We guide healthcare professionals in a solution-focused approach so clients can embrace possibilities, opportunities, and a fresh vision for the future.
Self-care is how you take your power back. – Lalah Delia
We recently returned from the ADCES23 conference in HOT Houston and are still processing all that we heard and learned from the speakers and exhibitors! This was an extra special conference as we were celebrating the 50th Anniversary of the Association. As Past Presidents, both Tami and Deb were recognized on-stage during the opening session. There were so many special events and opportunities to network with colleagues and friends, both old and new.
As we close out our summer self-care series, two sessions that particularly resonated with us that we want to share were presented by. Lauren Plunkett, RDN, LD, CDCDES, Frame a Healthy Relationship with Food Using Nutrition-Focused Language Skills and an engaging presentation by co-presenters Dr. Natalie Bellini, Dr. Diana Isaacs, and Dr. Sean Oser, Use Time in Range to Congratulate, Celebrate, Recognize, Align and Partner. (Lauren’s presentation is available On-Demand if you registered for the conference and didn’t catch it live.) All of these speakers emphasized the power of words and how we, as healthcare professionals (HCPs), can inspire self-care through the words that we use by using empowering language.
Optimistic Coaching & A Positive Food Vocabulary
Lauren, a person living with diabetes (PWD) reminded us that PWD have it in themselves to be exceptional! She acknowledged the significant impact that diabetes has on emotional health and that awareness of emotional health can help sharpen communication skills.She encouraged leading client/patient encounters with a positive attitude and engaging in “optimistic coaching” to support self–efficacy and quality of life. GIven that she’s an RDN, her particular focus was around addressing immediate needs and using positive food vocabulary, such as “colorful”, “flavorful”, “nourishing”, and “abundance”. She reframed food as “energetic nourishment” and that eaters focus on quality and addition (such as eating more plants, more fiber) rather than subtraction.
Asking Questions and Focusing on the Positive
During the discussion on time in range (TIR) the speakers emphasized that getting to know your patients can help to understand their daily lives which will lead to a greater understanding of their challenges and successes with diabetes management. When reviewing ambulatory glucose profile (AGP) data, HCPs were encouraged to find something positive to discuss, no matter how small. Only focusing on the negative is not empowering. As we @AFreshPOVforYou have discussed before, these presenters reminded the audience to not focus on data as “good” or “bad” but as neutral in order to help reduce the stigma often associated with diabetes. In addition, the presenters recommended technology to support people with diabetes in their management. While this ADCES23 presentation is not on-demand, we’re told there may be a repeat at the December ADCES Technology Conference.
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.
Where you stand determines what you see and what you do not see; it determines also the angle you see it from; a change in where you stand changes everything. – Steve de Shazer, pioneer of solution-focused brief therapy
As we continue our series on transforming primary care encounters, today we’re tackling the topic of combatting therapeutic inertia.
What is therapeutic inertia?
In a general sense, “therapeutic inertia” is a lack of timely adjustment to the treatment plan when a client’s treatment goals are not being met. In the diabetes management arena, therapeutic inertia means being slow to add or change the care plan if a client’s A1C is above target. Delays in implementing the most effective care for each person with diabetes can happen at any phase of diabetes treatment and can range for instance from referring for diabetes and nutrition education, to starting the first medication, or intensifying medication management, including starting insulin.
Why stop therapeutic inertia?
The evidence is clear on two things:
Managing glucose levels early in the course of diabetes leads to better long-term outcomes and reduces risk of complications.
Those who reach their A1C targets soon after they’re diagnosed with diabetes are more likely to keep their glucose in target.
This is such a timely and impactful topic that ADA has launched an initiative called Overcoming Therapeutic Inertia. There are many resources for primary care clinicians to learn practical tips to focus on diabetes care in a proactive, timely way to improve outcomes. Learn more here.
Does shared decision making play a role?
One key tenet of shared-decision making is that all care decisions are discussed together with the client, and decisions are made together, which will ultimately mean more people with diabetes are following their treatment plan. Research shows us that when people are not involved in their diabetes medication decisions, they often no longer take the medicine.
When we talk about therapeutic inertia we are addressing both the clinician reluctance to advance therapy and the client’s reluctance to follow through with prescribed therapy. When we add shared decision-making we remove some of the barriers to medication taking. We discuss the potential side effects of the medication, costs, schedule and impact to their lifestyle. These are important decisions that need to be understood for individuals to embrace new therapy.
