• Fresh Views

    Transform Primary Care Encounters: The Power of Person-First, Strengths-Based Language

    March 9, 2022

    The language for solution development is different from that needed to describe a problem. Steve de Shazer, pioneer of solution-focused brief therapy

    If you are just catching up on our thoughts around transforming primary care visits by incorporating solution-focused (SF) tools and techniques, check out our last post about the benefits of using a SF approach. This week in our series we are spotlighting the power of words – meaning the words that we choose in conversations and interactions with clients. As the authors of the transformative paper The Use of Language in Diabetes Care and Education (Diabetes Care 2017;40:1790–1799 | ) call out: 

    “Words are immediately shaped into meanings when people hear or read them, and those meanings can affect how a person views him or herself…Words have the power to “elevate or destroy”.”

    Person-first, strengths-based language

    We’ve written extensively about the power and benefit of using person-first, strengths-based language in diabetes care and education and how #languagematters. Research clearly shows that positive language is associated with positive health outcomes. And on the flip side, when people are faced with language that is judgemental, blames and shames, they are less likely to share openly with their healthcare team. 

    3 examples of how flipping a few words can flip the conversation:

    • Refer to one as a “person with diabetes”, rather than a “diabetic” (which labels them).
    • Refer to “check” blood glucose, rather than  “test” blood glucose” (which implies good/bad or pass/fail)  
    • Describe the scenario such as, “You take your medicine about half the time.”, rather than labeling one “noncompliant” (which shames)

    A SF approach is not possible unless there is open communication facilitated by strengths-based language. 

    Why does language matter in primary care?

    Again, language is powerful. We’ve discussed that the relationship between the healthcare provider (HCP) and the client is different. Instead of a hierarchical position, in SF relationships, the HCP and the client are considered “think partners”. They work together to identify solutions to move that individual forward towards achieving their goals. Thus, the language must follow to build the relationship.

    Importantly, the goal for those with type 2 diabetes (T2D) is to feel they are part of a partnership in their diabetes management with their HCP, where they can discuss their challenges and their strengths and work together. Is it possible to create and strengthen this relationship when words such as non-compliant, cheating, not working hard enough, or other shaming and blaming words are used? 

    When we use words that focus on what people “can do”, and words that describe their actions, we recognize and acknowledge that diabetes is managed by the person living with it and we acknowledge that it’s one piece of their life and not their whole life. When a person living with diabetes engages with their primary care team as a partner, much can be accomplished. As we’ve noted before, you are able to “flip” the conversation from a negative to a positive and foster that “think partner” relationship.

    Imagine a situation where an individual living with T2D looks forward to their primary care appointments because they are going to share with and learn from their HCP with no fear of judgment. They’ll talk about their struggles and challenges in a truthful manner and together they’ll identify areas that are working and small steps that can be taken to lead towards success.

    The most important lesson you can take away from this discussion is that using strengths-based language is actually easy to do. As our friend and colleague Jane K. Dickinson says, “when you put the person first (not the diabetes), the language will follow.” 

    Our goal is that people living with T2D will develop a positive relationship with their primary care team, and all involved will understand the challenges, the opportunities, and the need for an empowering approach towards diabetes care and education. And we believe that a change in language can lead that.

    If you’re not sure how to begin, consider starting your next encounter with one of these questions:

    1. Thanks for coming in today. What’s been going well for you in your diabetes management?
    2. It’s so nice to see you today, managing diabetes is really hard work – it’s like a part-time job. Tell me what  you’ve been happy/pleased with  about your diabetes management since we last met?
    3. We all need support in some manner. Diabetes is a team effort. How can I support you and support the changes you want to make? I’m here for you.

    We hope you’ve been learning little nuggets with each blog post as you build your solution-focused tool box for managing T2D in primary care. Keep reading our series on incorporating a solution-focused approach when managing T2D in the primary care setting. Our goal is to start slow and share small, achievable, bite-size practice changes you can implement over time. 

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

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

    Follow us on Twitter and Instagram @AFreshPOVforYou

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

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

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  • Fresh Views

    Telehealth: A solution-focused practice

    August 25, 2021
    Lorena Drago, MS, RDN, CDN, CDCES

    As telehealth continues to be a key aspect of healthcare, we reached out to our friend and fellow diabetes care and education specialist Lorena Drago MS, RDN, CDN, CDCES, owner of Hispanic Foodways LLC, to share her experience and solution-focused approach to engaging in successful telehealth visits.

    Here is what Lorena shared with us….

    Many health professionals have now adopted telehealth visits as part of diabetes care and education. I must admit that it has been a bumpy ride for health care providers and patients. Many of us have experienced technical issues. We are familiar with the “Can you hear me now?” plight as we connect to audio or have fallen victim to nostril intimacy when the patient moves the camera too close to the face. Let’s not mention those patients who believe pants are optional.

