The twelfth year of my 20-year overnight success: Broadening the bandwidth to Flourishing with illness

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I just got back from the Netherlands. I went as a speaker in Novo Nordisk’s 5th DAWN Summit. Doctors, patients, psychologists, policy-makers and researchers gathered from 33 countries for two days of idea-generation and planning how to improve the lives of people with diabetes. I met wonderful people equally committed to help people with diabetes live fuller, healthier, happier lives, including a noted Dutch psychologist, Frans Pouwer, who hearing of my Flourishing Approach now wants to research it.

While in the Netherlands, I was also invited to speak to the leadership team of AstraZeneca, NL. AstraZeneca acquired Bristol-Myers Squibb and now diabetes is one of their largest market sectors. 

For the past few years I’ve been noticing, increasingly, we live in a time I’d call “The Rise of the Patient.” As patients, we are leaders in our own right living with an illness, and many of us have insights and capacities to help transform healthcare delivery for chronic illnesses. My own work toward that is sharing with health professionals how to work from a Flourishing Approach, as opposed to the traditional Coping Approach. And for people with illness, to live from the same orientation. I shared the Approach with Ginger Vieira in this recent post, “From Coping to Flourishing: How a Better Mindset Can Transform Health.”

Every year since I’ve been working in diabetes I’ve said, “I’m in the first year of my 20-year overnight success.” Of course each year it increases by one. Now I am in the twelfth year of my 20-year overnight success – and I feel the traction: of my own success, of the power of the patient and of minds opening to the idea that we have to do chronic illness differently. Actually, I have been sharing the Flourishing Approach over the past several years at various conferences e.g. the American Association of Diabetes Educators’, TCOYD, DiabetesSisters and each time I am met with enthusiasm and respect.

In the past few months I have received many opportunities to share the Flourishing Approach and its tools around the world. In December in Melbourne, Australia at the IDF World Congress, where I addressed 134 Young Leaders in Diabetes on behalf of Novo Nordisk.  A few weeks later, at the Royal Prince Alfred Hospital in Sydney where I addressed the endocrinology department.  

In January I spent 18 days in Bangalore, India where I gave six classes and workshops to health professionals at the Jnana Sanjeevini Medical Center, a diabetes clinic for the poor. I have also addressed more than 200 medical professionals at two premiere hospitals in Singapore. Two years ago I gave a workshop for health  providers of the Pascua Yaqui tribe. It was held over two days and the second day patients joined providers and together barriers dropped, communication opened and both saw a new space open in front of them.  

In March of this year I presented the Flourishing Approach to the Telehealth group of NYC Health and Hospitals Corporation. There a staff of committed nurse/coaches speak weekly to people with diabetes in need of help. They, like all I have spoken to, have been delighted to hear this more positive approach and are interested in applying it in their coaching practice with patients.  

I have written a number of articles on this approach. “A Flourishing Approach to Mental Health in Patients with Diabetes” in last summer’s issue of the peer-reviewed On the Cutting EdgeTwo recent articles on The Huffington Post include, “Chronic Illness’ Opportunity for Patients and Providers” and “The Antidote to Living With Diabetes.” There will shortly be an upcoming article on Sanofi DX. And now I feel fully confident that I have enough research, tested the waters and seen everywhere I present this new framework/lens and way of working and living, providers and patients have only wanted more. 

So this year I will be writing my next and fourth book on flourishing with diabetes. It will provide the understanding of a flourishing framework and how – and why – we need to treat people with chronic illness differently than we do today. Moving from problem- to solution-focused. To look at what’s working instead of what isn’t, work from a trusted partnership, be compassionate, see the whole person and understand the context within which they live, not merely micro-manage the disease. 

We must offer hope and possibilities, knowing the power of both and that there is post-traumatic growth, not only post-traumatic stress. We must explore patients’ strengths and resilience, as we help them move toward a healthy, happy, vigorous, robust and purposeful life.

For twelve years I have said, “You can have a great life, not despite, but because of diabetes.” Because people shared with me this is how they were living. 

We can open a doorway to a new space to be with patients, and a new space for people with illness to be in, where coping is not the target or the answer, but flourishing is. 

It is time.

AADE’s 2013 Annual Conference report

interaction with audience

I returned Saturday night from the annual conference of Diabetes Educators, this year in Philadelphia. While there were fewer educators there than in year’s past, around 2,900 rather than 3 or 4,000, probably due to budget cuts, it was a pleasure for me to see so many people I know.