So how does incorporating a solution-focused approach address therapeutic inertia?
A solution-focused approach that encourages shared decision-making can be a tool to overcome inertia. As we’ve discussed previously, incorporating a solution-focused approach removes the shame and blame often associated with diabetes. When you discuss the clients goals and outcomes and what is working well for them, together you can identify the best therapy.
A solution-focused approach is a questioning approach, asking questions allows you to delve down to identify what is most important. An example of a medication-related question might be: What is most important to you when choosing a medication, the potential of weight gain or the need to check glucose before meals? ”And what else?” questions can be incorporated to learn more.
Since asking eliciting questions is a primary tenet, we encourage you to start all visits by listening and learning from your client. Remember, the client is the expert (read more about experts here), and even though they may be new to diabetes, they know what works in their life in other aspects, they know what they are capable of doing now.
When incorporating a solution-focused approach, each person will map out their own successful plan based on their lives, needs, strengths and desires. The care plan becomes personalized and directly relevant to the client. If something works, do more of it, help them recognize their strengths by identifying exceptions ( written about exceptions here.)
This solution-focused shared decision-making can build relationships and guide clients towards achieving goals, thus overcoming therapeutic inertia.
Next up
Join us next time as we continue our series on incorporating a solution-focused approach when managing T2D in the primary care setting. We’ll visit the moment of diagnosis with diabetes and share tips/tactics you can use to continue to help you build your solution-focused tool-kit.
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.
“Words are, of course, the most powerful drug used by mankind.” – Rudyard Kipling
Words are powerful! Consider these famous brands whose whole identity is defined by a few words.
Bounty: The Quicker Picker Upper.
American Express: Don’t leave home without it.
United Airlines: Fly the friendly skies.
Disney: The happiest place on earth.
We remember these words. These words have power. These words have certainly left an imprint!
We’ve focused a lot on the power of words over the last year in this blog. Words can define how people view themselves and their situations. Words can empower. Or words can stigmatize and judge. Our belief and practice @AFreshPOVforYou centers around using words that focus on strengths and create solutions, instead of words that dwell on the past and on problems.
You may know that we partnered to help create the Telly Award winning video, Changing the Conversation (you can find it here), that focuses on the impact words have when living with a chronic medical condition. The video begins with Words are powerful! We’ve watched this video hundreds of times and yet, it still brings a tear to our eyes. Why? Because the words resonate with our emotions and what we believe to be true, but most importantly, the words came directly out of the mouths of individuals who live with diabetes – Every. Single. Day. They shared their thoughts, feelings and emotions with us to create the inspiring words incorporated in the video.
Now what if the same thing happened with healthcare communication? If careful thought was given to words used in conversation with clients; choosing words that resonated with people living with diabetes. Words that mattered. We can change the way they feel. Words that empowered them. Words that could transform them for the better.
Over the course of writing our blog, engaging in research, and connecting with the diabetes community we have been compiling words that align with the tenets of a solution-focused approach to care and education. Words spoken by people with diabetes in surveys, research and focus groups. Words expressed during Twitter chats. Words written in papers.
So we considered…
How can we draw attention to these words and have them easily flow into conversations between diabetes care and education specialists and their clients?
As a step in that direction, we are launching into a new series of blog posts focused on some of these key words that inspire solution-focused thinking. These words, their meanings, and impact are so powerful that we will devote a blog to each word. Our hope is that each post will spur thinking, inspire, motivate and provide practical guidance as we’ll challenge you to incorporate the word into your daily practice and encounters.
How are your words impacting others today?
Together, we can slowly evolve our vocabulary and ultimately change our messages. Together we can embrace possibilities, opportunities and create a fresh vision for the 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 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.
Follow us on Twitter and Instagram @AFreshPOVforYou
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
Conducted a survey around the perceptions and impact of current diabetes education services. (You can learn more in this post)
Hosted 2 #DSMA Twitter Chats around taking a solution-focused approach to life with diabetes. (Read more about them here and here)
Conducted a qualitative research study via Twitter around the impact of implementing a solution-focused tool, the Miracle Question, with people living with diabetes.
