• Fresh Views

    ADCES 2020 goes virtual: 8 sessions you don’t want to miss!

    Tami & Deb at ADCES 2019

    With the Association of Diabetes Care and Education Specialists Annual meeting (formerly AADE) right around the corner, we’re taking a brief break from our solution-focused word of the week series to highlight some of the sessions that will be presented at the ADCES meeting on psychosocial and behavioral health and technology. They align with our thinking and approach, and we thought might be of interest to you too. 

    This typically in-person meeting is always one of our favorite times of the year! It is such a great opportunity to reconnect with friends and colleagues while being energized about the work we do in diabetes care and education. However, in light of the pandemic, this year’s meeting (like many others) has gone virtual. So it is with mixed emotions that we share this ADCES preview. While we  look forward to learning from colleagues in the comfort of our homes this year, we so wish times were different and we could share coffee or lunch together, catch up on everyone’s lives over a glass of wine, give a lot of hugs, and dance the night away at the annual Sunday night dance party. Especially for the two of us, we have not been together in person since last October. One of our hopes in collaborating on this blog together was that we’d have the opportunity to spend more in-person time together. While we engage via Zoom, it’s just not the same.

    We’re excited to share that  we had an abstract accepted to present as an oral session at the originally scheduled in-person meeting in Atlanta on “Flipping the Paradigm: Applying a Solution-Focused Approach to the AADE7 Self-Care Behaviors”! But due to the condensed nature of the virtual meeting we opted out, with the hope that we can share our full presentation next year (fingers crossed!). In the meantime, we’ve had our first research paper incorporating a solution-focused approach published! You can find it online, Applying a Solution-Focused Approach to Life With Diabetes: Insights Gleaned via Twitter. This paper resulted from our presentation at the European Association for the Study of Diabetes last fall. We report the findings of our online study where we employed the Miracle Question approach during a Twitter chat. 5 themes evolved of a desired future state: more of living life; laughter and humor; self-compassion; resilience; and support.  

    Here are 6 of the sessions of interest that you may want to check out (all times are central time zone): 

    GS02 – Mobilizing for Health Equity (Friday, Aug 14 9:00 AM, 1 hour)

    This session will provide the participant with an understanding of the history and impact of structural racism on health equity. Throughout the presentation, Dr. Blackstone will define structural racism and how it relates to the social determinants of health. The participant will leave the session with key strategies to make individual steps toward interacting with equity.

    F06 – Empowering African Americans With Diabetes Through Positive Thinking (Friday, Aug 14 2:05 PM, 30 minutes)

    African Americans face many challenges associated with diabetes self-management and it is common for them to fall into negative thinking patterns. Researchers suggest that positive thinking can lead to improved diabetes management and empowerment to foster independence, self-management and the ability to question and make informed choices. This presentation offers 6 positive thinking strategies that can be utilized to assist in empowering the African American participant.

    F05 – Integrating Diabetes Technology Into the Clinical Paradigm (Friday, Aug 14 1:00 PM,  (1 hour)

    New and emerging technologies can help people with diabetes optimize glucose levels, reduce diabetes burden, achieve improved quality of life, and reduce the risk of acute and chronic complications. Diabetes care and education specialists and clinical practices are struggling to keep up with the pace of technological change. While essential, expertise in diabetes technology is not enough. There must also be processes in place to streamline paperwork and documentation, optimize clinical flow, educate staff and providers, and obtain reimbursement. This session will provide an overview of how diabetes technology can be effectively integrated into the clinical paradigm and discuss the role of the diabetes care and education specialist as the clinic’s technology expert and champion.

    F12 – COVID-19 Update: Protecting Adults with Diabetes (Friday, Aug 14 3:45 PM, 30 minutes)

    A significant portion of the U.S. population is vulnerable to severe complications, including death, from COVID-19. In addition, social disruptions secondary to the pandemic response are creating new vulnerabilities in the provision of chronic disease care and self-management for non-pandemic illnesses. This presentation will expand foundational knowledge of the impact of COVID-19 on people with diabetes and provide strategies through education and technology to protect adults with diabetes from COVID-19 while reducing gaps in diabetes care and self-management.

    S06 – Diabetes Psychology and Diabetes Services: Similarities and Differences (Saturday, Aug 15 10:40 AM, 30 minutes)

    This presentation will explain how diabetes psychology is used to help people implement new behaviors, navigate social stressors and manage the feelings of anxiety, depression and stress that often accompany diabetes. A discussion of similarities and differences between diabetes psychology and diabetes services will be provided. A model for integrating diabetes psychology with diabetes services will be described with examples of implementation at the San Diego VA hospital.

