We guide healthcare professionals in a solution-focused approach so clients can embrace possibilities, opportunities, and a fresh vision for the future.
Gratitude and attitude are not challenges; they are choices.- Robert Braathe
Tami was expressing gratitude for this stunning sunset on a recent weekend escape to Isle of Palms, SC.
Expressing Gratitude is a topic we have written about several times as a tool that can be used in solution-focused encounters with clients. And it is a practice that we both embrace regularly. Expressing gratitude has been shown to help people improve their health, deal with challenges, and feel more positive. Really any time is a great time to develop and express gratitude – from the big things in life to the tiniest things (like the sunbeams coming in the window as we write this).
Following on this “season of thanksgiving” and closing out our year-long series on “Diabetes Technology and Solution-Focused Practice”, today we’re sharing 3 Gratitude Apps that you may wish to recommend to your clients (or use yourself).
We love that this app incorporates both the practice of gratitude and using positive affirmations (which we wrote more about in a previous blog here.) The user can journal in the app what they’re grateful for and add images. Plus, the app sends prompts as a reminder to record what you’re grateful for – for instance, “What made you smile today?” The user can also write their own positive affirmations to practice positive self-talk. Some of Tami’s favorites are, “I am kind. I will not worry. I am created for a purpose.” And from there, the user can create a vision board to focus on their goals and live life with intention. Deb also likes the fact that this app allows you to easily share with friends. To reinforce gratitude practice, Deb started sending text messages to friends to express appreciation. You can also easily post to social media channels.
365 Gratitude Journal
Rating 4.7
Price: Free & paid versions
System: iOS, macOS
Features/Content: Journal, virtual gratitude jar, prompts, sharing gratitude with others
This is a science-based gratitude journal that guides the user to see the world in a more positive light. The app sends daily gratitude prompts that are thought-provoking and shares stories that cultivate self-love, positivity, and joy (another aspect that we fully appreciate. See our blog about finding joy here.) One gratitude strategy we’ve recommended in our previous gratitude blogs is having a gratitude box (or jar) and this app incorporates a virtual gratitude jar for the user to fill with things they’re grateful for. The app even lets the user write and send a little gratitude card to someone.
This app is simple and is designed to make reflection and giving thanks easy. The app will send a daily prompt/question to answer to start you off. It’s at the ready to capture a grateful moment on the go. For reflection, the app allows the user to easily navigate past entries by timeline (such as to check frame of mind last December) or by prompt (such as to see the things that made you smile this year). This app is helpful in changing the mindset to look at the good, rather than focusing on the negative in the day.
We hope that you find these gratitude apps helpful to you and your clients!
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.
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.
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.
We hope your summer has been going well! We’ve been busy with work and spending time with family. Here @AFreshPOVforYo we are getting excited for the upcoming ADCES21 Virtual conference. For those of you that are attending, we have highlighted 13 presentations that are interesting to us and align with our thinking around behavior change, person-centered care, use of language, and of course use of technology. While there are many, many more sessions we plan to join, we are showcasing just a few!
We hope you’ll attend our session on Saturday 8/14/21 at 3:15 pm CT, S30 – Adopt A Fresh Point of View: A Solution-Focused Approach to the ADCES7 Self-Care Behaviors™. We presented two years ago at #AADE19 and shared an overview of what a solution-focused approach is all about. This year we’ll go a little farther and address the ADCES7 self-care behaviors. We’ll be sharing more info about our program in two weeks, so stay tuned for that!
While we wish we were connecting with our colleagues in person this August, we appreciate the great program put together virtually. We’re crossing our fingers that we’ll be grabbing a coffee or a glass of wine at ADCES22 in Baltimore next year!
Enjoy the meeting if you’re attending! We’ll share some of our thoughts about the meeting in a future post. We’ll also be Tweeting during the conference to share some pertinent information!
T02 – Help People With Diabetes Shift Their Mindset and Change Their Approach to Self-Care Behaviors
In this session, presenters will show a framework for how diabetes care and education specialists can empower people with diabetes to take a new relationship approach to change their entire emotional experience with diabetes to improve self-care behaviors.
