Motivational interviewing
to help people with diabetes
      improve their diet.
You have diabetes.
This is serious! You
DOCTOR     need to lose weight,
         clean up your diet, and
         take these medications
    ...
WIFE



You aren’t supposed
    to eat that!
Give me that cookie!
You look sad.
Here, have a treat!
                      MOTHER
Let’s check
  your sugar.
Oooh, it’s too high!




              NURSE
Why do you have
               all this junk food
                 in the fridge?



NUTRITIONIST
Blah, blah,
                     blah, blah,
    Blah, blah,     blah, blah…
    blah, blah,                     Blah, bla...
Leave me alone!
   I’ll just eat
whatever I want.
“Diabetic Diet”
Basic Guidelines
 • Eat 3 meals/day
 • Make your meals
   balanced
 • Check your sugar
 • Know how to handle
   highs and ...
Let’s choose a time to eat
breakfast, lunch, dinner and a
       bedtime snack.
Make every meal a cafeteria
  meal. You need a protein,
whole grains, and a fruit or veg.
Check your sugar to find
out what you should eat
    at the next meal.
Let’s talk about
  what to do when
  your sugar goes
too high or too low.
Let’s work on
 getting your
A1c below 7.
Let’s talk about counseling….
Traditional Counseling is counselor-centered.


 Your doctor says you have high
 cholesterol. Here’s a meal plan
 for you ...
Motivational Interviewing is client-
                     centered.

                                     I’m really conce...
What is Motivational Interviewing?

• Client-centered, directive method for enhancing
  intrinsic motivation to change by ...
The Goal of MI…
…to create and amplify discrepancy between
present behavior and broader goals.
Remember: Ambivalence is normal!


 Wanna hit
McDonald’s           I’m trying to watch my
 for lunch?            weight… b...
Consider your definition of motivation.


When is a client considered motivated?
• When they agree with your view?
• When ...
Ask open-ended questions.
Ask questions that allow for a wide range of
possible answers. The question may seek
information...
Ask open-ended questions.

In what ways has being
   overweight caused
   problems for you?
Affirm the person.
Say something positive or complimentary to the
client. It may be in the form of expressed
appreciation,...
Affirm the person.

   You’re a very
resourceful person!
Affirm the person.

  You’ve succeeded       I don’t think I can do it.
through some difficult
 changes in the past!
Reflect what the person says.
Use reflections to capture and return to the client
something that the client has said. Refl...
Reflect what the person says.

Kind of like a bunch   Everyone’s getting on
of crows pecking at    me about my diet and
  ...
Summarize perspectives on
               change.
Use summaries to pull together points made by the
client throughout the s...
Summarize perspectives on
                 change.
So you’ve told me that you don’t
like being tired all the time from
  h...
Ask permission before giving
                 advice.
This keeps you from falling into the “expert trap”
where patients st...
Ask permission before giving
               advice.
If you don’t mind, may I
share some information
 about carbohydrates?
Who’s Talking the Most?
Ask, “How ready are you?”
Healthy change can be bad.
Are you wrestling or dancing?
Carb Counting

Are you good at math?
Teaching your patients….

How much do you weigh?
Divide by 2.2. Multiply by 30.
                         (or 25 if you’re ...
Doing the math….

2000 kcal per day
30% of daily kcal from CHO
600 kcal from CHO
CHO 4 kcal/g
150g CHO per day
45g CHO per...
15g
?
Partnerships for Change
Partnerships for Change
Partnerships for Change
Partnerships for Change
Partnerships for Change
Partnerships for Change
Partnerships for Change
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Partnerships for Change