    D09 – Using Mindfulness in Veterans to Lower Diabetes Distress (Sunday, Aug 16 12:05 PM, 30 minutes)

    Mindfulness benefits veterans with depression and PTSD, but little is known about the impact of mindfulness in those with diabetes. This presentation will share our experiences and participant perspectives of a mindfulness-based diabetes education intervention that utilizes a digital application to support daily mindfulness in everyday life. Additionally, we will examine associations between mindfulness, diabetes distress (DD), stress-related symptoms, and glycemic management (A1C) and show how incorporating a mindfulness intervention into DSMES can target both DD and A1C in at-risk populations.

    Also, check out Deb’s 2 research presentations, one oral and one poster:

    F03C – 12-Month Outcomes for a Behaviorally-Enriched Diabetes Prevention Program for State Employee Commercial Drivers

    Not all participants achieve DPP outcomes. Identifying opportunities to augment, enrich and enhance the traditional program are needed to meet individual needs.  This session will present data from a 12-month observational study that evaluated the effectiveness of an innovative, behaviorally enriched  Diabetes Prevention Program (DPP), on program outcomes of attendance, weight loss and physical activity.  This innovative, coach-led, behaviorally-enriched DPP was designed specifically to engage and motivate a “hard to reach”, mobile population at risk for developing type 2 diabetes using a behavior and social assessment and decision support tool set to facilitate a practical behavior change model (Information, Motivation, Skills) integrated into routine team care delivery and clinical software applications. Note: Sarah Downs and Alyssa Griswold contributed as co-authors on this submission.

    P409 – Diabetes Education Through Peer Support for Hispanic Spanish Speaking People with Type 2 Diabetes

    Diabetes is twice as likely to affect Hispanic people than their Caucasian counterparts. Our previous community-based participatory research demonstrated that technology in addition to social support is necessary to effect diabetes-related behaviour change in Hispanic individuals with type 2 diabetes (T2DM). In this feasibility study, we address gaps in diabetes care for Hispanic people with T2DM by combining technology with an online peer support intervention. The inclusion of Hispanic, Spanish-speaking peer facilitators with diabetes lived experience will enable culturally appropriate discussion, advice and strategies to enhance the use of CGM and improve diabetes outcomes in participants. This poster presentation will describe the study background, methodology and intervention protocol.

    Also, please consider attending the Dexcom Educational Theater on Thursday, August 13, 2020 at 2:45 pm CT, Lighting the Fire: Bringing DSMES to Life with CGM with Dr. Bill Polonsky and Dr. Diana Isaacs. During this session, Dr. Diana Isaacs incorporates solution-focused principles when discussing CGM data with her clients.* This program is open to anyone whether attending the conference or not. You can register here.

    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

    *Note: Deb is employed by Dexcom but anything posted on this blog is her personal opinion.

  • Fresh Views

    A Fresh POV for You in 2020: Our Renewed Focus

    A beautiful sunrise to start a fresh day!

    A new year, new decade, and renewed focus for us here @AFreshPOVforYou! This blog is over a year old now, and while our overarching focus remains the same, our Mission has evolved over time.

    Our overarching goal

    Our broad goal at A Fresh POV for You is to focus on Possibilities, Opportunities and creating a Vision (POV) for the future, based on strengths and leveraging positive learnings from past experiences. Initially the primary focus of this blog was people living with or at risk for diabetes. However, we realized that we also want to share our learnings and how-to’s with other diabetes care and education specialists in order to begin to flip the paradigm to embrace a solution-focused approach in practice. 

    Our new Mission

    We guide healthcare professionals in taking a solution-focused approach to practice to enable clients with diabetes to embrace possibilities, opportunities, and a fresh vision for the future.

    Who are we? 

    We are solution-focused diabetes care and education specialists . We are passionate about doing diabetes care and education differently. Too much of life is spent focusing on problems. Forget the “problems”! Let’s turn attention instead to possibilities, opportunities, and a fresh vision for the future. As diabetes care and education specialists, let’s step alongside our clients as “think partners” to focus on what’s important to them, what’s already going well, and build upon that to reach their goals so that they may live life to the fullest. 