Learning Objectives:
At the completion of this activity, participants should be able to:
Describe a framework for empowering people with diabetes to change their emotional experience with diabetes
Describe how different types of relationships with diabetes impacts psychosocial and emotional functioning
Utilize practical tools to help people change their relationship with diabetes
T10 – Achieve Better Outcomes by Using Individually Customized Messages
This session will discuss how to achieve better results by combining smart goals, virtual programs, motivational interviewing, coaching, stages of change and behavioral strategies with customized messages designed individually to improve outcomes.
Learning Objectives:
At the completion of this activity, participants should be able to:
Combine behavior change techniques with customized messaging designed to improve individual outcomes
Embrace fears and help an individual to overcome barriers
Identify a starting point and build an action plan
T17 – Collaborative Psychosocial Care for Youth With Diabetes
Psychosocial care for youth with diabetes presents challenges for the care team. This presentation will cover engagement and treatment strategies that optimize diabetes care in youth and collaborative care provided by diabetes care and education specialists and mental health professionals.
Learning Objectives:
At the completion of this activity, participants should be able to:
Identify psychosocial care opportunities in youth with diabetes
Select validated surveys and screening formats for identifying psychosocial issues in youth with diabetes
Adopt concrete strategies to help youth with diabetes
T18 – Language in Diabetes Care From a Personal and Professional Perspective
Living with a disease that focuses on numerical values and patterns can be physically and mentally exhausting. Presenters will examine statements that trigger sensitive emotions and how to replace them with optimistic, inspirational coaching.
Learning Objectives:
At the completion of this activity, participants should be able to:
Collaborate with individuals to understand how they approach management of their diabetes
Articulate optimistic coaching methods to encourage individuals to live in partnership with diabetes
Reframe the standard clinical approach to a perspective that focuses on the individual experience
T27 – Diabetes Stigma: Causes and Consequences for the Concerned Clinician
In this session, participants will learn how diabetes stigma at individual, interpersonal and structural levels intersect and can compound other forms of social marginalization, contributing to health disparities and poorer outcomes.
Learning Objectives:
At the completion of this activity, participants should be able to:
Define diabetes stigma and name at least four dimensions of stigma
Name pathways by which diabetes stigma is associated with medication taking among people with diabetes
Promote diabetes pride in your practice and across the interdisciplinary diabetes care team
F04 – Too Good? The Potential Dangers of Perfectionism in Diabetes
This session will provide ways to recognize signs of unhealthy perfectionism in diabetes management, its medical and emotional risks, and tangible steps for helping individuals become more flexible, mindful and compassionate approach.
Learning Objectives:
At the completion of this activity, participants should be able to:
Explain how perfectionism exhibits in diabetes management
List possible consequences of perfectionism in people with diabetes
Utilize strategies for preventing perfectionism pitfalls among people with diabetes
F17 – Practical Approaches for Addressing Behavioral Health Needs
Nicole Bereolos, PhD, MPH, MSCP, CDCES, FADCES
Friday, August 13, 2021
12:40 PM – 1:10 PM
Performing an assessment of behavioral health needs in individuals with diabetes can be limited by lack of training, resources and time. This session will provide practical tools, resources and real-world examples to augment learning in this area for diabetes care and education specialists.
Learning Objectives:
At the completion of this activity, participants should be able to:
Identify the importance of addressing the behavioral health needs of PWD
Demonstrate real-world applications of addressing behavioral health needs
Utilize tools and resources appropriately to help address behavioral health needs in practice
D07 – Diabetes Care and Education Specialists and Behavioral Coaching For Mental Health: Creating Successful Partnerships
Korey Hood, PhD,
Brooke Benton, CDCES, MS, RD, LDN
Sunday, August 15, 2021
10:05 AM – 10:35 AM
Mental health issues can prove challenging to address for diabetes care and education specialists. This session will discuss how a behavioral coach can work alongside them to screen for mental health issues, recognize when individuals are struggling and connect them to available support resources.