    Overall, there are many advantages to telehealth, such as convenience, saving time, and saving money on travel. Despite working out some kinks, there are still some challenges, such as lack of internet, poor connectivity, and low digital health literacy.

    After a year and a half of telehealth visits, I would like to share my solution-focused practice approach to optimizing virtual visits.

    BEFORE THE VISIT: PREPARATION IS KEY

    FOR THE PATIENT

    Create a checklist and review with patient prior to the appointment.

    • Does the patient have access to a computer, laptop, tablet, or phone?
    • Does the patient have internet access? 
    • Have they downloaded the application they will use for the telehealth appointment? Do they need help? Do they know how to use it?
    • Do they have a quiet designated space for the telehealth appointment?
    • Has the patient completed labs, if required?
    • Does the patient have his/her anthropometric measurements?
    • Does the patient have his/her blood glucose results available?
      • Is the patient able to upload his/her results into the hospital/clinic portal?
      • Is the patient’s meter, CGM, smart insulin pens, and pump connected to a platform where the health care team can access the information?
    • Have they completed the required patient forms prior to the appointment? 
    • Do they have insurance information?
    • If it is a nutrition appointment, do they have foods and labels they would like to discuss?

    A patient navigator or administrative staff can compile this information and help prepare the patient for the visit. For patients who experience some of the aforementioned challenges, a telephone visit may be preferable.

    FOR THE DIABETES CARE AND EDUCATION SPECIALIST

    Prepare the agenda for the visit.

    What does the patient want to know? I ask the patient:

    • What are 1-2 questions you would like answered before the end of this appointment?
    • What would you like to learn today?
    • What is going well with your diabetes management?

    Build on what the patient already knows.

    If you can share the screen, show the patient a list of foods. Ask, “which of these foods raise your blood glucose the most? If you are not sure, just tell me you are not sure.” After the individual selects the foods, I know what the knowledge gaps are, and I shift the education to bridging the gaps in knowledge.  For example, I provide a handout with pictures of whole wheat bread, skim milk, whole milk, fish, carrots, nuts. If the patient says that whole milk raises blood sugar and skim milk does not, then I focus on discussing the difference between carbohydrates and fat.

    Focus on the wins.

    When you discuss glucose management, it is common to focus on out-of-range results. After all, it is paramount to identify and manage hypoglycemic events. However, there is an inherent fear that the healthcare provider will admonish the patient for poor results. To avoid this, I ask:

    What do you think happened?

    This question invites exploration and reflection. Allow the patient to pause and reflect. Usually, patients will say, “I forgot to eat, or I did not eat enough carbohydrates.” Ask,

    What have you done in the past that has worked for you to remind you to do something?

    This question will allow the patient to recall past effective strategies and positive outcomes.  If the patient doesn’t come up with any answers, then offer suggestions that have worked for other patients.

    Make sure to use teach-back. Ask: 

    Can you tell me or show me in your own words.  Can you summarize the key points of today’s visit?

    Goal setting

    Establishing goals is often tricky for some patients. I usually create a list of goals and ask the patient to select an easy win. This way, it is easy to achieve, and the patient will be more likely to move forward. For those patients who are goal driven, formulate more complex goals and adapt to the patient.

    AFTER THE VISIT: DATA REVIEW IS REIMBURSABLE

    CPT Code & Service Provided

    • 95249: Patient equipment, CGM placement, hook-up, calibration, training, sensor removal, and printout recording.
    • Service performed by: MD, NP, PA, RN, PharmD, RDN, CDCES
    • Reimbursement: Medicare: ~$55, Commercial ~$127

    95251: CGM data interpretation

    • Service performed by: MD, NP, PA
    • Reimbursement: Medicare ~$40, Commercial: ~$100

    99457, 99091: Remote patient monitoring; collection and interpretation of physiologic data

    • Service performed by: MD or other qualified health professional
    • Reimbursement: Medicare: ~$50-$60

    Lorena created the Diabetes Teaching Tools for your Virtual Practice to help diabetes educators:

    • Reduce consultation time
    • In less than 3 minutes, identify what the client doesn’t know so you can focus on what the client needs to know.
    • Engage the client in the learning process using “real-life examples.”

    The diabetes teaching tool kit includes:

    • 13 topics presented in a simplified-visually rich style
    • 8 interactive activities with real-life examples to help patients use newly acquired information
    • Tried and true carbohydrate knowledge assessment tool so you know what your patients know and don’t know about foods with carbohydrate
    • Download and share with your patients: https://rd2rd.com/downloads/diabetes-teaching-tools-for-your-virtual-practice/ 

    We thank Lorena for the multitude of solution-focused practice pearls she shared with us and our readers in this week’s blog!

