I have been familiar with Riva’s amazing work as an advocate for people with diabetes for years now. I was able to finally meet Riva at the last AADE meeting in San Diego where Riva, educators from Hong Kong, and I had a great lunch together. Our conversation was very special for us, as diabetes educators. We talked with Riva not as a person with diabetes (PWD), but as our teacher, our mentor and our educator. We wanted Riva to help us become better educators, we wanted to learn from a PWD and create a true concordance. This blog is special as I can share the learning with you. Enjoy the read!

Why should we cope when we can flourish?

The language of diabetes is to “cope” with our condition. Health care providers help us to do this largely by focusing on the “numbers” associated with our diabetes – our A1C, blood sugar, blood pressure, cholesterol, triglycerides…. then giving us recommendations how we can make those numbers a bit better. They are helping us cope with diabetes. But maybe that is the wrong goal.

You probably already know this: People are not motivated by numbers. What you may not realize is this focus on the disease, rather than the person with diabetes, leaves patients feeling unseen, unmotivated to change behavior and alone.

I said maybe coping with diabetes is the wrong goal. Imagine instead that the goal of diabetes treatment was to help people flourish with their diabetes. And, not in spite of their diabetes, but because of it. This is the work I am doing.

I am sharing a new treatment approach with health professionals around the world. I call it the Flourishing Treatment Approach. It is a strengths-based, positively framed approach that asks professionals to work with patients in a more holistic, open-hearted way. There’s no clinical evidence to prove its merits, no studies have been done. Yet the diabetes educators who are using the approach from India, to Sydney, to Denmark, to Tucson, report their patients are coming up with their own solutions and enacting them, and that they feel greater joy and satisfaction as true partners in their patients’ care. I should say many diabetes educators and nurses already work from a caring place. Now they have an actual methodology and tools to help them.

Let’s contrast today’s conventional approach; what I call The Coping Treatment Approach (CTA) with the Flourishing Treatment Approach (FTA). The CTA, as I mentioned, is disease-centered and problem-focused. There is one expert, the health professional, he/she looks at what patients are not doing well and then creates a treatment plan. The overall aim is to help patients avoid complications. Thus, we can also describe the approach as fear-based. 

The FTA, quite differently recognizes that there are two experts in the interaction, the health professional and the patient who is an expert on her diabetes. As such, they work together as partners. Through open dialogues the provider draws the patient’s attention to what she is doing well, what strengths she has and together they explore what small step the patient feels she can take next. The Flourishing Treatment Approach overall aims to help patients create what they truly want - a healthy and happy life. The treatment plan is co-designed. 

I often give this example that providers understand immediately. Patients are often asked to bring a logbook of their blood sugars. What do providers typically look for? The numbers that are out of range. There’s a tsk-tsk, a bit of admonishment and the patient is told, “You have to do better with this.” Imagine how your patient feels. What if instead providers looked for the numbers that are in range, no matter how many or how few. What if patients then heard, “Congratulations! Thirty percent of your numbers are in range! Amazing, tell me how did you do that? How do you think you could do a bit more of that?” Do you think patients would feel different based on these two approaches? Yes of course.  

Let me close with a small yet powerful example I witnessed of helping people flourish. In this case it was children. Two years ago I shared the FTA with medical professionals at a diabetes clinic for the poor in Bangalore, the Jnana Sanjeevini Diabetes Centre. Every first Sunday of the month the founder of the clinic, Dr. Srikanta, invited all the families in Bangalore who have children with type 1 diabetes to come to the clinic for education and free supplies.

That Sunday, with the fifty or so families seated in the room, Dr. Srikanta called each child up to the front. He held each small hand, he picked the little ones up and rested them on his broad hip. He smiled and asked them one question. “What will you be when you grow up?” knowing that in India some of these children will not grow up. Some will not live beyond eighteen or twenty-five. Nevertheless he asked his question and each child gave his answer. “I will be an astronaut!” “I will be a teacher, or a doctor, or a mother.” It didn’t matter what their answer was of course. What mattered was in that moment, in that question, he filled them with hope and possibility for a long and healthy life. He inspired them and their families to keep working at their care. That is a flourishing act. In partnership, raising another to see the positive, to discover their strengths, to feel they are not alone. This is the foundation of the Flourishing Treatment Approach.

One young female doctor who worked at the clinic, who sat beside me that Sunday in the front of the room as each child came up to answer his or her question, she had been one of those children dreaming of being a doctor only a dozen years ago.

Riva is the recipient of the 2015 IDF Award for education and advocacy. She has written three books, Diabetes Dos & How-Tos, 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It and The ABCs Of Loving Yourself With Diabetes. Riva speaks to patients and health care providers about flourishing with diabetes. Visit her websites DiabetesStories.com and DiabetesbyDesign.com.

Two Special Offers

1. Book Discount: Until midnight January 31, you can order Riva’s book, “Diabetes Do’s & How-To’s” for only $10/copy. Go to, https://www.createspace.com/4113450. Choose “add to cart.” Fill in: 25BMCV38 where you see ‘Apply Discount’.
2. Booklet: To receive a draft booklet of Riva’s Flourishing Treatment Approach, please send your name and email address to: riva@diabetesbydesign.com. You will receive this gift in exchange for filling out a brief survey (5 questions) regarding your experiences working with patients.