Learning Objectives:
At the completion of this activity, participants should be able to:
Highlight models that promote partnership between the diabetes care and education specialist and the mental health specialist
Discuss the relationship between diabetes and mental health
Incorporate screening tools and identify referring sources to collaborate with for providing mental health care
D19 – Diabetes Distress: An Overview of Prevalence, Assessment and Treatment
Lawrence Fisher, PhD, ABPP
Sunday, August 15, 2021
11:15 AM – 11:45 AM
This presentation will review the definition, clinical presentation, prevalence, assessment and treatment of diabetes distress due to its high prevalence and consistent links with self-management, making it an important target of clinical care.
Learning Objectives:
At the completion of this activity, participants should be able to:
Perform a clinical assessment for diabetes distress
Utilize recommended tools for clinical assessment of diabetes distress
Discuss the treatment of diabetes distress
D25 – Optimize Support During Crises With Supplemental Peer Support
Anna Norton, MS
Sunday, August 15, 2021
11:50 AM – 12:20 PM
During the COVID-19 pandemic, peer support communities can serve as a supplemental resource for people with diabetes to maintain their mental health well-being. This session will provide strategies for diabetes care and education specialists to connect people with diabetes to these communities.
Learning Objectives:
At the completion of this activity, participants should be able to:
Recognize the need for psychosocial support for people with diabetes during a crisis
Provide suggestions and strategies for connecting people in their practice to peer support communities
Identify reputable resources for diabetes management outside of the healthcare environment
Here are a few technology sessions you may be interested in as well.
T24 – Facebook Collaborative To Improve Diabetes Management
Sharing diabetes challenges and engaging with peers through Facebook groups helps people with diabetes make connections and learn/reinforce actionable self-care behaviors. This session will discuss how to use social media to teach, reinforce and support people with diabetes.
Learning Objectives:
At the completion of this activity, participants should be able to:
Discuss how sharing diabetes challenges fosters connections and improves self-care habits
Increase diabetes education support outside of the provider’s office using social media marketing strategies
Create engaging social media content to obtain measurable results
ET07 – Powered by Dexcom: Continuous Glucose Monitoring Empowers Self-Management and Expands the Horizons for Connected Care
Lindsay Vettleson, RDN, CDCES, ACE-CPT, ACE-CHC, One Drop
Friday, August 13, 2021
10:45 AM – 11:30 AM Join the discussion with DCES digital health experts that are leading the development and implementation of digital platforms to support people with type 2 diabetes to engage in personalized, data-driven, self-management and support coaches and HCPs to inform therapeutic decisions.
S04 – Technology Interventions in High-Risk Populations: The Identify, Configure, and Collaborate (ICC) Framework in Action!
This presentation will describe the ADCES technology framework Identify, Configure and Collaborate (ICC) using a program that delivers care with technology-enabled devices in high-risk communities.
Learning Objectives:
At the completion of this activity, participants should be able to:
Describe the Identify, Configure, and Collaborate (ICC) framework and its application to high risk populations
Discuss the role of the diabetes care and education specialist in evaluating technology interventions within their practice
Discuss a technology assessment tool that can be utilized to assess specific technology needs
We’ll see you in two weeks with a more detailed description of our Saturday educational session!
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.
“I realized that my sugar was like a rollercoaster. It would go up and down very clearly. So I started to go for walks. Not light walks, but fast-paced ones.” ~Study participant
Since the COVID-19 pandemic began the disparities in diabetes technology use in underserved populations has risen to the forefront. During the recent American Diabetes Association (ADA) Scientific Sessions data were shared about a novel use of an online peer support community combined with continuous glucose monitoring (CGM) use to educate, engage and empower people with type 2 diabetes. Since Deb was a co-investigator on this study, we reached out to Dr. Michelle Litchman, PI, Assistant Professor, University of Utah, College of Nursing to discuss the study findings and impact.
The ADA abstract: 151-O Using a CGM plus Online Peer Support Community Intervention to Address Health Disparities
Dr. Litchman, what makes this study unique and important?
