Tried and new?: Peer Mentoring for Behavior Change

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Thursday I’m going to be interviewed by Daniele Hargenrader . She’s compiling 20+ interviews with PWDs and those who support us about the value we have received and given helping others with diabetes. She will offer the interviews free for a week in November.

It prompted me to go back and read an interview I had conducted a few years ago precisely on this topic of peer-mentoring. It’s here on the Huffington Post. I interviewed, at the time, associate professor and research scientist Dr. Michele Heisler. Heisler was studying the value of peer-mentors and peer-mentor programs.

Heisler confirmed the value doing an unlikely experiment. She paired two low performing patients (high A1Cs) to mentor each other. She also surprised most of her colleagues who heard about her experiment and didn’t believe low-performing patients would improve by mentoring each other. Yet, they did. In an excerpt from my interview below Heisler  explains.

Q: There was something else surprising about your study. None of the patient partners had good control of their blood sugars when they began the program.

MH: That’s absolutely true. When we were planning this a lot of people said to us, “What are you doing?” because all our participants had high A1cs and were struggling to bring down their blood sugar levels. Many people felt that we should keep to a more traditional peer model where one peer with good control helps coach somebody with poor control. Yet for all the reasons I mentioned they were quite able to motivate each other and themselves. Interestingly, the least successful pairs in our pilot were someone with very poor control matched with someone with very good control who didn’t seem to have any problems. The person with poor control said to herself, “Gosh, this person is clearly not like me and I have nothing to offer her.”

Peer-mentoring has always seemed to me an extremely low-cost, high touch way to have people with diabetes help each other, and themselves. And much of the benefit, is not merely improved clinical outcomes, but support, learning real-live tricks (today we’d call them hacks) patients know and use, and lifting depression and lonliness. For the whole interview with Dr. Heisler, click here.

Circling somewhere near heaven

I was leaving the nursing home where my father lives. My dad at 93 years old sits in a wheelchair now and pajama bottoms. No more the slacks he wore only a few months ago. No more walking down the hallway with a cane, wobbly but walking.

I wrote not long ago that this is the man I grew up hating. Truly, I did. Yet these past few years love is all I feel. I think now he loved me a long time before he could show it. For when I see him – or rather as soon as he sees me – I get this reaction. I am his long-awaited Christmas present, swinging colorful piñata, and every joyful thing he can imagine rolled into one. (Mind you this is not my best side, and he’s Jewish.) But, hey.

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Leaving the facility, my mother turned to me and I don’t know why, asked me, “Do you think growing up in a house where your father and I were unhappy together had anything to do with your diabetes?” “Everything,” I said.

My mother looked crestfallen. “But it’s okay,” I said. “Look at what it’s given me. I know how strong I am… my compassion, sense of purpose. I love this work, the people it’s brought into my life, traveling around the world.”

Of course I wasn’t thinking in that moment about the six to eight shots a day, the six to ten finger pricks a day. Constantly counting carbs. Worrying that my evening walk or wine at dinner or delayed impact from my morning walk or miscalculation of dinner carbs will cause me to not wake up in the morning. Hmmm… maybe I was having a low when I answered my mother. Nah.

Somehow, in quiet moments, it all makes sense. How I grew up, having type 1, my transformation from shy, shy, shy to speaking on world stages, becoming in many ways the person I’d hoped to be and the richness of my life today.

I’m truly grateful that my father has lived long enough for this love to be our swan song. And my mother’s who brings him companionship and comfort every day. As all the gurus say, this moment is the only moment. This moment is your life.Screen Shot 2016-08-30 at 11.40.41 AM.png

 

What I brought home from the 2016 AADE conference

Just returned from the American Association of Diabetes Educator’s national conference in San Diego. There were about 3,500 attendees and the husband and I delivered an interactive workshop, attended by about 400 educators, on our Flourishing Treatment Approach. People loved it – a new approach based on what’s working rather than what isn’t.

