Introducing the Flourishing Approach at the Region Steno conference in Copenhagen

There’s little I enjoy more than sharing with health professionals the Flourishing Treatment Approach and training them, in less than two hours, in a few of its strengths-based skills – that often are the missing link to patient involvement and activation.

Screen Shot 2017-11-20 at 10.39.36 AM.pngIt is rich to see them work among themselves and gain new insights and skills. It is remarkable to see them nod in agreement when they hear, as if for the first time, things they have known intuitively all their lives: how people with diabetes being human beings, not machines, require a different way of engagement.

And it is sad that this more empathetic way of working has all but been trained out of health professionals in their medical education. And, it is reckless that safety, trust, listening and partnership’s ability to drive behavior is all but overlooked in our pressurized, standardized health system.

Wednesday, November 15th I worked with almost 100 diabetes nurses, educators, researchers and physical therapists at the Region Steno National Konference in Copenhagen. I had them practice beginning a conversation from a solution-focused perspective rather than a coping perspective.

Screen Shot 2017-11-20 at 10.39.10 AM.png

Health professionals typically find it difficult to start a dialogue looking for what a person with diabetes is doing well; it requires a new way of seeing and developing a new muscle. They, like other providers I’ve trained, also found it hard, and eye-opening

I also had them work in pairs listening for and then sharing the strengths they heard in their partner after she had told a particular story. They were struck by how close you can become to someone you don’t know in a matter of minutes, just by listening with your whole being, listening empathetically. How valuable this would be working with their patients.

On the Thursday I ran another workshop, this one at Steno and gave a keynote presentation on the theme of the previous day’s conference – Patient Involvement. My own view is that pulling patients into the medical world asking them to take on greater responsibility will not activate them more in their self-care.

We must have providers step into their patient’s world – to see how they live, learn about their challenges and resources, and meet them where they are. That is the connection through which people feel that they are not alone and become more confident, able and desirious to take better care of themselves.

We should be changing Patient Involvement to Provider Involvement.

I recited a quote during my keynote that when I first read it spoke completely to this idea. It was in an article by MD Atul Gawande, a surgeon at Brigham Women’s Hospital in Boston and Professor Harvard School of Public Health.

“In the 1990’s we replaced medical paternalism with the belief that we should activate patients by giving them options. But in the real world they ask us, “What would you do?” Because you are the expert, you still know better. This is for you to decide we say. And that is when people feel completely abandoned.”

Gawande goes on to say that palliative care clinicians also offer patients options and then they do something more. They ask, ‘What matters to you?’ And then they do something more, they listen.

And this is when patients feel connection and capability, two powerful motivational forces.

It is difficult to experience, myself, and to watch people with chronic illness suffering. In part because many providers lack the training and understanding how to effectively treat people with chronic illness. It is also tragic to see providers suffer from burnout and frustration, and leave the profession because they lack these skills.

This is why every time I get to change this landscape, to strengthen providers’ skills and the bond between patient and provider, I know I am just where I’m meant to be. How tremendous this time it turned out to be Copenhagen.

NationalKonference_MathiasLoevgreenBojesen_0015.jpg

Photo by Mathias Løvgreen Bojesen

 

Afrezza does it for me first time out

IMG_7438.JPGI know a lot of type 1s have waxed poetic over the amazing effects of Afrezza-particularly it’s quick onset and just as quick exit from the body. That always appealed to me, but I couldn’t fathom how I could use it when the smallest dose it comes in, in its little colored blister packs as seen above, is 4 units. Eating low carb I rarely take more than 1 unit of rapid acting insulin for a meal.

That said, when I went to my endo last month something made me ask him if he had any samples he could give me so I could just try it. And, with unusual foresight, I packed it last night into my luggage for a two month trip I have just embarked upon overseas. While my blood sugar is pretty predictable when I’m home sticking to my routine, it’s all but that when I travel and have little influence over what I eat, jet lag, what my body’s biorhythms are doing, etc, etc…

So right out of the box, or I guess I should say gate, landing in Amsterdam at 9 AM Dutch time, 3 AM NYC time, being met by the husband, we sat for a cappuccino. Boom! My blood sugar began climbing from 102 to 194. I got out my insulin and began dosing single units until I’d taken 5. I daren’t do more. Even though my blood sugar was 264 and didn’t seem to be budging, I knew eventually it would. And that’s the crux, it takes so dang long to come down.  Two hours later it was slowly sliding back down.