This study was developed based on two separate PCORI-funded projects that incorporated community-based participatory research principles and community advisory boards (CAB). The first CAB partnered with individuals within the Hispanic community to better understand diabetes technology needs and desires. The second CAB included diabetes online community partners to best understand how online peer support could reinforce diabetes technology use and healthy behaviors.
What were the components of the study?
We developed an intervention that combined continuous glucose monitoring (CGM) plus an online peer support community (OPSC). To support the needs of Hispanic and Spanish-speaking adults with type 2 diabetes not using insulin, the CGM+OPSC intervention was optimized to be culturally and linguistically appropriate. Participants wore CGM to visualize their daily glucose patterns and engaged in weekly personal experiments. Personal experiments included health behavior challenges related to general diabetes topics (being active, healthy eating, etc.) and were posted to the OPSC weekly. The OPSC were managed by trained Spanish/English bilingual peer facilitators who also lived with diabetes and used CGM. This mixed method study assessed how participants used the intervention.
Participants completed a 1-week blinded baseline CGM recording (N=31) then engaged in the CGM+OPSC intervention for 12 weeks. Of those that continued into unblinded phase (n=22) study engagement was excellent (N=21).
What were some of the key outcomes of the study?
We analyzed exit interviews and identified 3 themes: (1) CGM “personal experiments” helped participants gain knowledge about how diet, exercise, medications, stress, and sleep impacted glucose levels; (2) the OPSC reinforced healthy behaviors through personal experiments, collective learning and social support; and (3) CGM engagement increased OPSC participation and participation in the OPSC resulted in greater CGM utilization, suggesting a positive feedback loop.
We also found that self-efficacy levels significantly improved when comparing pre to post intervention.
Tell us about the figure you presented.
The figure above describes a positive feedback loop in which CGM could help see how glucose levels changed when they engaged in health behaviors, and the OPSC provided structure (personal experiments) and emotional and informational support to reinforce healthy behaviors. The promise of diabetes technology can only be seen with continued use. This study showed that an OPSC is one way to enhance CGM use. It is possible that OPSC could support other diabetes technologies and in other populations or languages.
Tell us more about the peer facilitators.
We hired and trained five Hispanic Spanish/English bilingual individuals who were living with diabetes and using CGM. Having a group of peers that the participants could relate to was critical to the study’s success. The peer facilitators could provide tips and tricks from their own lived experience while also providing encouragement to those who might be struggling. All peer facilitators were supported by the research team and a bilingual certified diabetes care and education specialist. After the study completed, the peer facilitators helped develop training videos to support future research.
What is the key message you would like readers to take away today?
Hispanic, Spanish-speaking adults with type 2 diabetes have a great desire to use diabetes technology. However, diabetes technology must be optimized for language, cultural and social support needs. The CGM+OPSC intervention provided participants with the tools necessary to learn, problem-solve, and make healthy behavior changes and is a promising intervention to address health disparities.
Is there anything else you would like us to know?
This study would not have been possible without important community partners. We thank the CABs from both PCORI studies who helped guide us to developing this novel intervention.
Of note, this abstract was awarded “Best Abstract” in the Glucose Monitoring and Sensing presentation group! We congratulate and thank Dr. Litchman for sharing the ADA presentation with us and look forward to future publications.
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.
Word cloud from participants with diabetes in some of our research
“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!
In our series on diabetes and technology, today we’re revisiting a previous post about the power of language. When using technology tools, especially for virtual visits, the words we choose are just as important, if not more so than with in-person conversation. It’s hard (or even impossible) to read body language, voice tone and inflection, etc. So choosing person-centered, strength-based language during technology discussions is critical.
If you’ve followed our blog over the last 3 years, you’ve seen that we’ve focused a lot on the power of words. 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.
Changing the conversation
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. You see some of those in the word cloud above. Words spoken by people with diabetes in surveys, research and focus groups. Words expressed during Twitter chats. You can read a few of our blogs about strengths, exceptions and possibilities here.