There were many from the DOC (Diabetes online community) including Cherise Shockley, Scott Johnson, Manny Hernandez, David Edelman, Amy Tenderich, Lee Ann Thill, Kelly Kunik, Kerri Sparling, Bennet Dunlap, Haidee Merrit, Hope Warshaw and more, where do I stop? 

Cherise and Scott led a DSMA twitter feed evening where everyone was answering patient call in questions. And all these guys I’ve just mentioned have diabetes blogs – just google them.

There were people from industry I always like to see including Rob Muller from Roche, Andreas Stuhr and Laura Kolodjeski from Sanofi, reps from my own A1C Champion group, Anna Floreen and Bill Woods from Glu.org…and on and on.

There were 1,000 exhibitors in the exhibition hall. And there were educators. An impassioned group of professionals. Gary Scheiner, educator extraordinaire was awarded the 2014 Diabetes Educator of the Year award and my friend Claire Blum won AADE’s technology award.

While there was a smaller turnout, I felt some winds shifting in the diabetes landscape. Now when presenters used the words, “adherence” and “non-compliance” they did so making fun of those terms, realizing this is no way to categorize patients.

The loud saw of being “patient-centric” and using “motivational interviewing” seems to be subsiding. And actually my own presentation, “Dancing Together: The Power of a Relationship-Centered Approach,” introduced the paradigm of working together, HCPs and patients, talking, exploring, in a compassionate partnership to ultimately design treatment plans – together. That there is a time to teach and a time to listen. A time to be and a time to build. That motivation is nice, but skills are necessary and often overlooked.

Roche generously sponsored giving a copy of my book, “Diabetes Do’s & How-To’s” to the 141 educators who attended the presentation, and I thank them.

For highlights of what was on view in the exhibition hall, take a look at Amy Tenderich’s review.

Back from the AADE

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I know I’ve just returned from San Antonio because my body is craving guacamole and the smell of fresh mint in those juicy mojitos! Ah, but that’s not what you tuned in for, is it?

The annual diabetes educators conference was a hit with thousands of diabetes educators, nurses, physicians and pharmacists attending the 4 days of lectures, bonding, learning and renewing their credentials, and their spirit. The first evening at the poster event while all were mingling, I asked several CDEs what keeps them going. The answer was always the same, “Making a difference in someone’s life,” and that feeling was palpable.

The meeting kicked off with President, Deb Fillman’s welcome address.  I was extremely happy, and surprised, to hear her talk so emphatically about the need for change. The need for educators and the profession to look outside the box for new ways of working as more will be asked of them. 

Prevention is becoming a big topic in health care and for CDEs. The U.S. Senate’s passage of the health care reform bill late last year includes a provision to establish a National Diabetes Prevention Program. This means an expanded role for CDEs in the prevention of diabetes. Although god only knows how they will do more given the thousands of educators for millions of patients.

Fillman asked the audience to be more adventurous with change in their personal lives, taking on challenges and reaching for more fulfillment and success, as it will flow into being even better mentors and educators. Fillman also spotlighted the AADE’s new online tool, “My AADE Network” which helps members connect wherever they are and create an online community and remote learning.

Rear Admiral and former AssistantSurgeon General, Susan Blumenthal, was the keynote opening speaker. She pressed the sense of urgency upon us that we need to stand up to deal with the obesity epidemic now that’s taking a huge toll on America’s health and economy.  

The exhibition hall, always interesting to me, didn’t get as much traffic as usual and vendors didn’t know why except to suggest the short hours precluded many attendees from spending much time there if they were sitting in on continuous lectures. Also, the bookstore made a decision to only carry ADA publications and those of their speakers doing book signings. Other authors needed to show their own book(s) at their own booth, if they had one. 

I presented Saturday morning a behavioral program titled, “Beyond Motivational Interviewing: What Can Happen When You Catch Someone Doing Something Right.” There were about 100 attendees excited to be introduced to an entirely new mindset and model for working with diabetes patients: a mindset of “flourishing” with diabetes and a coaching model that enables health professionals to work as facilitators with patients, as appropriate, to:

1.  Explore the context of patients’ lives 

2. Play “Strengths Detective” to help patients recall and reconnect with capabilities they’ve used in the past

3. Collaboratively design mechanisms for sustaining healthy habits, causing positive behavior change faster and more sustainably than when only using the traditional model of “telling patients what to do.” 

This is exciting stuff that you’ll be hearing more about. I am currently putting the finishing touches on a curriculum to train health professionals on this mindset and model along with my two partners,Boudewijn Bertsch and Eileen Murphy.