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)
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)
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)
In follow-up to the EASD presentation, had our work published in the European Medical Journal focused on diabetes. (Find it here)
Submitted a paper on taking a solution-focused approach to diabetes care and education accepted for publication in AADE in Practice journal.
Submitted a paper sharing some of our research findings to The Diabetes Educator journal.
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.
Here is how Tami is getting more veggies this summer. A share from the CSA she joined!
A couple of weeks ago we shared four highlights from ADA Scientific Sessions focused around behavioral health. This week our focus is on other exciting developments: Did you know that ADA has updated their nutrition guidance? The summary, Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report, was published in Diabetes Care, May 2019 and you can access it here.
Since the last nutrition guidance was published five years ago, evidence has continued to evolve around the impact of food and nutrition on diabetes management and overall health.
Here’s what’s new…
#1 – Enhanced focus and guidance around prediabetes and the impact of lifestyle change to prevent or delay type 2 diabetes.
#2 – Evidence supporting that a variety of eating patterns and eating plans can help people with diabetes achieve metabolic goals and eat healthy. Individualization is important. There is not one “best” “one-size-fits all” approach. There are 8 different eating patterns acknowledged to be beneficial in managing type 2 diabetes:
Vegetarian or Vegan
Low fat
Very low-fat (such as Ornish or Pritikin)
Low carbohydrate
Very low carbohydrate
DASH (Dietary Approach to Stop Hypertension)
Mediterranean style
Paleo
No one pattern has emerged as being superior to the others. The first six in particular are beneficial for weight loss. The low carbohydrate and very low carbohydrate patterns have demonstrated the most evidence for lowering blood glucose, so if blood glucose is above target or one desires to try to reduce diabetes medications, adopting a low or very low carbohydrate eating pattern is a helpful option.
Four commonalities among all healthy eating plans include the following:
Emphasize non-starchy vegetables
Minimize added sugars and refined grains
Emphasize whole foods over highly processed foods
Replace sugar-sweetened beverages with water as often as possible.
#3 – Initial and ongoing support through individualized medical nutrition therapy (MNT) and diabetes self-management education and support (DSMES) make a difference. They are fundamental in diabetes management, not only at diagnosis, but during times of changing health status. Reported A1C reductions from MNT can be similar to or greater than what would be expected with treatment using currently available medication for type 2 diabetes.
#4 – The greater the weight loss, the greater the health benefits. In type 2 diabetes, 5% weight loss can help achieve health benefits, while 15% weight loss or more is the optimal goal when needed and can be feasibly and safely accomplished. For prediabetes the goal is 7-10% weight loss to prevent progression to type 2 diabetes. Keeping as much of the weight loss off over time is critical. Also noted is that more than 50% of people with type 1 diabetes have overweight or obesity.
One fun way we’re getting our fruit servings!
6 solution-focused swaps to put the new nutrition guidance into practice and answer the question “What Do I Eat?” Nutrition has long been recognized as the cornerstone for successful diabetes management. One of the most commonly asked questions when receiving a diagnosis of diabetes is “What can I eat?” (In fact, Tami wrote a book addressing just that, entitled What Can I Eat Now? (The 3rd edition will be released in early 2020). We are particularly excited to see acknowledgement that a variety of approaches can “work”. Personal preferences and maintaining the pleasure in eating as much as possible (while achieving health goals) are high priorities in our perspective. Here are 6 solution-focused swaps to help put the nutrition guidance into practice.
Swap whole fruit in place of fruit juice. Whole fruit has more fiber, is more satisfying, and will not raise blood glucose as quickly as the juice. A whole orange, for instance,has nearly three times more fiber than orange juice.
Swap infused water (a zero calorie alternative) in place of a sugar-sweetened beverage. One favorite combination is sliced lemon, sliced cucumber, and fresh mint. Place in a large pitcher, fill with ice, add water to the top, and chill for 2-3 hours to allow flavors to infuse.The longer the water sits, the stronger the flavors become. Infused water bottles accomplish the same thing in a portable fashion.
Swap unsweetened almond milk in place of dairy milk. Embrace a more plant-based option and save 10-11 grams carbohydrate per cup.
Swap cooked spaghetti squash or zucchini spirals in place of spaghetti noodles. Get extra non-starchy vegetables and save 35 grams of carbohydrate per cup.
Swap mashed avocado on a sandwich in place of mayonnaise. Get healthier fats, and embrace more plant-based and Mediterranean-style eating.