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
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.
Sunrise dawning over the hills of Central Kentucky
Let’s go invent tomorrow instead of worrying about what happened yesterday. – Steve Jobs
When we discuss technology and the opportunity for technology to support person-centered, strength-based discussions, we always return to the impact of person (patient) generated health data (PGHD). As technology evolves, more PGHD are appearing and creating new opportunities to identify things that are working well and identify successes to build upon. With older technology, when individuals were using traditional insulin pens and syringes, we were unable to rely on PGHD to help people in their diabetes management.
So, as part of our series on diabetes technology and solution-focused practice, this week we’re focusing on one of the newer technologies, Smart Insulin Pens.
We reached out to our friend and colleague Janice MacLeod, MA, RD, CDCES, FADCES, Director of Clinical Advocacy at Medtronic Diabetes, to share her experience and knowledge about how the diabetes care and education specialist (DCES) can incorporate solution-focused techniques into their practice when using Smart Insulin Pens and discussing PGHD.
Here is what Janice shared with us….
Smart insulin pens (SIPs) are bringing the millions of people who rely on insulin therapy into the digital age making possible a connected diabetes care ecosystem for people with diabetes and their providers. The first FDA-cleared commercially available SIP in the United States, InPen™ is designed to automatically record doses, track active insulin, send missed dose alerts and provide meal and correction dose recommendations. The user is also able to share integrated data reports with their care team allowing users and their care team to coll
aborate in real-time or asynchronously to make data-informed adjustments in the care plan as needed. Data visibility leads to more collaborative conversations.
The DCES can lead the team in helping people who rely on insulin to IDENTIFY the best method of insulin delivery for them. If the individual prefers injection therapy but would like the smart dosing support previously only available through pumps, a SIP is a great option. Next, it is important to get the patient off to a strong start by helping them CONFIGURE the SIP for their specific needs. This includes providing individualized insulin therapy settings. Finally, the DCES can lead the care team to COLLABORATE with the user by providing a plan for sharing and reviewing the data together on an ongoing basis. (You can read about the ICC framework in our blog here.) Partner with the individual to uncover and resolve barriers to taking insulin. Next, optimize the long-acting insulin dose before fine-tuning meal and correction dosing factors.
DATAA Counseling Strategy
The DATAA counseling strategy was introduced by Isaacs et al (Isaacs D, et al. Technology Integration. TDE, 2020;46(4):323-333). Here is an example of using this approach with integrated glucose, insulin dose and meal data available for the first time through SIPs:
D – DATA: Thank the individual for sharing their data report and acknowledge their diabetes care efforts
A – ASSESS SAFETY: Review the glucose stats and graph assessing and resolving any issues with hypoglycemia as a priority
T – TIME IN RANGE: Note times of day or days of the week where the care plan seems to be working well. Discuss ways to replicate this success at other times of day or days of the week.
A – AREAS TO IMPROVE: Note if there are missed doses, a need to check glucose prior to dosing or to use the dose calculator recommendations or to set reminders to check if a correction dose is needed. Maybe it is a dose timing issue. Having a conversation about the data leads to problem solving!
A – ACTION PLAN: Together with the patient determine the next steps to take, for example:
Set dose reminder in app for lunch dose
Take my dinner time dose 15 minutes prior to eating
We thank Janice for the information 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.
“You`re only as weak as you let yourself become, and you`re only as strong as you allow yourself to be.”
~ Daniel Hansen
Beautiful bougainvillea, Palm Desert, CA
In this week’s installment of Diabetes Technology and Solution-Focused Practice we’re discussing mobile apps. In our last blog we focused on using a solution-focused approach to interpreting and discussing continuous glucose monitor (CGM) data. This week’s blog we’ll focus on a new discovery for us – the WW mobile app. We will share insights on other apps in future blogs. We believe that using solution-focused language within mobile applications can improve user engagement with the app, as well as encourage individuals to make progress towards their health behavior goals.