A phenomenal play called, ‘Close to the Heart’ produced by Amylin was one of the conference’s highlights. With real actors in tow, it dramatized a patient getting a diagnosis of diabetes and how she deals with it, along with her relationships with her jealous best friend who is struggling with her diabetes, her supportive, yet pre-diabetic husband, and physician. Even I who have had diabetes for 38 years felt anew this woman’s confusion and pain. 

After the half hour performance Dr. Steven Edelman of TCOYD, Psychologist Bill Polonsky of BDI, heart surgeon Robert Chilton, Dr. Stephen Brunton and host Davida Kruger, certified nurse practitioner, answered questions in a panel discussion. Kudos to Amylin for going outside the box. It was a smash, and I know Amylin has plans to make short videos of it.

The general session closed with an in-your-face presentation by Dr. Michael Roizen, Chief Wellness Officer at Cleveland Clinic about the cost, both physical and economic, of our obesity and diabetes tsunami. Roizen has been an impressive change-agent spearheading the “Lifestyle 180 Program” at the Cleveland Clinic, which was first piloted with Clinic employees and now available to patients.  

One point Roizen made that still resonates is — food is an absolute, you can’t make a deal with food. What you eat is critical to your body and your health and either will or won’t turn on the genes for illness. For instance the sugar in ice cream will change the proteins in your body. That, he says, is a given. You can burn off the calories, but too many unhealthy foods and you’re creating inflammation which creates disease. 

Next year’s conference is in Las Vegas. I think my husband is already booking the hotel and buying his binoculars to look for Elvis.

What’s in the Exhibition Hall at the AADE conference

Major buzzing in the hall

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EatSmart, this scale does it all

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Pelikan Sun lancing device, it’s gold

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A pocket glucose spray

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A dream pasta, Dreamfields

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Dr. Francine Kaufman closing the conference

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You can make a difference in a child’s life

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Now, to  conclude my last post, remarking on the annual American Association of Diabetes Educators Conference in Washington D.C. Let’s be honest, the most fun at one of these events is looking at all the stuff in the exhibition hall, and of course eating your way through it. I managed to do both: nibbling almost every few feet on low-fat blueberry yogurt, Activia, walnuts, cereal bars, Lean Cuisine, soft serve ice cream and lots of tidbits that resembled food but I’m not really sure they were. Gadget-wise, in truth I’ve been to a lot of exhibition halls and I didn’t find all that much new, but these things are worth mentioning:

  1. Eat smart. A small, great looking scale that measures everything and tells you how much it weighs, its calories, carb content and 7 or so vitamins and minerals. To be honest, my husband was immediately attracted to the gadgetry while I thought oh another thing to be bothered by. But, having it in our kitchen now and knowing that the plum in my fruit bowl I’m about to eat has 27.6 carbs is an incredibly useful addition to my management.
  2. Meters, meters, meters everywhere. Glucose meters have become a parody product, but I did see one that caught my eye by Intuity. You put your finger over a hole at the bottom, it pricks it and in seconds gives you your blood sugar reading. Notice, no test strip. Due out next January, now let‘s just hope they make it a little less masculine looking.
  3. On site A1c testing. I only learned recently many doctor’s offices offer A1c testing right in their office, while I’m always trekking off to the lab. Well, here at the show I could avail myself of five booths that would give me my A1c result within minutes, so of course I had to test this. I tried three different booths and came up with a 5.0, 5.4 and 5.5. Given that I’d just had my A1c done at the lab two weeks ago and it was 5.8, I’m inclined to say two of my three tests at the exhibition hall were in the ball park.Reli-On makes a kit where you smear some blood on a pad, mail it in and get your A1C results in a week.
  4. My lancing device ratings. Since we all know lancing devices cause more pain than injections I have a personal investment in keeping up with improvements in this area.
    1. First place winner– Pelikan Sun. It’s battery operated and has a feather touch. Downside: expensive, about $200 for the instrument and a little larger than a pack of cards. I’m told lancets should be covered by insurance Upside: you won’t mind testing 10x a day.
    2. Accucheck Multi-clix. The best, least painful cheap lancing device. It runs on a track so the lancet doesn’t shred your skin when piercing. My favorite run of the mill device.
    3. Renew from Can-Am Care. Operates on the same track technology as Multi-clix. Cool packaging and the only other stand-out in the pack. You can request a free trial sample online.
  5. Pumps are getting smaller and more are getting tubeless. Omnipod, the only tubeless pump right now promises a pump half the size within two to three years, I’m staying tuned, and Medtronics is working toward the same. I’ve always said when the pump is the size of a credit card, count me in.
  6. Omron, a company that makes blood pressure machines and pedometers is coming out with a new pedometer next year that’s slim, you can slip it in your pocket rather than clip it on your belt and it will work at any angle. I like the ease of putting it in a pocket. The husband loves the techie gadgetry.
  7. Glucose Rapid SprayA tiny atomizer mist spray. 5 to 10 sprays onto your cheek will help bring your blood sugar up a bit when you’re going low. Handy to carry when away from home or exercising, but I’m told not a resue item. I’m waiting for my first potential low blood sugar to give it a try.
  8. Dreamfields. A dream of a pasta. I gave up pasta for a dozen years due to how high and how quickly it raised my blood sugar. Now Dreamfields has created a pasta that nets only 5 grams of carbs per serving and I know it works. They’ve reconfigured the pasta’s molecular structure and much of it is highly non-digestible when traveling through your stomach. It still tastes delicious but doesn’t break down into carb. I swear give it a shot. I find it at my local supermarket chain, Key Food, but they’re distributing many places.