Swap quinoa or brown rice instead of white rice. Get a whole grain, more fiber with a plant based and DASH friendly option..
Eating healthy is a journey shaped by many factors. All food and beverage choices count. We encourage finding what works for you, and doing more of it!
You can read our part 1 review of the ADA Scientific sessions focused on behavioral health here.
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Celebrating with family and friends on the 4th of July is a highlight of the summer for many. Sometimes it can be challenging to maintain healthy habits during group gatherings, especially if everyone is not on the same page. It’s helpful to have strategies in your back pocket to pull out. Today we want to share with you 5 solution focused strategies for navigating picnics and celebrations. We put these into practice during our recent trip to France, with the goal of enjoying a special vacation together, yet keeping it healthy. We’ll share how they worked for us. And we invite you to consider how the strategies may work for you.
Here we are: Four diabetes educator AADE past and current presidents (with our husbands), getting ready to enjoy a Mediterranean-style dinner at a house we rented on the southern coast of France in Eze (We all traveled together to Ireland 4 years ago so we knew we would have a great time!) Learn more about that trip in our blog post, Going off the beaten path..
5 Solution-focused Strategies for Picnics and Celebrations
#1- Eat fresh and local. We are fans of supporting local farmers and enjoying local produce at the peak of ripeness. When trying to decide what to take to a gathering, think local and fresh. Picnics can be laden with rich casseroles and sides, so taking a fresh, low carbohydrate side that you know will work for you helps to insure there is something you can eat at the event. One of our favorite go-to’s that is ALWAYS the first dish to disappear is this (you may know it as Caprese salad): juicy ripe sliced tomatoes on a platter, topped with a slice of fresh mozzarella cheese, chopped fresh basil (or a dollop of pesto sauce), then drizzled with olive oil and balsamic vinegar. Sometimes we’ll layer sliced avocado on the tomatoes as well. Serve with salt and pepper grinders alongside so everyone can manage what goes on their salad.
A version of the Caprese salad we enjoyed in France made with yellow tomatoes
Deb shopping at the local market in Arles, France
Fresh herbs at a local market in France
#2 – Portion your picnic plate by the healthy plate for diabetes. When you are ready to sample the celebration spread, if there’s a choice on plate size, go with a smaller plate (maybe the ones that are out for salads or desserts). Then fill half the plate with non-starchy vegetables (such as veggie salads, green beans, or sliced tomatoes), one fourth of the plate with lean protein foods (such as a grilled turkey burger or grilled chicken), and one fourth with carbohydrate foods (this is where potato salad, corn on the cob, or a sweet treat may fit). When asked how high one can “pile the plate”…try to keep it no higher than a deck of cards is thick. This simple strategy has brought success for many when navigating picnics and celebrations. And, Tami recalls one client she worked with that embraced this as a “year-round” strategy, purchasing the “old fashioned” partitioned 9-inch paper plates to use at home. He went on to lose over 30 pounds managing his portions and blood glucose in this manner. And he was thrilled that he didn’t have to wash dishes!
We put the healthy picnic plate into practice on one of our outings to taste local Provence wine. We had a lovely outdoor picnic (on the perfect sized plate), including fresh salad, vegetable quiche, and fresh strawberries, all served in baskets! We felt very French!
#3 – Stick with small tastings. Maybe there are a number of things on the picnic table that you want to enjoy. And maybe you are not sure exactly what is in some of the dishes or how much carbohydrate they contain. One tried and true strategy is to stick with small tastings. You can sample a number of different items if you choose, fitting them within the plate sections reviewed above. And there’s a lesser chance of sending your blood glucose out of range with small tastings versus a serving spoon portion. This is a great strategy for travel as well discussed in our blog on Traveling with Diabetes.
We put this strategy into practice during our trip too as we embraced a Mediterranean eating style.. And while we had such fun sampling many delectable foods and treats, we came home without gaining any weight.
#4 – Fit in fitness. With the eating and celebrating, fitting in fitness can help manage blood glucose and spend more time in range. Whether it’s participating in a local walk/run, swimming, playing cornhole, or joining the kids in a water balloon toss. How can you fit in fitness on the 4th?