WW App: Deb’s experience…
As you may know, Weight Watchers is now known as WW. I have been using their app, the WW app, to help stay on track during the COVID-19 lockdown. You can learn about the different WW programs and pricing here. There are several options to choose from, I only use the app for logging and motivation. I was encouraged to continue using the app because of the nature of the messaging. Then I began to wonder if they were incorporating a solution-focused approach?
From a weekly in-App push a few weeks ago, the headline was “Why you should do what works: You might already have more tools in your toolbox than you think.” If that doesn’t sound like solution-focused messaging, I’m not sure what does! The post reminds us that people typically focus on what isn’t working well and how to deal with challenges. Of course, that is not motivating, and not helpful when trying to make hard health behavior changes.
But, what if you “Flip the switch” so to speak? (See our many blog posts from 2019 about “Flipping the paradigm” – here’s one on healthy eating, and here’s one on healthy coping). The WW message goes on to encourage focusing on the things that come naturally and leverage strengths or what’s worked in the past! Wow! We’ve written about strengths in this blog multiple times (you can read about strengths here), and so believe in focusing on what one does well, building confidence, and increasing happiness by doing so.
Make Strengths your Secret Weapon. According to WW, leveraging your strengths will help you be successful. They suggest asking 3 questions to uncover strengths:
When do I feel like my best self?
What makes me unique?
What comes most naturally to me?
Those are questions that diabetes care and education specialists (DCES) can easily incorporate into diabetes-related conversations with clients as well. Once those questions are answered, WW suggests creating an “affirmation” to help remember to focus on personal strengths. You can read their post here. One exercise that helps people think through writing their own affirmation includes showing a word cloud to help direct thinking about potential ideas of strengths (including humor, cleverness, bravery, creative etc.). What a powerful visual tool, that would be so easy to employ in any diabetes care and education program! Finally they suggest saying the affirmation out loud every morning or posting on your computer so it will be visible every day. For instance, “I am strong.” “I am resilient.” You get the idea
I loved this way of thinking about making healthy choices, and reading and engaging with the content. I created my own affirmation and have it posted on my computer with a sticky note so I glance at it multiple times during the day! Tami has affirmations on her desk and in the kitchen that she sees when making coffee in the morning to start the day off.
Helping clients create their own affirmation using solution-focused principles is a great opportunity to highlight what is working well already and focusing on their strengths, as well as supporting the development of resilience.
Do you recommend mobile apps to your clients?
If you have a client interested in weight loss or adopting healthy eating habits, the WW mobile app might be a good option. (We are not endorsed by WW and do not receive any compensation from WW). Knowing the positive strength-based language that is being used is so encouraging. Also of note, WW recently hired Adam Kauffman, formerly of Canary Health, to head their diabetes program (read the press release here) so we’re excited to see what’s to come in the future.
We plan to continue to write about a variety of other technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching. Stop back by in 2 weeks to see what’s up next!
We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!
If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients.
Deb is employed by Dexcom but her words and opinions in this blog are her own.Tami is employed by the University of Kentucky Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.
“The future depends on what we do in the present.” – Mahatma Gandhi
Views of the Sierra Nevada Mountains from Folsom Lake, Granite Bay, CA
In this week’s installment of Diabetes Technology and Solution-Focused Practice we’re discussing continuous glucose monitoring or CGM. If you’ve been reading our blog, you know we’ve written about CGM before in our posts about Exceptions and Possibilities and also in our series on “Flipping the Paradigm” when applying a solution focused approach to Monitoring.
Focus on “exceptions” rather than “problems”
When we think about applying a solution-focused approach to CGM, Bright Spots and Landmines by Adam Brown comes to mind. It’s a framework for evaluating diabetes habits and decisions. (You can read our 2019 interview with him here.) As we were identifying our technology themed blog posts, Deb happened to watch a North Carolina JDRF Chapter presentation by Adam (see slides here) that really highlighted the approach we encourage diabetes care and education specialists (DCES) to take when discussing CGM data.
When evaluating CGM data similar to that below, the typical first response may be to focus on the glucose spike and try to identify what went wrong.
