care and education program! Finally they suggest saying the affirmation out loud every morning or posting on your computer so it will be visible every day. For instance, “I am strong.” “I am resilient.” You get the idea

    I loved this way of thinking about making healthy choices, and reading and engaging with the content. I created my own affirmation and have it posted on my computer with a sticky note so I  glance at it multiple times during the day! Tami has affirmations on her desk and in the kitchen that she sees when making coffee in the morning to start the day off.

    Helping clients create their own affirmation using solution-focused principles is a great opportunity to highlight what is working well already and focusing on their strengths, as well as supporting the development of resilience. 

    Do you recommend mobile apps to your clients? 

    If you have a client interested in weight loss or adopting healthy eating habits, the WW mobile app might be a good option. (We are not endorsed by WW and do not receive any compensation from WW). Knowing the positive strength-based language that is being used is so encouraging. Also of note, WW recently hired Adam Kauffman, formerly of Canary Health,  to head their diabetes program (read the press release here) so we’re excited to see what’s to come in the future.

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

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Applied to CGM

     “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.

  • Fresh Views

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

    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

  • Fresh Views

    Flipping the Paradigm: Applying a Solution-Focused Approach to Being Active

    Remember that any exercise is better than no exercise. – Anonymous


    Pisgah National Forest in the mountains of Western North Carolina. It was a beautiful hike to the falls!

    Welcome to week 2 of our 7-week series on applying a solution-focused approach to the AADE7 Self-Care Behaviors for managing diabetes. Last week we shared about taking a solution-focused approach to Healthy Eating – you can read it here.  Today we’re focusing on  Being Active. Being active can take many forms, from simply moving more during the day to intentional bouts of exercise. You can also find ways to incorporate fitness through activities that bring you pleasure or joy (such as our beautiful hike to the falls pictured above).  

    As a refresher, the AADE7 is a framework for organizing diabetes self-management education and support, as well as for identifying key areas for behavior change to manage diabetes. The 7 core behaviors are:

    Our series is focusing on “flipping” the conversation from a “problem focused” (traditional medical) approach to a solution-focused conversation. 

    AADE7 Self Care Behavior #2: Being Active

    “I hate to exercise” may be a familiar comment heard by many diabetes care and education specialists (DCES). (In fact, it’s the title of a great book too, The I Hate to Exercise Book for People with Diabetes) For those who are challenged to fit physical activity into their day we feel empathy and understanding because some days it’s a challenge for us too! Life happens! 

    Some people are born athletes. And physical activity may always be a priority them. If you fall into that category, you might find it hard to understand the challenges other people face with being active. If you can relate, try to take a step back, and think of something that is really challenging for you to engage in. Then try to keep that frame of reference when you’re talking about being active with your clients.

    Beyond lack of enjoyment in exercise, finding time to fit physical activity into a busy, challenging day, can also be hard. As DCES’s, solutions that we may generate and propose to others, may not always be realistic. Using solution-focused talk, together, we can help clients identify what they like, and what makes sense to them. We can also guide them in identifying things that make them happy, and find existing strengths. From there, we can help them create opportunities to be active.

    It’s important to take care to refrain from “all or nothing” thinking, described by Adam Brown in his book Bright Spots and Landmines (we interviewed Adam here). We need to help clients take small steps towards a more active lifestyle and acknowledge their success, even if it doesn’t align with our thinking of what being active means. Let’s flip the focus of the discussion and help people feel successful and recognize their strengths.

    Deb and Diana (Deb’s daughter) hiking in the Dolomite Mountain Range in Northern Italy

    Instead of focusing on what is not working well or what is “wrong”, here are 3 illustrations of how to flip the conversation:

    Try this: I know how hard it is to have a job where you sit at the computer all day. Tell me more about your office and work setting. Let’s think of some ways you can increase your movement and get you up from your chair. 

    Instead of this:  Did you know sitting is the new smoking, sitting all day is going to kill you. You need to move more.

    Try this: You mentioned you’ve been using the MapMyWalk app on your phone. How has this helped you be more active? What else can you do to be more active?

     Instead of this: You’re using the MapMyWalk app but you still not getting 10,000 steps a day.

    Try this: When you’ve been successful adding physical activity into your schedule, what did that look like? How did you do it? How can you do more of that?

    Instead of this: You’re falling short of the goal of getting 150 minutes of exercise each week..

    Focus most of the time and energy on thinking about and discussing what is already good, effective, and successful.

    During a solution-focused conversation, the DCES’s focus is on discussing and exploring what is already working, is effective, and is successful, then leveraging that to identify solutions, rather than focusing on past problems. 

    When you meet again, here are 3 follow-up questions to try:

    • How were you able to focus on solutions to try to fit fitness into your schedule?
    • What kept you on track toward achieving your activity goal? 
    • What was different about the days you were able to be more active?

    We’ll challenge you each week to try incorporating some flips into your conversations and let us know what impact they have.

    Join us next week as we discuss a solution focused-approach to Healthy Coping!

    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

  • Fresh Views

    The Miracle Question Applied to Diabetes at #AADE19

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

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

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

    Change is here!

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

    Taking a solution-focused approach to managing diabetes

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

    Tami and Deb getting ready to present at #AADE19

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

    What is the Miracle Question?

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

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

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

    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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