Now 1:30 PM Dutch time, 7:30 AM NYC time, we went for lunch. I had mushroom soup and a stir fry with just vegetables and beef. I didn’t take any insulin because I figured I had enough on board to cover this meal. I didn’t. Boom! It started climbing again. Now, at 200 again, I took one unit of insulin and we walked around the corner back to our hotel so I could try Afrezza. No way I wanted a repeat of the morning’s runaway blood sugar train and wait hours to come back down.

A short search through my knapsack revealed the little box. A quick video on YouTube showed me how to load the inhaler and take a drag. Then I put Pinkie’s (Dexcom CGM), receiver and my iPhone both, in my pocket, and said a little prayer. I had no idea if I’d inhaled properly and would see results and I was scared if I did, how low would I go?

The darn stuff works! Within 15 minutes my climb reversed and I was coming down. Within 45 minutes I was at 120, In an hour and 15 minutes Pinkie was telling me I was at 84 with the arrow going straight down, then 70, arrow still straight down, then 55. I felt fine, but who knew. Checking on my meter I was 86. I remembered when your blood sugar’s going up or down rapidly, Pinkie needs time to catch up and straighten herself out from the roller coaster. I took 2 glucose tablets to create some cushion. Within 2.5 hours I was 105 and I felt Afrezza had left my body

If I hadn’t already taken the 1 unit for lunch, and just taken the Afrezza, I think it would have worked just great. As I’ve been told, 4 units of Afrezza, the smallest dose, works like 2 units of rapid acting insulin in the body. I can definitely see the value of heading off skyrocketing highs and getting back in target range much faster than with injected insulin. That is always my frustration, how slow insulin is to get working.

While I can’t use Afrezza often because I am insulin sensitive and do eat a low carb diet, I’m going to want to have it around when what’s around me is not my norm.

So, listen up everyone in Copenhagen, London, Abu Dhabi, Singapore, Sydney, San Francisco and Portland where I’ll be coming through, Afrezza is in my backpack and if you see me taking a drag I’ll probably have a smile on my face. Rest assured, it’ll be the insulin I’m toking on, not a souvenir from Amsterdam ;-).

My father passed away sunday

Screen Shot 2017-11-07 at 6.37.50 PM.pngScreen Shot 2017-11-07 at 6.38.28 PM.png
My dad above at my wedding 16 years ago. As you can see, I tend to be a controller. But I think in the end, he controlled when he left us.
He died peacefully early Sunday morning after four years of Lewy’s Body Dementia and two years in a nursing home. He would have been 95 this month. The service was yesterday. It was a lovely day. The husband and I got a ride up to the nursing home from our friend Geri, she also carried in her car two other friends from the city.
It’s funny; at first I hesitated to invite people. I didn’t want anyone to feel obligated, but when friends began saying they wanted to come, I realized how special their gift to us was: their presence, love and kindness, and the history we’ve shared.
The husband and I printed cards Sunday night from my old greeting card designs. We picked two of my inspirational designs that were meaningful to my father. We handed them out at the service as a celebration of a life, and they told the story of a man always looking to get and give love.
My mother read the lovely poem I leave at the end, “Gone from my sight,” which she has always loved, and I do too now.  I spoke about my complex relationship with my father, thanked all the nurses and aides who had taken such good care of him these past two years and told them, “he died at home,” for the nursing home was his home. My brother shared his own remembrances. Then the husband moved everyone with his tearful and heartfelt tribute and gratitude to the people who made me, my parents. Gadget guy has a very tender heart.
About 23 people attended, which amazed us. Some friends of mine and my mother’s, my mother’s mah jong partners, some of the nurses and aids from my father’s unit. It felt rich and full. And, it brought home how moving it is that we rally round each other, gather and give solace when sorrow comes.
There was one surprise when several of us went to my mother’s apartment after the service and lunch. We brought my father’s belongings, which the nursing home had packed for us, into her apartment. Opening the first box we fingered sequin blouses and half used mascara. My mother laughed that maybe my father had a secret life. In fact, half the boxes were the life remnants of a fellow nursing home resident who must have died this same week, named Alice Greenberg. I’m sure it was the first time Alice left the home in years. This morning someone came and took Alice’s belongings back.
Today we donated much of my father’s clothes and the left over lunch from yesterday to the neighborhood homeless shelter. My mother said as we turned the goods over to a lovely young man, “Maybe I could volunteer here when I’m ready.” He welcomed her anytime. She is blessed with a year’s bereavement counseling sessions, which will take her back to the nursing home where she’s spent the last two years and loves the people.
My mother is remarkably strong. At 87 she is still feisty as a friend called her, walking, talking, laughing and exhausted. Since my brother and I have been here for days, reality has not yet set in. She also fell in love with my father these last few years and it was noticeable to all who knew them. It will hit, it will come, and go, and come……
And I am fine. My father had a long life, as I wrote two years ago, I fell in love with him these past few years, and he was so well cared for in the end. With my brother’s quick wit, humor brought us together this week as well as sadness. We’ve laughed a lot as we huddled around my father’s bed this past week. In fact, it often felt like we were in  episodes of Seinfeld or the next hit episode of Norway’s Slow TV.
If there’s any lesson for me it might be the renewed realization that
our shared humanity is paramount
you never know what’s going on for anyone else
be kind
just showing up is a gift you give
and I’ll discover what’s coming as it comes.
If you’ve been following this blog with me, now and then, thank you.