    Stop back by in 2 weeks to see what we write about as we continue to share about a variety of other technologies that impact and influence diabetes care and education!

    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.

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  • Fresh Views

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

    October 14, 2020
    The horn sounds as the ferry leaves the port in Edmonds, Washington

    “Listening is often the only thing needed to help someone.” ~ Unknown

    Listening is a crucial skill to hone in all areas of life and things we do, both personally and professionally.

    TODAY’S WORD IS LISTENING

    In solution-focused practice, listening is a critical component of the therapeutic relationship, and the ability to be a “think partner” to the client alongside you. Listening for what’s important to him/her, what areas they’re having success in that you can build upon, and listening for challenges and concerns they may have. With limited time to spend with a client and guidelines or recommendations deemed important to deliver, it can be easy to forget the human aspect, that the client before you is a person too (read our previous blog post about Being Human here). They may be stressed, overwhelmed, angry, grieving, etc. and looking for support and someone to help them find solutions, rather than receive a list of marching orders. 

    A real world example

    Along those lines, an acquaintance of Tami’s recounted a recent interaction at a cardiologist’s office. This acquaintance who we’ll call Carol had developed heart arrhythmia and was sent by her primary care provider to a cardiologist to be placed on a holter monitor for a month to determine exactly what was going on. Carol arrived at one of the large health system campuses having no idea that it would take her 45 minutes of walking to get from her car to the actual office in the hospital complex (coming in contact with more people that she’d come in contact with since the pandemic began!). She finally arrived at her destination, anxious, stressed, and short of breath, to be whisked in a room, connected to and handed the holter monitor, verbally given numerous instructions, and sent back out the door. She shared with Tami that she felt totally overwhelmed when she left, she wasn’t sure exactly what to do, and was extremely frustrated and scared. It seemed that she was “just another number to get in and out of the office”. That human touch had somehow been lost. She felt as if she was just a “problem” to be “fixed.”There was no listening to her concerns or real opportunity for questions. That said, granted, there are many positive healthcare interactions where listening IS a core part of the interaction, however, this scenario struck us as a timely reminder that in many it is NOT.

    Listening can transform interactions

    Over the last couple of years we’ve shared a variety of tips, techniques, and approaches to embrace and employ a solution-focused approach to practice (rather than one focused on “fixing problems.”) Some solution-focused techniques may seem simple…such as encouraging more listening. That seems simple. However there is a strategy in place. When listening from a solution-focused perspective, you listen in the present state while trying to co-create conversations to help your client visualize their ideal future state, and move in that direction. It means looking for cues and clues to identify strengths. Practitioners call solution-focused discussions the “language of change.” When acting as the “think partner”, the practitioner listens for the clients words and meanings that are focused on change. Once identified, the clients own words are then used to move towards generating solution-focused change. Every answer requires continued listening and is another opportunity to identify a potential move towards solutions. It is simply not possible to implement a solution-focused practice without heightened listening skills.

    EACH WEEK WE INVITE READERS TO PARTICIPATE IN A SOLUTION-FOCUSED CHALLENGE… This week, we encourage you to actively focus on listening before speaking with clients. Your conversations will be different than focusing on diagnosing and treating problems. 

    1. Ensure each meeting with a client is focused on their concerns and what is important to them.
    2. Listen for clues and cues that highlight exceptions, current resources and strengths the client identifies. Maybe open the conversation with a simple question, such as, “What’s been going on in your world?” It’s broad, enables the client to take the conversation where they wish, and can provide insight into other aspects and impacts in their life.
    3. As the conversation evolves, use the clients own language to help the client envision their preferred future

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

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

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is an employee of Dexcom but all comments are her own.

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  • Fresh Views

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

    September 30, 2020

    “Fight for the things that you care about. But do it in a way that will lead others to join you.” – Ruth Bader Ginsburg

    • The Highlands of Scotland on a September day from our travels 3 years ago

    It’s official – summer has come to a close! (At least in our parts of the world). We welcome autumn and the change of seasons it brings. We find that this time of year is a time for reflection for us. A time we often reflect back over the year and look ahead to what the remainder of the year will bring. How about for you?  On the note of fall and reflection, we’re sharing a favorite pic from Scotland in September a few years back with a beautiful reflection of the Highlands in one of the lochs. It’s an image imprinted in our minds! (You can learn more about our perspective on “imprinting” happy memories here.)

    TODAY’S WORD IS COMPASSION

    One topic we think it’s particularly  important to reflect on is COMPASSION. Compassion as a healthcare professional with your clients. Compassion towards others you encounter. Compassion towards yourself. With the recent passing of Supreme Court Justice Ruth Bader Ginsburg, we’re reminded of the impact of compassion. She was someone who had a strong sense of compassion while working to serve the people, a champion for equal rights in all areas of life.