However, when taking a solution-focused approach, we want to turn focus to all of the things that are working well (rather than what went “wrong”). Similar to Adam’s “Bright Spots”, we call them “Exceptions” or times when the problem did NOT occur and when things were going well. Below you can see where Adam focuses on his Exceptions, instead of his “landmines” and identifies all of his successes during the day. If we only focus on times that are not working well, we miss identifying successes.
CGM creates a great opportunity for discovery learning!
When CGM was first incorporated as a management tool, the focus was typically on hypoglycemia, and preventing serious events from happening. As CGM has evolved and more individuals with type 2 diabetes are incorporating it into their diabetes care, the focus has broadened and now includes focus on making healthy behavior changes. CGM creates a great opportunity for discovery learning, where people can try different foods or activities and personally experiment to learn what works well for them. While Adam identifies 42 factors that can impact blood glucose, he stated that there are more likely more than 60-100 factors if you include mental health and other daily issues. There’s so much to learn!
As DCES use CGM in practice with clients with type 2 diabetes, applying a solution-focused approach to CGM data can be motivating and help reinforce habits and choices that result in increased time in range (TIR) and overall quality of life. (The recommended goal for TIR is > 70% of glucose values between 70 and 180 mg/dL) Focusing on their “best day” pattern (the day with the greatest TIR) and working towards increasing TIR is a positive goal to strive for because they can “do more of what’s working” instead of giving up or stopping something they enjoy. Our “fresh view” photo today was taken by Deb on an easy hike near her home. Physical activity is one of many factors that can help one see more TIR.Applying a solution-focused mindset with CGM can help your clients want to learn to use their own data to learn about their diabetes and create a plan that works for them, where they can be successful.
Do you use CGM in your practice and with your clients?If you do, try focusing on times when they are in their goal range and inquire about their actions and activities during that time. Help them identify what’s working well and what choices will move them towards more TIR.
One mnemonic to facilitate conversation is MGLR, which stands for “more green, less red” when looking at the TIR bar. The goal is to see more green (time between 70-180 mg/dL) and less red (< 70 mg/dL). Talking about TIR can be a great way to have a solution-focused discussion and to help clients identify opportunities to succeed instead of focusing on past failures.
A second mnemonic is FNIR, or “flat, narrow and in-range”, which is a goal for the trend graph. When viewing the trend graph the goal is to have the majority of the data fall within the target range, again typically 70-180 mg/dL without extreme variability swinging from below range to above range. CGM creates an opportunity to move towards a clients goals while providing constant, non-judgemental feedback on their progress.
We plan to continue to write about a variety of other technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching. Stop back by in 2 weeks to see what’s up next!
We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!
If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients.
Deb is employed by Dexcom but her words and opinions in this blog are her own.
It’s not what you look at that matters; it’s what you see. – Henry David Thoreau
Joshua Tree National Park, California
Back in January we shared the top 10 things that 2020 taught us (you can read it here) and #5 was to Keep a mindset focused on finding solutions, rather than focusing on problems. Little did we know that we would be applying that lesson to many aspects of our lives throughout the year. In some ways it’s difficult to believe that an entire year has passed since the world first shut down and the new concept of “social distancing” became the norm. And with that the need to quickly find a solution to no longer being able to meet with clients in person. Tami works with a dually accredited Diabetes Self-Management Education and Support program (DSMES) in public health which quickly became part of a statewide pilot to pivot to online virtual delivery. Rather than fixating on the “problem” at hand (no longer being able to meet in person), she and the team focused on creating solutions, leveraging the ideas, input, skills and expertise of the team she works with. To echo the Thoreau quote above, it’s all about what you envision and see in looking to the future.