Gone From My Sight

I am standing upon the seashore. A ship, at my side,
spreads her white sails to the moving breeze and starts
for the blue ocean. She is an object of beauty and strength.
I stand and watch her until, at length, she hangs like a speck
of white cloud just where the sea and sky come to mingle with each other.

Then, someone at my side says, “There, she is gone.”

Gone where?

Gone from my sight. That is all. She is just as large in mast,
hull and spar as she was when she left my side.
And, she is just as able to bear her load of living freight to her destined port.

Her diminished size is in me — not in her.
And, just at the moment when someone says, “There, she is gone,”
there are other eyes watching her coming, and other voices
ready to take up the glad shout, “Here she comes!”

And that is dying…

 

The universal language, a smile

Just spent the morning cleaning up my desktop. It’s like I can’t see what’s in the fridge if it’s not in the front, I don’t know what files I have if I can’t see them.

But I figured before I tossed this one, since it does make me feel a little lighter when I see it, I’d post it and then chuck it back in my docs.

You embrace yourself.pngWas one of my early drawings when in the 80’s I was designing inspirational cards. A smile doesn’t just make you feel closer to others when you share one, but happier yourself when you share one just with you.

5-day Diabetes Empowerment Summit. Tune in, it’s FREE!

Screen Shot 2017-10-29 at 9.41.40 AM.png
My amazing friend and fellow type 1, Daniele Hargenrader, is running her second diabetes summit. This time, she concentrates on empowering yourself to live with diabetes – and she’ll have 25 experts help you do just that.

It’s FREE and it runs from November 1 through November 6. Tune in here.

Screen Shot 2017-10-29 at 10.33.19 AM.png

I can’t help but add, my book, “The ABCs Of Loving Yourself With Diabetes” is a perfect tool to support you in your self-love and self-care. And now, it’s less than $10 on Amazon.

About the summit from Daniele:

How well do you take care of your emotional health around living with diabetes?

People with diabetes were asked about how they nurture themselves. 60% stated that they do NOT have tools to help build consistent habits around creating a mindset of empowerment around living with diabetes. Are you one of them?

Join 25+ myself plus other top doctors, experts, coaches, authors, and more, most of whom live with diabetes, and learn our best lessons, systems, and frameworks to help overcome the mental and emotional barriers of living with diabetes.

Most medical professionals never mention the incredible importance of fortifying our emotional health practices while living with chronic disease, because they truly don’t/can’t understand the true day to day lived experience of diabetesthemselves.

We took matters into our own hands to bridge that gap by creating The Diabetes Empowerment Summit!

WHY ATTEND?
Your host, Daniele Hargenrader, BSNS, CHC, CPT created The Diabetes Empowerment Summit because conventional medicine failed her on her journey with type 1 diabetes because nobody ever mentioned how crucial it was to address the extreme emotional side of living with chronic illness, or how to find a peer support system to learn from and grow with. This led to many years of an eating disorder, clinical depression, obesity, and an overall sense of helplessness.