It’s always a delight to see those I’ve met through the years in the diabetes space – in the flesh – and share news and just, well, face-to-face space.

One of my favorite two sessions (as you might imagine I go to the behavioral sessions more than medical) was diabetes psychologist Susan Guzman’s on the shame and stigma of diabetes. I was surprised to see shame is even higher among type 1s than type 2s.

We’ve got to do something about this, including the shaming language we use like “bad blood sugar numbers,” “non-compliant” and “diabetic.” A team of diabetes influencers met separately to begin a grassroots movement to start changing the language landscape of diabetes, led by CDE, PWD Jane Dickinson.

I also got a lot of hope out of the session given by diabetes psychologist Bill Polonsky and doctor Richard Jackson.  I learned something surprising given what we always hear. That  those living with diabetes are doing loads better than people were years ago. For one, diabetes complications have dramatically reduced. See the difference from 1978 to 2009.

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As Bill says, “Well-controlled diabetes is the leading cause of nothing.” Of course, for me, well-controlled diabetes is a leading cause of – pride, strength, self-esteem, compassion and a more purposeful life, among other benefits.

I also picked up two tips worth sharing at the Dexcom table in the Exhibitor Hall.

  1. When you calibrate your Dexcom the first day you need only do it at 3 different times during the day. When the transmitter first starts up and asks for two calibrations, two hours after breakfast or lunch when your blood sugar will be at its highest (to expand its accuracy range), and before bed so you don’t get woken up for a 12-hour calibration the middle of the night.
  2. After picking up my fabulous stickie in Tokyo (which I’ve written about and posted photos of here a few stories ago) that fit perfectly around my Dexom transmitter and sensor, I learned there’s a site called GrifGrips.com that sells stickers that both go around your Dexcom and over. The choice is yours.

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Home again it’s time to unpack and get back to work and play feeling fortunate to have had such a great trip and met so many wonderful, caring diabetes educators, bloggers, colleagues and comrades.

The rivalution – you can’t “control” blood sugar

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I’m getting very vocal these days about the insanity of expecting people with diabetes to  “control” their blood sugar. I feel I’ve got the right. 44 years of daily, hourly experience, scientific and systems theory behind me, and the known and accepted unpredictability of biological systems. That’s us.

Don’t let people – your doctor, educator, spouse, anyone – tell you to control your blood sugar. Ask them what your blood sugar numbers should be, what they mean, what actions typically cause higher and lower numbers – and how to respond to the numbers you get to stay in your target range as much as you can. And if you don’t know what your target range is – ask. It’s your body, your health, your life.

If you missed it, this is WHY you CAN’T CONTROL your BLOOD SUGAR. But there’s a lot you can do to influence your numbers. And those times when they give you the finger for no good reason, with all the “right” things you’ve done, just know that’s diabetes.

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2 Best breakfasts for diabetes

A month ago I was traveling through Europe and my downfall is my love for muesli. But muesli has a million carbs. My very kind sister-in-law, who lives in The Netherlands, found a low carb muesli in the “health food” section of her supermarket, and I feasted. I decided, why not throw together a similar mix once home.

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Above my cereal all prepared. This recipe will look like a lot of work – it’s not. It just takes a few minutes preparation because I throw a lot of stuff in. But there is no cooking, baking, etc. You can also mix up a big batch at the beginning of the week; I happen to like preparing it fresh as a morning ritual. Here’s the mix before the milk is added.

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Here are the ingredients. Know that these ingredients can be changed up according to your tastes, so you can certainly leave some out or change the fruits. Just bear in mind, it’s low carb because what goes into your bowl is mostly seeds and nuts.

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Amounts are not exact, but you’ll get the idea:

• spoonful of chia seeds

• spoonful of flaxseed meal (ground flax seeds)

• spoonful of hemp seeds

• spoonful of uncooked rolled oats

• handful of mix of pumpkin and sunflower seeds and poppy seeds

• handful of nuts

• few berries and one prune cut into little pieces

• enough salt for flavor

• 1 packet stevia

• tsp cinnamon

As for the milk, I will often add a bit of half and half, then Almond milk and then some water just to dilute it. The chia and flax seeds will want to soak up the liquid. I find this cold and crunchy cereal just perfect for a summer day – and so anti-oxidant, omega-3 nutritious.