Fitness was a part of our daily routine while in France. Our days were filled with sightseeing and tons of walking, with most days averaging 15,000 steps or more. We came back in the afternoons and and swam in the pool.Then in the evenings we played games, laughed, and laughed some more as we de-stressed and regrouped. Below you can see part of our group walking down to our street to catch the train.
Daily short walk to the train station
5- Stay hydrated. No matter where you are at this time of year, it’s likely to be warm (or hot)! Keep a calorie-free beverage at your side to sip on. We are fans of the Yeti cups and water bottles (we’re not paid by Yeti to say this, just fans) which have kept our iced drinks cold for over 12-hours in the summer heat! Another favorite trick is to freeze bottled water and use it as ice packs in the cooler, then drink it as it thaws.
In France, while the temperature was only 72, the sun was intense and felt more like 92. Hydration was important. We all brought our water bottles to sip on and stay hydrated in the heat.
We had such a great trip that we are all hoping to gather together again in another 2 years and maybe this time explore the Greek Islands!
As you prepare for 4th of July celebrations, we encourage you to consider:
What strategies have worked well for you in the past to navigate picnics and gatherings?
Which of the strategies that we’ve shared might help you?
We’d love to hear from you on strategies that worked for you! Happy Independence Day!
Enjoying good food, good friends and Fresh Views near Marseilles, France!
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“Wellness is the complete integration of body, mind and spirit – the realization that everything we do, think, feel and believe has an effect on our state of well-being.” ~ Greg Anderson
Tami, Mike, Deb and Mark enjoying the “Fresh Views” in Marseilles, France
We’ve just returned from a relaxing vacation in the South of France where we imprinted enough “fresh views” to last us quite a while! But we are quickly back to work, with the first stop post vacation at The American Diabetes Association Scientific Sessions in San Francisco. A Fresh POV for You attended some inspiring sessions, particularly those focused around behavioral health. (If you’ve been following our blog, you know that’s a special interest of ours.) We thought we’d share highlights from several that were particularly impactful.
Highlight #1
One of the most rewarding presentations was the Richard R. Rubin Award lecture, presented by Dr. Frank J. Snoek, PhD. The award recognizes an individual who has contributed to the science of the behavioral aspects of living with diabetes. Dr. Snoek’s talk #DiabetesPsychologyMatters focused on the important connection between behavior change and mental health. As one of his slides depicted…they are two sides of the same coin!
Dr. Snoek noted that one goal is to shift the burden of diabetes distress, so that higher distress can be moved down to moderate, and moderate moved down to low. He also indicated that a single high score on a distress scale does not mean that an individual needs professional help, or is in a maladaptive situation. Everyone with diabetes experiences diabetes distress at some point and at some level.
Additionally, he discussed the correlation between mood and behavior, an area of significant interest to us at A Fresh POV for You. He described that when someone actually feels good, they are able to shift their priorities towards less pleasant activities that might help them achieve more long term goals. However, when someone has a low mood, they tend to seek short term rewards to help them feel better in the present.
Overall he emphasized the need to enhance access to care and specifically called out what he described as “indirect interventions” – including Diabetes Self Management Education and Support (DSMES), psycho-education as well as internet/mobile interventions. Specifically, he called for incorporating behavioral techniques along with existing pure “education” practices.
Photo of Frank Snoek’s slide at ADA Scientific Sessions showing the indirect psychological support that can be provided by nurses, diabetes educators, etc.
We believe that by incorporating Solution-Focused Brief Therapy (SFBT) techniques and counseling approaches, diabetes educators can address the needs of people living with diabetes, incorporating “two sides of the same coin”.Addressing both the self-management education and support needed for behavior change, while at the same time, addressing mental health concerns, such as diabetes distress. In essence, we can “fill the gap” that exists in access to psychological care. Overall this lecture solidified our efforts in moving this approach forward within the diabetes community.
Highlight #2
Another impactful session focused on complications associated with diabetes. The emotional toll of diabetes complications-What have we done for them lately. The panel was moderated by Dr. Korey Hood, a behavioral scientist. Panelists included Chris Aldred (aka The Grumpy Pumper), Kerri Sparling (Six Until Me), Matthew Heywood, and Ina Mendoza. They spoke frankly and candidly about their experiences living with diabetes complications. Managing diabetes is tiring enough, then add a complication, and it becomes so much more complex. Much of the discussion addressed the stigma associated with diabetes complications and how the panelists were/are often told that they “should have done better”. Ouch. #LanguageMatters when talking about complications. Making people often feel “less than” when they have a complication. Where is the compassion in care?