Helping Third World Children with Diabetes

The conference was closed by Dr. Francine Kaufman, pediatric endocrinologist at the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital Los Angeles. Kaufman is a tireless advocate against childhood diabetes. She shared clips from a documentary she made for the Discovery Health channel, Diabetes: A Global Epidemic, where she traveled through Africa and India bringing medicine, training and treatment to poor children, families and caretakers. Countless children are dying of diabetes because there is no medicine, no meters, no test strips, no doctors. In places where insulin is obtained on an irregular basis children are given whatever is available. Can you imagine using only Humalog one month, then only Lantus another, then NPH yet another? How would you ever figure out your protocol? I get chills just thinking about it.

If you would like to donate unused, unexpired medical supplies they are taking them atwww.Lifeforachild.org. You can also contribute $1/day and a child will receive medicine and testing supplies.

Having this podium I leave you with my own closing remark which is an observation: I found it profound that here in America we are literally dying of abundance: too much food and too many luxuries that make us lazy, while around the planet people are dying of scarcity: too little food, too little medicine and too few health care professionals.

It’s something to ponder, I think.

In the Convention Center with diabetes educators

Washington D.C. Convention Center

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Inside a great maze of learning

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AADE President opens the event

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Elizabeth Edwards key-note speaker

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Shuttle buses everywhere

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AADE bookstore, upper right corner 

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The great Exhibition Hall

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 As promised, here’s my brief report of the 35th annual conference of theAmerican Association of Diabetes Educators (AADE). 4,000 educators from around the U.S. and a sprinkling from outside the U.S. convened at the Convention Center in Washington D.C. for four days of lectures to earn credits and learn the latest news regarding drugs, devices and behavioral practices to better help their patients. They are an impassioned group truly wanting to make a difference. Having a concern of my own, why I’m getting red dots every time I inject, each educator I asked went right to work examining the problem and investigating my behavior truly wanting to help, and yes, I did take advantage of my circumstances.  Unfortunately, diabetes educators are dwindling in number each year while patients are increasing, making their work ever-more demanding.

My husband and I descended upon Washington together both eager to hear what educators are learning, teaching, what’s new in the field and how patients are being served and responding. I also wanted to thank, in person, the many experts who were speaking there and have been helping me with the book I’m currently writing, debunking diabetes myths. Arriving the night before the conference began our first self-assigned task was to find fruit for the husband’s next morning breakfast. Within a 20 block radius of downtown D.C. there is not a banana, orange or apple to be had. Trust me, I know; I asked shopkeepers, restauranteurs, passers-by and the hotel concierge. The closest we came was Tang, a powdered orange juice like drink at a CVS drugstore, but alas, not a single piece of fruit. I found it remarkable that blocks away 4,000 people had convened to learn how to help patients improve their diet and eating habits, and yet in our nation’s capital I could not find a piece of fruit. Proving once again diabetes is not just a medical issue, not just a behavioral issue, but also a systemic issue: our society’s infrastructure does not support practicing the healthy behaviors we hear about daily on the morning news.

