• Fresh Views

    Decision Fatigue: Tips to decrease the burden

    May 15, 2019

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

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

    What is decision fatigue?

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

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

    Embrace a minimally disruptive approach

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

    4 Solution- Focused Tips to decrease the burden:

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

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

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

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

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

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

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

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  • Fresh Views

    Bringing order to chaos: A solution focused approach

    May 8, 2019

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

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

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

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


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

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

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

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  • Fresh Views

    How to apply our solution-focused “Triple Crown”

    May 1, 2019

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

    “It’s Breeding

    And it’s training

    And it’s something unknown

    That drives you and carries you home

    And it’s run for the roses

    As fast as you can

    Your fate is delivered

    Your moment’s at hand

    It’s the chance of a lifetime

    In a lifetime of chance

    And it’s high time

    You joined in the dance”

    -Dan Folgelberg’s Run for the Roses

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

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

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

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

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

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

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

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

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

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


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

    Deb and Tami at Keeneland, Racecourse, Lexington, KY

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  • Fresh Views

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

    April 24, 2019

    A new day dawning

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

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

    What exactly is co-design?

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

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

    How has @AFreshPOVforYou been engaged in co-design?

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

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

    How are we using co-design now?

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

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

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

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