One question from the audience was, “What can we do to make this better?” So, A Fresh POV for You posed an answer to consider….”How about incorporating a more solution-focused approach into practice? With focus on the solutions and strengths an individual has to help move them forward, rather than focusing on past problems and trying to identify why they occurred.” We know that no matter how much effort goes into managing diabetes, sometimes people still get complications. We also referred to Adam Brown’s Book, Bright Spots and Landmines,, featured in one of our April blog posts. Focusing on “bright spots” are similar to focusing on the “exceptions” or the things that are going well used in a solution-focused approach.
Stigma was a theme common through many of the behavioral health sessions. As recipient of the Outstanding Educator in Diabetes Award, Virginia Valentine, shared a moving presentation, The most important thing we give to people is…Hope: Overcoming stigma in diabetes and obesity,. She explained that the stigma associated with diabetes causes blame and shame, and that “Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of being loved or belonging.”-Brene Brown. She reminded the audience that “the only thing people with diabetes did wrong is when they picked their grandparents.” She ended her presentation with a review of the language guidelines that foster person-first, strength based language.
Highlight #4
Finally, there was the session on #LanguageMatters- Strategies to Improve Communications in Diabetes Care. Jane K Dickinson, and Joe Solowiejczyk, both healthcare providers and people living with diabetes, gave their perspectives on the use of language. Notably, Jane was the lead author on the publication , The Use of Language in Diabetes Care and Education (we’ve written about #languageMatters in the past here). Then Kevin Joiner connected the dots between the stigma associated with language when engaging in a healthcare discussion. Finally, Dr. Jane Speight, lead author of the Australian Position Paper, A New Language for Diabetes, helped to identify strategies for healthcare providers to communicate more effectively with people living with diabetes. We were excited to see them show the Telly Award Winning #LanguageMatters video that was co-designed with the #DOC and released last year at the AADE meeting, Changing the Conversation.
Deb watching the Changing the Conversation #LanguageMatters video at the #ADA2019 meeting (Photo credit Renza Scibilia)
Check back July 10th as we share another big highlight from ADA Scientific Sessions, discussion of the recently published “Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report”.
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We are grateful that we are taking some time off and seeing some fresh views! We’ll be back next week with some new perspectives to share! Enjoy this re-posting of an earlier blog that seemed to resonate with many!
Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow – Melody Beattie
Do you think about gratitude during your daily routine? Is it a habit you practice? Deb was recently on vacation and needed some self-care so decided to get a massage. When she was checking into the spa they showed her three smooth stones, each with one of these words on it: Hope, Love and Gratitude.When asked to choose one emotion that she wanted to focus on during the massage, she chose Gratitude. While laying face down during the massage, a smaller stone was placed below her face so she could see and reflect on the word “Gratitude” during the massage, and to help her think about being grateful. (You see that stone in the photo above) This fresh view and experience created a new desire to be more thoughtful and intentional about being grateful for what is and what she has.
What do you think about when you see or hear the word ‘gratitude”? The simple definition is “a feeling of thankful appreciation for favors or benefits received; thankfulness.” But the practice of gratitude means so much more.
According to the American Heart Association several clinical trials show that engaging in a practice of gratitude can lower blood pressure and help the immune system. “Grateful people engage in more exercise, have better dietary behaviors, are less likely to smoke and abuse alcohol, and have higher rates of medication (taking)”. Several studies suggest that gratitude can decrease stress and anxiety by activating the areas in the brain that the release feel-good hormones serotonin and dopamine.
Research discussed in the Jan/Feb, 2019 issue of Diabetes Self-Management also shows that positive psychological states such as gratitude are associated with improved physical health in people with diabetes, improved sleep, and increased self esteem. While the relationship is not fully understood, positive emotions such as expressing gratitude, are linked to healthier lifestyle choices. And healthy lifestyle choices including healthy eating and being active are in turn linked to overall health.
How can you get started with gratitude?
Here are 5 strategies to help develop daily gratitude habits:
Have gratitude reminders. These are simple cues to remind you to focus on gratitude daily. Maybe it’s an alarm on your phone, a bracelet or wristband, a photo, a magnet even a post it note. And with that reminder, pause, take a breath and focus on being grateful in that moment.