It’s now her mission to help make sure it doesn’t fail you!

Join us if you have ANY TYPE of diabetes, or you love or care for someone who does. Health care providers very much included and welcome! Will you be there?

The Diabetes Empowerment Summit will help you:

  • Learn how to succeed in life with diabetes emotionally, physically, spiritually, and mentally through learning HOW to cultivate the mindset of empowerment around day to day choices through education & easily actionable self-love/care practices
  • Understand how to build life-long friendships and accountability partners, gain the support of medical professionals & coaches, and create and empowering, dependable network of peers who truly “get it” when it comes to living with diabetes
  • Finally understand what the term “psychosocial” (that, as of late, gets thrown around clinically but is never put into terms all of us can first understand, and then do something to improve once we do) really means regarding living life with diabetes, WHY it is so important to understand as a patient, caregiver, or clinician, and learn a wide variety of proven tools we can all use to change our psychosocial experience with chronic disease for life.
  • Learn how to navigate the intense emotional overwhelm and loneliness that often comes with feeling alone in our lives with diabetes and other chronic diseases
  • Understand how to massively increase self-confidence & the internal desire (inspiration) to participate in the necessary day to day, hour to hour practices that it takes for people with diabetes to live happy and healthy

The Diabetes Empowerment Summit is online and free from November 1-5, 2017!

Register for FREE here!

If you learn even one bit of information or a different perspective from one presenter that changes the way you think for the better, it will absolutely be worth it!

Looking forward to seeing you at the summit!

The Broken Brain – only 8 days left to watch

 

Screen Shot 2017-10-21 at 11.45.29 AM.pngDr. Mark Hyman interviewing Dr. Richard Perlmutter, author of Grain Brain

I’ve been watching a new online series of Dr. Mark Hyman’s called Broken Brain. Dr. Hyman works in functional medicine – which aims to treat the cause of disease – not the symptoms, and is famous for debunking the myth that carbs are better for us than fat.

Turns out the health of our body directly affects the health of our brain. Inflammation in the body, much of which is caused by insulin resistance – the cause of type 2 diabetes – causes inflammation in the brain, which in turn leads to dementia, Alzheimer’s, Parkinsons, MS and other diseases.

It’s a great informative series, Hyman interviews brain experts, neurologists and nutritionists, and it’s well worth watching. The quick take away is – cut the sugar, refined carbs, grains and processed foods, get more healthy fat and fiber in your diet, more sleep and less exposure to toxins.

But, do yourself a favor and spare the time to watch the series – http://brokenbrain.com/trailer/. Sign up now, there’s only 8 days left to watch.

Video taping 45 years of wisdom into 10 soundbites

Screen Shot 2017-10-09 at 2.41.26 PM.png

I was in a studio in Chelsea – no, not London, shucks!, New York. Digital video publisher, HealthiNation, is taping six “real” people with diabetes for a series of educational diabetes videos.  The videos will be online end of the year at ComCast Connected Health. The videos will share info from doctors and other experts  – and patients, to capture the feelings of living with diabetes and help others feel less alone.

I am not a novice in front of the camera. In fact one of my two majors in college was Mass Communication. As an independent study project, I hosted a cable TV talk show. I was the host, interviewer, script writer, guest-finder, producer…you get the idea.

But it’s been awhile and I forgot how everything – in the making of short videos – gets edited down into one minute “memorable, you nailed it!” statements. Oh, did I say one minute? I meant thirty seconds. No, fifteen.

I actually had a lovely time. The interviewer pictured here in black and white stripes was from Australia and I enjoyed her accent. I just find cinema amusing.

So, since I’m sure what might be salvaged from my 1:15 minute interview, might be three :15 soundbites, I’ll give you ten from my 45 years of living with type 1 diabetes wisdom that I shared last Friday on 17th Street off Fifth Avenue:

1. Learn everything you can – everything – and keep learning

2. Ask for help when you need it. It’s not weakness but strength.

3. Carry glucose tablets in everything so you’re never without – including on your husband

4. Per above, do your best to prevent going low, but it will happen. Try as we might, we can’t “control” blood sugar.

5. Don’t beat yourself up for anything. Learn from it.

6. When you’re out of familiar surroundings, let those you’re with know how to help you should you go low – and it’s not a cookie!