But, forgive me, I digress. The conference was opened by Amparo Gonzalez, current president of the AADE. Her lilting accent welcomed everyone in the huge basement hall where I sat amid a sea of largely Caucasian, middle-aged women, with perhaps one man to every 50 women. Elizabeth Edwards, the key-note speaker, gave an hour long, impassioned address sharing her own experience of living with cancer and built a bridge between all of us who live with a chronic illness. She was real, warm, bright, funny, engaging, shared her darker days with cancer and spent the last 15 minutes comparing Senators McCain and Obama’s health plans. While she promised to be impartial, which I believe she was, she gave both plans low grades letting us know neither is as workable as either politician would have us believe. I left concerned that our already broken health care system is not getting fixed anytime soon. Unfortunately, two days later her broken marriage was being aired on the Convention Center’s TV monitors every few feet.

Here’s what educators are learning:

  1. New medicines, largely that deal with type 2 diabetes, and more meds on the horizon indicate diabetes is not merely an insulin problem, gastric hormones are getting more and more attention.
  2. The artificial pancreas is inching ever forward in trials largely due to the efforts of  the Juvenile Diabetes Research Foundation.
  3. Diabetes educators’ largest hurdle is getting patients to change behaviors: adopt healthier eating habits and exercise.
  4. Educators’ second biggest hurdle is once they’ve gotten patients to adopt healthier behaviors, getting them to sustain them. The drop off seems to occur 4-6 weeks later.
  5. Educators are being encouraged to shift from being “teachers” instructing patients to being “coaches” partnering with patients.
  6. “Peers for Progress” is a new AADE initiative getting underway to utilize patient mentors. We knew it was coming, too many patients for too few educators.
  7. Personal note: My book, The ABCs Of Loving Yourself With Diabetes, initially declined by the AADE bookstore because it wasn’t deemed something educators would find useful, sold out in the first few days.

Most educators I spoke with find trying to change patients’ behavior difficult and challenging, yet derive enormous fulfillment when they can help a patient succeed. As one told me, “If I can really make a difference for just 10% of my patients, I’m so happy.” I think they are soldiers, every one of them always on active duty. In truth, I’m surprised there isn’t a higher burn-out rate amongst educators. 

 
In my next post I’ll tell you what I found new and interesting at the Exhibition Hall where another 1,000 people had gathered to show their wares.  

 

 

7, a lucky number, even with diabetes

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Remember that ground-breaking management book from Stephen Covey – The 7 Habits of Highly Effective People? Well, Mr. Covey and the American Association of Diabetes Educators (AADE), with support from Bayer Diabetes Care, have released a small pamphlet applying his 7 habits to diabetes care. Covey’s inspiration for the booklet? His wife was diagnosed with diabetes.

I imagine the thinking behind this booklet is to give patients a new tool to manage their diabetes, adding to the typical diet, exercise, meds routine. This tool has the patient draw from a more emotive place: understanding, listening, cooperating and picturing your perfect life. What impresses me is the head-nod to the fact that managing diabetes is not just about medical management, but includes our emotional, mental and spiritual being. Covey’s habits are:

1)   Be Proactive – Choose your actions, and be responsible for them

2)   Begin with the End in Mind – Create a vision for your life based on what is most important to you

3)   Put First Things First – Prioritize tasks based on importance and what one thing can you do regularly that will make a positive difference in your life?

4)   Think Win-Win – Build relationships with others by helping them succeed, too. From this you create the positive energy of cooperation which leads to success in all things in your life, including diabetes management.

5)   Seek First to Understand, Then to Be Understood – It’s about listening. Listen to your health care team to gain the practical skills of self-care

6)   Synergize – Combine guidance from your team and support from friends and family

7)   Sharpen the Saw – Keep everything sharp: your body, mind and spirit

It’s hopeful watching the AADE move in this patient-empowerment direction. In a perfect world, patients’ attention, with the help of their educator, would be on greater quality of life, not so singly focused on diabetes task management, but weaving that into a vivid picture of a happy and healthy life. For a positive vision of our life is truly where our motivation and energy come from — for all things — including managing diabetes. Diabetes educators would exhibit less ‘directorial skills’ and more coaching skills, helping people design a ‘life plan’ with diabetes in it, rather than just a ‘numbers plan’ — blood sugar, blood pressure, lipids, you get the idea. But since we can’t ignore the numbers aspect of diabetes management, at the back of the booklet you’ll find the AADE’s 7 self-care behaviors.

The booklet is a nice start. To get yours – and it’s free – go to: http://http://www.diabetes7.org. What we need now is a well-trained team of educators ready and able to help patients put these habits into play. Well, I guess one can’t ask for the moon, the stars and the sun all at once. But this moonbeam is a small ray of hope. For more information about the AADE, particularly if you’re looking for a diabetes educator in your area, go to: http://www.diabeteseducator.org.