Keep a gratitude journal. We both have found this to be a good personal practice to express gratitude more readily and find things to be more grateful for. Some log entries in their journal weekly, and others daily. Our personal goal is to identify at least 3 things daily for which we’re grateful. Tami numbers her entries and is working toward 1000 things for which she’s grateful. Some things are big (Entry #622 – Protection through a tornadic storm). Some things are small (Entry #1- Sun and warmth on my shoulders). While the goal is to write in the journal daily, sometimes life happens and weeks may go by without an entry, but we pick right back up with our entries.
Start a gratitude box. Keeping a box (jar, album, folder, or whatever works for you) filled with notes, pictures, and moments you are grateful for can bring a boost when needed. Tami keeps a folder on her desk and a file on her computer filled with nice notes and photos, as well as an album on her phone of messages and moments she’s grateful for to refer back to when she needs a reminder. Deb has a bulletin board in her office that displays happy memories in photos, ticket stubs, quotes, flyers etc. that she can look at during working at any time.
Voice or write down one (two, or three) good things that happened in your day. On the homefront, this is a gratitude practice Tami has used with her son over the years. In the days when she would take and pick him up from school, she found that the drive time was a good time to learn about his day. That conversation always began with these words, “Tell me something good that happened today.” He knew he needed to answer that, acknowledging something good, before talking about the challenges of the day.
Use gratitude apps. There are a number of apps with a range of capabilities including sending reminders, sharing uplifting thoughts, and organizing memories for which you are grateful. Deb has been struggling with back pain from a chronic disc problem and was at a place where no position brought relief, not sitting, standing or lying down. It was getting challenging to think clearly and work. She began using the Calm app, decided to take the Calm masterclass in gratitude, and use their 7 days of gratitude meditation. The process has helped her to find daily items to be grateful for during a time when it was challenging to not be engrossed in the pain.
Here are 3 other things Deb has learned through this experience:
Learning #1 – When you have a chronic condition that is challenging you, think about ways to appreciate and focus on what you do have and what is working for you.
Learning #2 – Try not to compare yourself and what you may be dealing with to others. While the grass might look greener on the other side of the fence, we never truly know what others are going through.
Learning #3 – Trying to simply look at what is right in front of you and be present in the moment.
Maybe you employ one of these strategies. Or several.
Here are 3 tips to help maintain your gratitude practice once you get started:
Find a daily time to practice gratitude and try to be consistent. Maybe it’s when you get up in the morning. Maybe it’s before you go to bed at night. Maybe it’s when you’re exercising.
Write what you feel. Don’t censor it.
Refrain from making the list repetitive. Be specific finding new ways to approach gratitude.
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While we are on the road a few days, we’re re-posting our original blog so that new followers can learn a little about us. Have a great week!
Deb and Tami in Italy a couple years back enjoying some Fresh Views!
Thanks for checking out our new blog “A Fresh POV for You”! Join us as we focus on Possibilities, Opportunities and creating a Vision (POV) for the future, based on strengths and leveraging positive learnings from past experiences.
Who are we?
We are healthcare professionals and diabetes specialists passionate about positivity and empowering people with diabetes to live life to the fullest! Deborah is a nurse. Tami is a dietitian. We both have spent our entire careers partnering with those living with diabetes to leave a positive imprint.
We are also speakers, authors, wives, moms, adventurers, and avid travelers always in search of the next fresh and magnificent view. (You see one of those stunning views in this photo, looking out over a vineyard in Italy). You’ll learn more about us and some of our adventures over time.
What is our focus?
Simply put, our goal is to inspire those living with diabetes, or at risk for diabetes to design a life that has a personal sense of balance, is realistic and fun. A life that works for them. It goes without saying that managing diabetes is complex and burdensome. The constant focus on problems can make it even harder. We are passionate about turning the focus to abilities and possibilities. What will be different and new instead of what will NOT happen anymore? What is desired instead of what is NOT wanted? Let’s learn from each other!
Why did we start this blog?
Since November is Diabetes Awareness month there’s no better time than now to let you in on our new adventure in diabetes that’s been in the works behind the scenes for some time.
Getting to know us personally, beyond professionally is important. We believe in the concept of a “therapeutic alliance”- which means that the relationship between health care professionals and people with diabetes is the most important component.