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Above is my other great low carb breakfast, a flax seed muffin, which I’m sure I’ll revert back to when the temperature drops. Recipe here.

 

 

Understanding a life makes for more successful treatment

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I’m sharing a new treatment approach with health professionals for managing diabetes. I call it the “Flourishing Treatment Approach (FTA).” It is a powerful way to help people with diabetes not just cope with diabetes, but flourish.

I have written many articles about flourishing with diabetes, which you can easily google. One of the foundations of the FTA is to discover who your patient is and their life context. Context is so important. How we live: our daily routine, family, neighborhood, supports, what resources are available to us, what challenges we have…You may tell a person with diabetes to “do this, do that,” but if you have no idea how they live chances are you will not be successful.

I read this story below in a book I’m currently reading, Putting Stories to Work: Mastering Business Storytelling by Shawn Callahan. It drives home the point how important context is.

“In 2007, The Washington Post sponsored a little experiment. The Grammy Award–winning violinist Joshua Bell was asked to busk inside a Washington metro station to see what crowd he might draw and what money he might make.

A few days before, Bell had played in front of a sellout crowd at Boston’s Symphony Hall, with many people paying $100 for their seats, so you would imagine that he’d do pretty well in the metro.

Well, at around eight o’clock in the morning—peak commuting time—Bell opened up his violin case to catch coins and then played his heart out for 43 minutes. A total of 1097 people passed him by, and while a few tossed the odd quarter into his case, the rest didn’t even acknowledge the virtuoso performance.

The Bell experiment showed that meaning is malleable and context plays a big role in what version of a story you might hear. Two people might tell entirely different Joshua Bell performance stories, one involving a concert hall and the other a subway station.

For this reason, it helps if you listen out for a number of stories around any issues you are trying to make sense of, so that you can triangulate meaning.”

Successful diabetes management is not just about “the person.” Context has massive impact on behavior. Taking the time to learn the context within which people live and operate will help make you and your patient more successful.

Angels sitting on my shoulder

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Rummaging through my top drawer this morning, that sooo needs to be cleaned out, I came across something I’ve had for decades – a pack of Angel cards. Remember those?

Each tiny card in the tiny box has an angel drawn on it and a spiritual quality written – like compassion, integrity, faith, gratitude, humility…The idea is to pick a card a day and meditate on that quality bringing it into your day.

I immediately picked a card and got Expectancy. My first thought was how could Expectancy not be selfish? Yet when I passed the card a few minutes later and saw it again, I felt my whole body lift slightly, feel more buoyant. I smiled as an automatic response. Expectancy was thrumming through me, and making me happy.

I didn’t know what to be expectant about but liked holding the feeling of expecting something good (my choice). Expecting something good makes you feel good. One could say most of our negative thoughts are merely feelings of expecting something bad.

Then I thought why not share with the husband? I brought the cards out from the bedroom, extended them to him face down and had him pick a card. He picked “Freedom.”   And of course now it makes perfect sense.

He should feel free to give me any gift of his choosing and I’ll be awaiting with joyful expectancy😉

Inside view how the practice of medicine is changing

Screen Shot 2016-06-28 at 1.24.30 PM.pngI love reading readable books from health professionals. It truly helps inform me of their world since I can only sit on the other side of the examination table. You may know some of my favorite doctor/authors – Dr. Danielle Ofri for instance. She has written several books about things patients have taught her and writes for the NY Times. Then there’s  M.D./patient Rachel Naomi Remen who is also trying to help health professionals recapture the enthusiasm with which they first entered medicine.

I just picked up another such book, cover above. I’ve only just started but these passages below jumped out at me below. You can also read a very favorable review from the NY Times, and also an excerpt there.

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