    We have both spent our entire careers partnering with people with diabetes to leave a positive imprint. In our discussions and research with people with diabetes, we’ve heard loud and clear that many are not happy with the diabetes care and education services they have received. A remark that has frequently bubbled up is related to leaving a healthcare appointment feeling badly because of significant negative talk and attitudes – feeling as if they, the person with diabetes, has done something wrong, and thus are not motivated or inspired to do things differently. We are advocates for person-centered, strengths-based language, and believe that self-compassion is essential when living with a chronic condition. 

    A peek at our research findings

    From our research we’ve learned that incorporating a solution-focused approach into our interactions with clients makes a difference. Five themes emerged from our qualitative study regarding what  “would happen” in a desired future state, including: more living life; laughter and humor; self-compassion; resilience; and support.Together, let’s do more of what works, and focus less on what’s wrong.  

    Top 10 things we accomplished in 2019

    1. Conducted a survey around the perceptions and impact of current diabetes education services. (You can learn more in this post)
    2. Hosted 2 #DSMA Twitter Chats around taking a solution-focused approach to life with diabetes. (Read more about them here and here)
    3. Conducted a qualitative research study via Twitter around the impact of implementing a solution-focused tool, the  Miracle Question, with people living with diabetes.
    4. Conducted in-depth focus groups with people living with diabetes to gain insight around wants and needs to co-design the future of diabetes care and education services. (Read more about co-design here)
    5. Presented at the American Association of Diabetes Educators annual meeting  on implementation of the solution-focused tool, the Miracle Question adapted for diabetes. (Read about that here)
    6. Presented at the 55th Annual Meeting of the European Association for the Study of Diabetes (EASD) on our Twitter Chat research. (Read our abstract here and our blog posts here and here)
    7. In follow-up to the EASD presentation, had our work published in the European Medical Journal focused on diabetes. (Find it here)
    8. Submitted a paper on taking a solution-focused approach to diabetes care and education accepted for publication in AADE in Practice journal.
    9. Submitted a paper sharing some of our research findings to The Diabetes Educator journal. 
    10. Outlined the content for a solution-focused handbook (more to come in the next year!)

    Top learning from 2019

    A solution-focused approach to diabetes care and education resonates with people with diabetes and diabetes care and education specialists!

    Our fresh views

    We’ve called our weekly blog posts our “Fresh Views” because not only do we share views and practical guidance in the diabetes realm, we also often share inspiring fresh views we’ve experienced in our travels, be it a beautiful sunset, a sandy beach, or towering mountains.

    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. So, aside from being passionate diabetes care and education specialists, we are also speakers, authors, wives, moms, adventurers, and avid travelers always in search of the next fresh and magnificent view! We have lots of creative ideas and ways we hope to engage in innovative diabetes education services! 

    Follow us @AFreshPOVforYou on Twitter, Instagram, and Pinterest and learn more about our fresh views! 

    If you are a healthcare 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. 


  • Fresh Views

    Relatable Individualized Solution-focused Education: A Sneak Peek from the @AFreshPOVforYou Retreat

    Relax. Refresh. Renew. Play. Sing. Laugh. Enjoy. Forgive. Dance. Love. Hug. Share. Kiss. Create. Explore. Hope. Listen. Dare. Trust. Dream. Learn. TODAY! ― Steve Maraboli, Unapologetically You: Reflections on Life and the Human Experience


    A view of the gardens at the West Baden Springs Resort in French Lick, Indiana

    We posted this blog back in April during our Fresh POV for You retreat. There continues to be much interest in our work! Since we are traveling this week to present some of our research at the European Association for the Study for Diabetes (EASD) conference in Barcelona, Spain, we thought it timely to revisit this post with a few updates!

    In the spirit of travel, this week’s blog is a re-post from French Lick Indiana, home of Larry Bird of Celtics fame, and also the French Lick and West Baden Springs resorts. Working together, but on opposite ends of the country, (Tami in Kentucky and Deb in California) means we have to be creative finding opportunities for in-person meetings. Luckily, things came together……. a spouse work meeting in Ohio, and a visit with a son the Maurer School of Law at Indiana University, created the opportunity for our first formal @AFreshPOVforYou board meeting.

    Over the past several months we have been exploring ideas around creating innovative diabetes education programs and services that are co-designed by people living with diabetes or prediabetes. Basically that means, we are attempting to actively involve people with or at risk for diabetes in the design process to ensure the end result meets their needs.

    If you’ve been reading our blog, then you know that we love “fresh views” and spending time together enjoying beautiful scenery and experiences.  We feel energized and are more creative thinkers when we take a break, are relaxed, seeing things from a new perspective, laughing together, and often with a nice glass of wine!