Here’s Tami’s telehealth experience…
I will never forget hearing people say, “What’s so hard about switching to facilitating online. You just open up your computer and talk!” But it quickly became evident that virtual delivery is SO much more than that…my home office rapidly transformed into a small studio complete with green screen for virtual background (to hide the chaos of working from home), a webcam (for clear image and sound), a ring light (for proper lighting), a second device to log-in (to see what the participants are seeing), elevating my laptop (so it was the right height), rigging up my desk so all props were within reach, placing my notes where I could see them and still look in the camera, plus learning how to use Zoom and Docusign! And not to mention adapting the entire curriculum and mode of delivery to be interactive and engaging. Many times I told my husband I not only had to be a content expert, but also be engaging, be entertaining, and be my own IT. It seemed that each day new considerations and challenges popped up (after all, I didn’t know what I didn’t know), but we kept a mindset focused on building solutions. And thank goodness for technology in these days of “social distancing”! The photo above from Joshua Tree is reflective of the many pieces and aspects that together built a successful telehealth program and required us to rely on a strong network of people, technology and new ideas to be resilient. (If you’ve followed our blog, you know we enjoy sharing a fresh view through an inspiring photo with each post!)
Tami’s office set-up for virtual delivery
Engaging differently through virtual visits
One quick learning with the transition to virtual DSMES delivery was that engagement is significantly different through virtual visits. Engaging virtually can bring an added level of stress…How do I connect to Zoom? My internet is unstable. How do I mute myself? Can you hear me? How do I turn off my camera? Can you see me? How do I position my laptop because I don’t like what’s in my background or how I look?…I bet you can relate to some of these! In an effort to reduce stress, and start each encounter on a positive note, I started each session in a solution-focused manner with the questions: What’s 1 thing that went well this past week (no matter how big or small)? What’s 1 change you were able to make? How were you able to do that? Whether unmuting and sharing, or replying in the chat, this helped acknowledge each individual’s hard work and guide the discussion toward finding solutions. At the conclusion of each DSMES series when setting post-program goals, again we turned focus to areas each individual was already achieving some success and how they could leverage that for future benefit.
Telehealth virtual delivery was a success!
I’m happy to share that after facilitating multiple cohorts our program has had a 100% completion rate for most of the cohorts! Much higher engagement and completion than in-person delivery. That’s a huge win!
How has technology changed your practice or your thinking? We’d love to hear from you!
Over the next few posts we’ll write about a variety of other technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching. Stop back by in 2 weeks to see what’s up next!
We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!
If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients.
Deb is employed by Dexcom but her words and opinions in this blog are her own.
Perspective is everything when you are experiencing the challenges of life. – Joni Earackson Tada
Arch Rock, Joshua Tree National Park, California
In this new year, are you looking to add a fresh perspective to your diabetes care and education conversations?
Over the past two years, through this blog and our research publications and presentation we’ve been sharing tips and guidance to help diabetes care and education specialists incorporate principles of solution-focused practice into their conversions with clients. At its core, solution-focused practice is based on relationship building between the client and the clinician who acts as a “think partner.” The overarching themes of most of our blogs help the diabetes care and education specialist to view their interactions with a new perspective and challenge them to think differently. (With the mention of “overarching” we thought the photo above as fitting for our “fresh view” for this post.)
With the rapid evolution of technology-enabled care during the COVID-19 pandemic, we’ve been discussing the need to focus some of our learnings to support the use of solution-focused principles when incorporating technology into care and education. So, we’ve decided to launch a series of blog posts focused on different aspects of technology-enabled diabetes care and education and incorporating solution-focused principles. Over the next few posts we’ll write about various technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching.
In the meantime, there are two papers focused on incorporating technology into practice that we encourage you to check out. They were published by colleagues (including Deb) in August 2020 in The Diabetes Educator journal (now The Science of Diabetes Self-Management and Care):
The second paper used continuous glucose monitoring (CGM) as an exemplar for integrating technology into practice. In this paper a simplified process for evaluating CGM data was presented. This DATAA model (an acronym for download data, assess for safety, time in range, areas to improve and action plan) not only simplifies data interpretation, but also includes solution-focused principles along with strength-based language practices to empower people to use their data for learning and behavior change.
Stop back by in two weeks to see which technology to impact and influence diabetes care and education that we focus on first!
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.