Awhile back, we discovered an approach called Solutions Focused Brief Therapy. It resonated with us because of the focus on possibilities, opportunities, and creating a vision for the future. How about applying this to diabetes? We look forward to sharing with you as we learn more!
Then we joined together to craft content for two recently released brief videos focusing on the use of empowering language in diabetes. Language that puts the person with diabetes, their needs and their values first, thus moving away from language that judges, blames and shames. These videos are based on the language position paper published by the American Diabetes Association and American Association of Diabetes Educators. (You can check out the paper and the videos here and on our blog homepage). Over the months that we worked on the video project we had many soul searching discussions about how diabetes care and education needs to evolve and innovate.
And thus was born A Fresh POV for You! If you are someone who feels challenged and overwhelmed with aspects of life with diabetes – or someone who just wants to learn more about our creative approach – follow our blog as we begin to share more about our exciting new adventure over the next few months. We have lots of creative ideas and ways we hope to engage in innovative diabetes services! Our goal is to create programs and services that resonate and make sense for people living with diabetes.
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“The Path Out Of The Valley Appears When You Choose To See Things Differently.” ― Spencer Johnson, Peaks and Valleys: Making good and bad times work for you–at work and in life
Hilltop village of Eze, France
Provence and the southern coast of France have long been on Tami and Deb’s travel to-do list. From the beautiful Luberon valley and it’s fields of lavender to the hilltop town of Eze in the French Riviera. We look forward to sharing with you some photos and experiences from the peaks and valleys we encounter on this upcoming journey. There will be many amazing views and lots of time spent soaking up and “imprinting” those views. As you may know, we use the practice of imprinting (described here in our blog) as a mindfulness exercise. When you are in the moment and enjoying a special view, feeling, experience etc., take a moment and a breath, to capture everything and imprint it in your mind forever. Not only does it help you appreciate what you have and acknowledge gratitude in the moment, it also creates an opportunity for you later when life may be more challenging. You can recall your imprinted memories when you feel overwhelmed.
On the theme of peaks and valleys, peaks and valleys are a routine part of life. And part of life with diabetes without a doubt. However, when life feels like a rollercoaster and the peaks and valleys are constant, that may signal it’s time for a new approach. Peaks and valleys are opportunities for change.
Let’s use continuous glucose monitoring (CGM) as an example that’s part of life with diabetes for many. When looking at CGM tracings, such as the one below, it’s not uncommon to see peaks and valleys. It’s easy to see those peaks (or time above range) as negative and a “problem.” And as for the valleys “below sea level” – that plunge into an uncomfortable low blood glucose – you don’t care for those either. Rather than thinking about these peaks and valleys as “problems” to be “fixed”, is it possible to take a step back and think differently?
Continuous Glucose Monitoring (CGM) tracing for a 24 hour period
While the many peaks and valleys on this CGM report might create a sense of frustration and fatigue, how might we use a solutions focused approach to manage thinking?
We know from Adam Brown, interviewed in our recent blog on Diabetes Bright Spots and Landmines, that there are 42 factors that impact blood sugar. Some of these factors are much easier to measure and manage than others. Maybe you’ve been sick or struggling with a very stressful life event. You need to give yourself permission to just say, “Some days diabetes is like this. Some days I don’t know why I’m not in range, and I’ll see what happens tomorrow,” without feeling guilt, blame or shame. Sometimes it’s hard to really know what’s happening, and a “problem-focused” approach isn’t going to help.
In looking at the tracing above, you see blood glucose in range between 10:00 am and 1:00 pm. That’s where to start. What was going on then? What can you learn from this time in range to repeat and help see more time in range in the future?
Let’s look at an activity tracker record as another example.
Activity tracker report of steps taken over 2 different weeks
In taking a quick glance we see definite peaks and valleys in activity. Rather than focusing on the “problem” of the day there’s only 22 steps tracked, (maybe the activity tracker battery died??), instead let’s focus on the day where there were over 13,000 steps! And the day where there’s over 10,000 steps. What was going on those days? How did this individual successfully fit that many steps in? How can that occur more often to help achieve physical activity goals?
As you look to the next week, month, or year. We challenge you to consider peaks and valleys as catalysts for positive change.
And check back over the next few weeks as we share some peaks and valleys that we encounter on our journey.
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