    Enjoying a horse and carriage ride through the Indiana countryside

    Over the past year we’ve been planning, thinking, strategizing, writing and sharing our ideas with others in the diabetes community to make sure we are on the right track. Incorporating our practice of using solutions focused coaching, we’ve been asking ourselves, “What’s working well for us and what do we want to do more of?”  On a personal note, a few of those replies include the following:

    • Do hard work in the morning when our minds are most creative
    • Take activity breaks
    • Embrace humor
    • Incorporate things that make us happy and that we find joy in
    • Express gratitude for what we see and experience
    • Plan for future retreats to keep us on track and advancing our vision

    We’ve taken a set of possibilities and turned them into opportunities and are excited to see our vision for the future starting to become a reality! Our March 20, 2019 blog shared learnings from a Twitter chat that we co-hosted with the diabetes online community focused around what would bring joy when engaging in diabetes education services. We had some insightful and amazing feedback. We decided that we really needed to dig deeper, and find more opportunities for people living with or at risk for diabetes to guide us as we design programs and services. So following the Twitter chat we released a survey and had a fantastic response. We followed up the survey with some focus groups.

    We have learned that many are not happy with the diabetes education services they have received in the past and there’s great opportunity to innovate and evolve. We had similar responses from both the Twitter chat, survey and focus groups.  People are interested in community and learning from others living with diabetes; they want individualized education and not a “canned program”; and they want to be an equal team member whose experience and knowledge is valued and appreciated.

    For our focus groups, we employed MDR Consulting, a national business research firm to conduct and summarize the data for us so we can learn more and identify how we might design programs and services that will provide relatable, individualized, solution-focused education (and actually bring people joy)! Our goal is that the voice of the person living with diabetes will be clear and lead the way.

    As a thank you for our focus group participants, we’ve been engaging in complimentary solution-focused coaching sessions with them. These interactions have truly brought to light the value and benefits of a solution-focused coaching approach (rather than focusing on trying to “fix problems”).

    We are excited for the future and our next steps! We’ve been writing and have submitted papers to a couple of journals that we are hopeful will be published soon. We’re excited to be presenting some of our research Friday at the EASD conference. And, we’re in the planning stages to conduct a research study incorporating solution-focused coaching. Exciting times!

    Thanks for being on this journey with us. We look forward to sharing our goals and dreams with you and are eager for your feedback.

    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.

  • Fresh Views

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

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

    Doing things differently leads to something exceptional. – Anonymous

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

    The strength in a therapeutic alliance

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

    The power of language

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

    Focusing on solutions, not problems

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

    10 questions practitioners can use to build a therapeutic alliance

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

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

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

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

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

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

    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.

  • Fresh Views

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

    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

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

    Follow us on Twitter and Instagram @AFreshPOVforYou.

  • Fresh Views

    Diabetes Bright Spots & Landmines: Insights from author Adam Brown

    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.

  • Fresh Views

    Focus on Solutions (rather than on problems): 10 Solution Focused Questions

    Our daily notebook that reminds us of our priorities

    Today we’re sharing with you the cover of a notebook we both keep on our desks to capture ideas and thoughts, and also keep us grounded as to what’s important in life. This week Deb is embracing the last four …Relax more. Worry Less. Play more. Work Less. It’s Spring Break time and she is taking a break with family (and undoubtedly will  have photos of some great views to share when she returns!). Incidentally, “Play More. Work Less” was Tami’s New Year’s Solution in 2017, long before owning this journal! (see more about New Year’s Solutions in place of New Year’s resolutions here).

    If you have read a few of our blogs, you know that our approach is future-focused, goal-directed, with focus on solutions, rather than on problems. Today we want to share with you 10 solution focused questions that you may ask yourself when faced with a challenging situation. Or, use with clients if you are a healthcare practitioner.

    10 Solution Focused Questions

    1. What is different or going differently?
    2. What’s going better?
    3. Think about the positive moments surrounding the situation. Suppose those positive moments were to last longer. What difference would that make for you?
    4. Suppose the positive moments were to last longer. What conclusions could you draw from that?
    5. What do you see as a next step?
    6. In your opinion, what would be a very small step forward?
    7. How great is the chance that will work out?
    8. What might be the next sign of progress or your next step?
    9. What will you be doing differently then?
    10. Who in your life will be the first to notice that?

    The assumption of a solution focused approach is that individuals have some knowledge of what would make their life better and that everyone who seeks help already possesses at least the minimal skills necessary to create solutions.