7. Make d-friends in person, online, chat, hang out – they “get” it

8. I tell everyone diabetes has made me healthier than I would be without it. It’s given me the incentive to eat healthy and walk an hour a day. Otherwise, I’d be a slob and have multiple conditions. (I didn’t really say the last sentence, but who knows)

9. The public doesn’t know: 1) diabetes is about more than not eating cake and cookies, 2) diabetes is serious and can lead to debilitating complications 3) there’s such as thing as type 1 diabetes

10. You can have a great life not despite but because of diabetes. It has brought me some really, really good stuff: friends, work, strength, health, purpose

4:14 PM – Lights out

Time to go celebrate my budding new career, sound-bite songstress

 

FreeStyle Libre Flash Glucose Monitoring System Approved!

Screen Shot 2017-09-28 at 6.48.50 PM.pngAfter distribution in 40 countries around the world – finally – the FDA approves this competitive glucose monitoring system in the U.S.

I’ve used the Libre “Flash” twice. Once when my sister in law smuggled the system to me from Holland. That was 2015 and I wrote about it here. Unfortunately, everything was in Dutch and our blood sugar mg/dl measurements were in the European system, mmol/l, but I got the gist. I used the “Flash” a second time in Israel this past January. I felt the system was more accurate the second time around. I don’t know whether that’s true or not. Its accuracy is on par with Dexcom.

I am a Dexcom user. I have the G5. I’m also a fan of the Libre. It is so easy to insert, is so small and thin and requires no calibration. That’s no finger sticks unless you want to check yourself on your meter. Which of course I advise whenever you’re not sure the number on your Libre makes sense.

The Libre has been approved for 10 day wear. Now here I feel cheated. Everywhere else in the world it’s approved for 14 days. And, while we’ve figured out how to “under the radar” extend the life of a 7-day Dexcom sensor, I don’t think the same is possible with the Libre sensor.

That said, the Libre fits better with my lifestyle. I’m a very routine person and so I don’t see the need to, or use my Dexcom day to day. I work at home where I control my food. I eat mostly the same things day to day, exercise the same way, an hour walk in the morning, and so my numbers are fairly predictable. Well, as predictable as blood sugar numbers can be.

I tend to use my Dexcom when I travel – for obvious reasons – I’m out of my routine. The problem though with Dexcom is I can’t use it intermittently. Once you start a Dexcom transmitter it runs for 90 days. Period, and then shuts off. So while I may need it for two weeks in May, I may not need it again until August. By then, the transmitter’s dead and I need a new transmitter which on my insurance isn’t cheap.

The Libre, however, is a sensor that runs 10 days. Each 10 day session starts anew. Much easier for my needs, although whether it’s covered on my health insurance will be key.

Freestyle Libre should be available before the end of the year. Abbott is working to get insurance coverage, until they do the reader (device you swipe over the sensor to see your numbers with about a 3 year lifespan) will cost about $69 and each sensor about $70.

For full coverage of the Libre and its journey to market take a look at Mike Hoskins’ great report today on DiabetesMine.

Forest bathing, proven to improve health

Screen Shot 2017-09-17 at 6.07.53 PM.png

I spent my birthday a few weeks ago at my friend’s house in a small suburban city an hour above Manhattan. His house is plentiful with big glass windows and doors and all you see when you look out of them are trees, and sometimes critters like deer, rabbits and turkeys.

Being surrounded by trees (no animals required) is called forest-bathing. Really. There’s a name for being around tons of trees – and it’s healthy. Of course it is. I always knew, city kid that I am, that visiting my Aunt in Maryland eons ago, when we finally drove off the turnpike and the landscape became green, and I was enveloped by trees, I breathed differently. Deeper. It made me more relaxed, more restful. It made me calmer and happier. Actually, it made me more in touch with myself.

I know there are people who feel this way on the beach, but I’m a tree-girl. If you want to read more about forest bathing and the real phenomena that it is, click here.

Leave it to the Japanese to actually name it. Now I’m sure they’re working on a way to miniaturize it and have it delivered by a robot.