    On a scale of 1-5, how would you rate your level of compassion towards your clients? To others you encounter? To yourself?

    BENEFITS OF COMPASSION

    Evidence suggests that there are actually physical benefits to practicing compassion. People who practice compassion produce less of the “stress hormone” cortisol, experience greater happiness (and thus impart happiness to those around them), and even appear to produce more of a hormone that counteracts the aging process. Good stuff all the way around! 

    The key to developing compassion in your life is to make it a daily practice.

    Compassion can be expressed in many ways; in small acts of kindness, when working with teams at work by respecting everyone’s opinion, and by supporting people with diabetes in their choices.

    4 COMPASSION PRACTICES FOR HEALTHCARE PROFESSIONALS 

    Reflect on recent interactions you have had with your clients with diabetes, and your level of compassion. Compassion in attitude, language, and interactions are core in solution-focused practice. It’s easy to become so focused on delivering pertinent recommendations, in constrained amounts of time, that compassion may unintentionally fall to the way-side.

    In evolving to solution-focused practice, here are 4 different compassion practices that you can perhaps incorporate in interactions with clients:

    1 – Greet each morning with a compassion frame of mind. Take a couple of minutes each morning to focus your mindset on being compassionate. Keep a note where you’ll see it  with affirmations to practice, such as, “Today I am alive. I am going to make the most of it and not waste it. I am going to have kind thoughts towards others. I am not going to get frustrated or think badly about others. I am going to be compassionate to others as much as I can.” 

    2 – Practice empathy. Many believe they have empathy, and on some level nearly all of us do. But many times we get so side-tracked in the client encounter that we may let our sense of empathy slide. In client interactions, try to imagine the challenges, stress or pain they are going through, in as much detail as possible. This moment of mindfulness can help change perspective in attitude, language, and the overall interaction.

    3- Recognize what you have in common. Try to identify something that you may have in common or have experienced when the client is in front of you. At the root of it all, we are all human beings. We need recognition for hard work done. We need caring. We need happiness.

    4- Practice acts of kindness. Practice doing something small each day to make life happier for someone else, even in a tiny way. Imagine that you are the person in front of you, dealing with diabetes challenges on top of routine life stuff. Maybe the act of kindness is a simple smile, a kind word, or just spending a few minutes talking about life (outside of diabetes) with the other person. Find a way to make it a daily throughout-the-day practice.

    Another “reflection” from the Highlands of Scotland on a September day 3 years ago

    PRACTICE MAKES PERFECT

    These compassion practices we’ve shared can be done most anytime, anywhere. Greeting each morning with a compassion frame of mind, can help set the stage for interactions during the day.

    EACH WEEK WE INVITE READERS TO PARTICIPATE IN A SOLUTION-FOCUSED CHALLENGE… This week, we encourage you, at the end of each day, consider taking a few minutes to reflect on your day. Maybe it’s during a commute home, while taking a walk, while fixing dinner, or while getting ready for bed. Think about the people you met and talked to, and how you treated each other. Think about the intent that you started the morning with. How well did you do? What could you do better? What did you learn from your experiences today? 

    Try acting with compassion until you are good at it. With practice, compassion can become an integral part of interactions that you can do throughout the day, throughout life.

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

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

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is an employee of Dexcom but all comments are her own.

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  • Fresh Views

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

    August 5, 2020
    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.

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  • Fresh Views

    A Fresh POV for You in 2020: Our Renewed Focus

    January 22, 2020
    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. 


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  • Fresh Views

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

    September 18, 2019

    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.

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  • Fresh Views

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

    August 14, 2019
    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.

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  • Fresh Views

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

    April 10, 2019

    Coastal view in Makaiwa Bay, Kamuela, Hawaii

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

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

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

    Diane:

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

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

    Fran:

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

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

    Diane:

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

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

    Fran:  

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

    Do you have any tips you can share with us?  

    Diane:

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

    Fran:  

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

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

    Diane:

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

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

    Fran:  

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

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

    Diane:  

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

    Fran:

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

    Any suggestions for others?

    Diane:  

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

    5 Tips for Successful Travel with Diabetes from@aFreshPOVforYou

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

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

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

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

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

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

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

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

    Follow us on Twitter and Instagram @AFreshPOVforYou.

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  • Fresh Views

    Diabetes Bright Spots & Landmines: Insights from author Adam Brown

    April 3, 2019

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

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

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

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

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

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

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

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

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

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

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

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

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

    Q3: How can people get Bright Spots & Landmines?

    Adam:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Here are some questions to help Find Diabetes Bright Spots:

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

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

    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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