    If you incorporate these questions or other tools we’ve shared we’d love to hear from you. If you’re a clinician, are these techniques helping you to build a therapeutic alliance with your clients? If you’re a person living with diabetes, does this approach resonate with you and your needs as you manage your diabetes?

    We look forward to sharing some new fresh views with you soon!

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  • Fresh Views

    Going off the beaten path


    From our off the beaten path adventure to  Ireland’s rugged West Coast

    Life throws challenges and every challenge comes with rainbows and lights to conquer it. –  Amit Ray

    With St. Patrick’s Day a few days away, memories of a trip we took to Ireland 4 years ago come flooding back into our minds. We and our husbands, along with two other couples, each of us from a different part of the US, convened for what became a trip of a lifetime.

    While the trip began in Dublin, the real adventure started when we got off the beaten path. When we got away from touristy spots, outside our comfort zone, and took a cross country road trip to the Western rugged coast of Ireland. The picture you see above with the rainbow was taken from the back yard as we were “imprinting” and savoring our last view at the end of the trip. This trip truly turned out to be our proverbial pot of gold at the end of the rainbow.  On this journey not only did we see magnificent castles, abbeys, history galore, sheep galore, glorious green like we’ve never seen, and breathtaking views, we laughed A LOT. We strengthened friendships, we made new lifelong friends in Ireland, but most importantly we learned that when you go off the beaten path (so to speak), good things can happen. You get a different view. You gain a different perspective. You get a different experience. (And yes these experiences are in our gratitude journals and brought us great joy! If you’ve been reading our blogs you’ll know how we embrace expressing gratitude and finding joy in life).

    The majesty of the Cliffs of Moher, County Clare, Ireland

    Reflecting and bringing these experiences back to our practices leads us to ask: What if you went off the beaten path so to speak, and rather than focusing on the things in life when managing diabetes that are NOT going the way you want, instead, focus on the things that ARE going well? In our experience, so often we see that healthcare professionals and those living with diabetes alike, fixate on things that are not as desired – whether its an out of range blood glucose, a high A1C, or frequent hypoglycemia. That can leave you burnt out, and frankly beat down. What if instead you get a whole different experience by taking the road less traveled? Focusing on what you are doing well and how you can achieve or do that more.

    This next week we challenge you (whether you live with diabetes or not) to identify at least 1 thing that’s gone well. Is it possible to repeat what you did to lead to more “positive” experiences and days?

    In closing, returning to the our Irish adventure. The four couples deeply bonded on this trip. We valued the time spent together. It  made us realize we wanted to spend more time together over similar shared experiences. So, we are in fact planning another “off the beaten path” adventure across the South of France this summer. Adventuring through life experiences worked for us. It brings us joy. So we are going to do it again. We are sure to have some new perspectives, new learnings and beautiful views to share with you!

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  • Fresh Views

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


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

    Doing things differently leads to something exceptional. – Anonymous

    Our blog last week focused on being a human first.  There was so much information in that one blog post that we decided to highlight and reinforce a few concepts today. So here we go!

    The strength in a therapeutic alliance

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

    The power of language

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

    Focusing on solutions, not problems

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

    10 questions practitioners can use to build a therapeutic alliance

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

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

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

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

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

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

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  • Fresh Views

    Being human first: Perspectives around optimizing healthcare interactions


    Tami and Deb enjoying fresh views in Chicago, finding freedom and joy in life.
    T

    Of course different people fulfill different functions in this world. It cannot be otherwise. As far as intellectual or physical abilities are concerned – knowledge, skills, talents, and energy levels – human beings differ widely. What really matters is not what function you fulfill in this world, but whether you identify with your function to such an extent that it takes you over and becomes a role that you play. When you play roles, you are unconscious.“   – Eckhart Tolle

    Deb’s been listening to an Oprah’s Book Club book on Audible, Eckhart Tolle A New Earth: Awakening to Your Life’s Purpose. While Deb has found the book deep, and a challenging “read”, she’s found that it creates an opportunity to take an introspective look at the way we engage in the world. Tolle believes everyone can find “the freedom and joy of life” if they live in the present moment.

    Deb has also been listening to Oprah’s weekly Super Soul Conversations Podcast to review each chapter of the book, typically while taking her daily walk (and it’s helping a lot to understand and internalize the concepts). During a recent podcast there was discussion between Oprah and Tolle about roles people play and how roles inhibit thinking.  In applying some of Tolle’s principles to our mission and vision here @AFreshPOVforYOU, there was an “a ha” moment for Deb around how the #languagematters movement in healthcare needs to expand to include not just the words we use, but also how we implement person first language. (check out our November blog on why language matters here)  To really put the person (not the “patient”) first, there needs to be a “person” on both sides of the interaction for true person centered care.