  1. 1. Motivational interviewing to help people with diabetes improve their diet.
  2. 2. You have diabetes.
  3. 3. This is serious! You DOCTOR need to lose weight, clean up your diet, and take these medications every day!
  4. 4. WIFE You aren’t supposed to eat that! Give me that cookie!
  5. 5. You look sad. Here, have a treat! MOTHER
  6. 6. Let’s check your sugar. Oooh, it’s too high! NURSE
  7. 7. Why do you have all this junk food in the fridge? NUTRITIONIST
  8. 8. Blah, blah, blah, blah, Blah, blah, blah, blah… blah, blah, Blah, blah, blah, blah… blah, blah, blah, blah… Blah, blah, blah, blah, blah, blah… Blah, blah, blah, blah, blah, blah… Blah, blah, blah, blah, Blah, blah, blah, blah… Blah, blah, blah, blah, blah, blah, blah, blah… blah, blah…
  9. 9. Leave me alone! I’ll just eat whatever I want.
  10. 10. “Diabetic Diet”
  11. 11. Basic Guidelines • Eat 3 meals/day • Make your meals balanced • Check your sugar • Know how to handle highs and lows • Learn, learn, learn
  12. 12. Let’s choose a time to eat breakfast, lunch, dinner and a bedtime snack.
  13. 13. Make every meal a cafeteria meal. You need a protein, whole grains, and a fruit or veg.
  14. 14. Check your sugar to find out what you should eat at the next meal.
  15. 15. Let’s talk about what to do when your sugar goes too high or too low.
  16. 16. Let’s work on getting your A1c below 7.
  17. 17. Let’s talk about counseling….
  18. 18. Traditional Counseling is counselor-centered. Your doctor says you have high cholesterol. Here’s a meal plan for you to follow. Try to eat less fat and get more exercise, okay? Ummm… okay.
  19. 19. Motivational Interviewing is client- centered. I’m really concerned about my blood pressure. It’s hard for me to cut back on salt because it’s the only way I can taste my food. What are the health concerns you might like to discuss today?
  20. 20. What is Motivational Interviewing? • Client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence • Developed by Miller in 1983 for treatment of problem drinkers, expanded in 1991 by Rollnick • Can deliver better outcomes, as it increases client’s feelings of self-efficacy and ownership of the problem-solving process
  21. 21. The Goal of MI… …to create and amplify discrepancy between present behavior and broader goals.
  22. 22. Remember: Ambivalence is normal! Wanna hit McDonald’s I’m trying to watch my for lunch? weight… but I would love a cheeseburger!
  23. 23. Consider your definition of motivation. When is a client considered motivated? • When they agree with your view? • When they accept the diagnosis? • When they state a desire for help? • When they show distress, and depend on you? • When they comply with treatment? • When they have a successful outcome?
  24. 24. Ask open-ended questions. Ask questions that allow for a wide range of possible answers. The question may seek information, invite the client’s perspective, or encourage self exploration.
  25. 25. Ask open-ended questions. In what ways has being overweight caused problems for you?
  26. 26. Affirm the person. Say something positive or complimentary to the client. It may be in the form of expressed appreciation, confidence or reinforcement. Comment on the client’s strengths or efforts.
  27. 27. Affirm the person. You’re a very resourceful person!
  28. 28. Affirm the person. You’ve succeeded I don’t think I can do it. through some difficult changes in the past!
  29. 29. Reflect what the person says. Use reflections to capture and return to the client something that the client has said. Reflections can simply repeat or rephrase what the client has said or may introduce new meaning or material.
  30. 30. Reflect what the person says. Kind of like a bunch Everyone’s getting on of crows pecking at me about my diet and you, huh? my weight.
  31. 31. Summarize perspectives on change. Use summaries to pull together points made by the client throughout the session. This can become the basis for an action plan.
  32. 32. Summarize perspectives on change. So you’ve told me that you don’t like being tired all the time from having high blood sugar. And you’ve decided to try to drink more water and less soda. Do I have that right?
  33. 33. Ask permission before giving advice. This keeps you from falling into the “expert trap” where patients stop listening because of the experience of being lectured or talked down to.
  34. 34. Ask permission before giving advice. If you don’t mind, may I share some information about carbohydrates?
  35. 35. Who’s Talking the Most?
  36. 36. Ask, “How ready are you?”
  37. 37. Healthy change can be bad.
  38. 38. Are you wrestling or dancing?
  39. 39. Carb Counting Are you good at math?
  40. 40. Teaching your patients…. How much do you weigh? Divide by 2.2. Multiply by 30. (or 25 if you’re overweight) Multiply by 30%. Divide by 4. That’s your grams of carbs per day! Divide by 15. That’s your carb servings!
  41. 41. Doing the math…. 2000 kcal per day 30% of daily kcal from CHO 600 kcal from CHO CHO 4 kcal/g 150g CHO per day 45g CHO per meal plus 15g CHO snack
  42. 42. 15g ?

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