    One section of Oprah’s weekly podcast addressed healthcare and how when a healthcare professional “plays the role of healthcare professional”, he or she may become “unconscious” of the fact he or she is a human person while embracing their “healthcare role”. And, that the “patient” across from them is also a person. Something vital is then missing. And as a result, the person (“patient) may end up feeling disconnected and dismissed.

    The discussion brought to mind a recent #DSMA Twitter chat that @AFreshPOVforYou joined a couple of weeks ago. One question asked during the chat was: “How can healthcare practitioners facilitate more empowering or effective communication with patients or vise versa?”  One enlightened participant, the incredible behavioral and data scientist Dr. Chandra Osborn replied, “Be a human first – a practitioner second.”  

    Her reply really struck a chord, and aligns with the closing words in Tolle’s quote above, “When you play roles, you are unconscious.“ Let’s repeat that…..”When you play roles, you are unconscious”. How can there be empowering or effective communication if people are not “present” and if they are “unconscious”?

    Along those lines, We @AFreshPOVforYOU have experienced this first hand.

    Deb’s experience…

    Deb recalls a visit with her daughter to the pediatrician where they never once made eye contact. The doctor typed on the computer the whole time, asking impersonal questions and fulfilling her role. They did not feel like they were part of the conversation.

    Tami’s experience…

    Tami remembers a similar scenario while sitting alongside her mom at hospital discharge following her mom’s knee surgery. The healthcare team was talking all “around” both of them, talking to each other, asking questions, giving a multitude of instructions, rarely looking at them or expressing interest in their point of view or concerns. They did not feel like they were part of the conversation either.

    We’ve heard many similar stories from people with diabetes – how at times the relationship with their healthcare provider was not ideal. Some have stated they cancelled an appointment because they didn’t want to be scolded for an A1C value that was higher than expected. Or because their weight was up a few pounds.

    In traditional healthcare people with diabetes are expected to play the role of patient and clinicians play the role of doctor, nurse, dietitian etc.  Yet this type of engagement does not promote healthy communications and relationships. As Tolle recounts, “Authentic human interactions become impossible when you lose yourself in a role.”

    We’ve experienced being on both sides of this equation.  As diabetes educators, we are always striving to improve, but we are not perfect. We’ve made our share of mistakes, but we’ve grown and learned from them. Deb recalls one client she saw years ago that was very frustrated with her because she was following the “assigned content” for the appointment per the prescribed healthcare provider orders, and at the end of the visit the client said, “we didn’t have time for any of my questions!”  That meeting really left an impact on her, she was playing the “role” of a diabetes educator and she never made that mistake again. Fast forward to a more recent experience when she received a call from a healthcare provider who referred his patient to her.  The doctor said, “I’m not quite sure what you did, but Mr. Jones is never satisfied with anything  or anyone, but he could not stop talking about how his appointment with you was the best diabetes visit he’s ever had.”  You know what she did? She started by asking him about his family and recent vacation, and then asked what was going well with his diabetes management?  She was being a human first and he was treated like a person.

    If you follow our blog, you know that we are advocates of solution focused therapy. In the context of solution focused therapy, the client/person with diabetes is viewed as the expert and the most important element is the “therapeutic alliance” between the client and the practitioner.  The relationship is the key to being able to work together. And to build a relationship it requires being present, being conscious of one’s own behaviors, use of language, and body language which all tell a story. We believe it’s critical to enter healthcare exchanges as a human first- not playing a role – with each party recognizing their part in the conversation/interaction as valuable.

    Our goal, through incorporating principles of solutions focused therapy and coaching in diabetes care and education, is to change the conversation, the interaction and the experience of the diabetes community to improve health.  As Eckhart Tolle says, we need to “become conscious of being conscious.”  We need to work as a team, be present in all of our interactions and most of all be human.

    In closing, we leave you with a few thoughts on what you can do when you engage in a healthcare interaction.

    If you are a healthcare provider:

    1. Be human first
    2. Check your ego at the door
    3. Appreciate that the person in front of you is as an expert on their condition
    4. Listen carefully before speaking
    5. When possible, sit on the same side of the table
    6. Understand the burden associated with living with a chronic condition

    If you are a person living with a chronic condition:

    1. Be human first
    2. Actively participate in your medical appointments and your self-management to the best of your ability
    3. Work in partnership with your care team
    4. Be honest about your capabilities

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