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Bright Spots & Landmines: A Diabetes Game-Changer

By Hadley Turner

It’s easy for most anyone to fall into a pattern of focusing on the negative—especially those with difficult-to-manage chronic diseases such as diabetes. In fact, stigma, shame, and self-blame are widely discussed barriers to not just emotional wellness but also physical health in both type 1 and type 2 diabetes.

In August, Today’s Dietitian attended the American Association of Diabetes Educators annual meeting in Houston and had the privilege of sitting in on a presentation by Adam Brown, senior editor of diaTribe, the patient-focused online publication by The diaTribe Foundation. The Foundation is an educational resource for people with diabetes and advocates for the diabetes patient population to policy makers such as the FDA, the media, and innovators who look to better the lives of those with diabetes. Brown—who’s had diabetes since 2001—discussed his commitment to changes in his food, exercise, mindset, and sleep habits that deliver astonishingly healthy and consistent A1c and blood glucose levels and—more importantly—keep him feeling healthy and happy.

The strategies Brown outlined in his session come from his book, Bright Spots & Landmines: The Diabetes Guide I Wish Someone Had Handed Me, a collection of diabetes management strategies Brown developed through his own experience with the disease. Published in 2017 by The diaTribe Foundation, the book has garnered praise from health care professionals including certified diabetes educators, authors and bloggers, diabetes advocates, and people with diabetes.

Brown certainly wasn’t new to writing about diabetes when he penned Bright Spots & Landmines; since 2013, he’d been sharing diabetes management strategies that worked for him in his popular “Adam’s Corner” column on the diaTribe website. Then, in 2015, Brown says, “my mentor and the founder of diaTribe, Kelly Close, suggested I compile all my best diabetes tips into a single guide. Bright Spots & Landmines is what emerged from that process.”

On writing the book, Brown says, “My No. 1 goal was to make it actionable, meaning anyone can pick it up and immediately improve some aspect of his or her life.” And it’s worked: “The advice has resonated with people who are newly diagnosed all the way to those with 50-plus years of diabetes.” 

It’s available as a low-cost paperback or Amazon Kindle e-book, and is even available to download as a PDF for free, which is Brown’s biggest point of pride about the book: “Maximizing the book’s mission—to help as many people as possible—required us to prioritize access,” he says. All profits from the sale of the book benefit The diaTribe Foundation.

To celebrate American Diabetes Month, Today’s Dietitian offers RDs a closer look at this enlightening, practical guide for people with diabetes, which hopefully will inspire clients to see the “Bright Spots” in their own journey of living with and managing diabetes.

Introduction
In the introduction to Bright Spots & Landmines, Brown tells his story of being diagnosed with type 1 diabetes in his adolescence and the years of feeling frustrated with what he viewed as personal failures—blood glucose measurements that swung radically between highs and lows, far-too-high A1c levels, a terrifying episode of severe hypoglycemia. At diagnosis, Brown says, he was offered very little nutrition advice, and the advice he did receive (eg, “You can eat what you want, as long as you take insulin for it”) was unhelpful, if not dangerous.

Close to a decade ago, however, Brown started to learn more about nutrition and began using a continuous glucose monitor (CGM). Using the CGM’s real-time feedback, he recorded what made his blood glucose spike or fall to dangerous levels and what kept it within a healthy range.

The introduction also explains how the book is structured. It covers four main aspects of diabetes management: food, mindset, exercise, and sleep. Each wellness area includes Bright Spots—positive lifestyle behaviors and choices that make diabetes management easier and make the person with diabetes feel better, with the goal of doing more of these behaviors—and Landmines—consistent mistakes that cause health or mood effects or make the person’s life more difficult, with the goal of doing these things less often. At the conclusion of each chapter, Brown provides “Questions to Ask Yourself” to help the reader record and identify their own Bright Spots and Landmines.

Bright Spots outnumber Landmines 2:1 in this book, which Brown says is intentional, citing the blame and shame of diabetes. “The framework of Bright Spots & Landmines is a game-changer for many people. Bright Spots are so often overlooked and undervalued; we all tend to focus on things going wrong. [The book] is about asking, ‘What is working, and how can I do more of that stuff?’ A ‘Bright Spots’ orientation puts wind in the sails rather than constantly tearing them down,” he says.

The Bright Spots and Landmines included in each chapter, Brown says, illustrate what works best for him and aren’t meant to be blanket recommendations. He encourages readers with diabetes to give a variety of behaviors a try, record what happens, and make adjustments from there—and to consult with their health care providers before making any big changes.

Food
Bright Spots & Landmines’ first chapter focuses on food. Brown runs through his Bright Spots for food and nutrition, some of which include eating less than 30 g of carbohydrates at one time, checking blood glucose two to three hours after meals (or wearing a CGM) to learn what foods work and don’t work and make course corrections, always making at least one-half of his plate vegetables, and eating an early dinner more than three hours before bedtime with no snacking afterwards. He also incorporates mindful eating practices, such as asking himself whether he wants to eat because he’s hungry or out of boredom or availability of food in a given moment.

Brown has found through trial and error that a low-carb, high-fat eating pattern (10% to 15% of calories from carbs, 60% to 70% from fat, and 15% to 20% from protein) works best for him, but he doesn’t imply that this will yield results or be sustainable for everyone, and he doesn’t follow or recommend a ketogenic diet specifically. He tells readers not to take his word for it but to measure their own blood glucose response to different levels of carbohydrate intake to find what works best for them.

Brown lists drinking sugary drinks, making too many excuses and exceptions, and overeating to correct hypoglycemia as some of his food Landmines, with specific and actionable ways he avoids these Landmines such as checking ingredient lists.

He shares specific tips that help him stick with these positive behaviors, such as keeping healthful foods available and easy to prepare and keeping junk foods out of the house. Brown also lists foods and meals—illustrated with bright and colorful photos—he often prepares to maintain his food Bright Spots (he says his chia seed pudding recipe is one of his favorites and is a big hit with readers, too). For data-driven readers, Brown includes visuals of his blood glucose measurements over time as he follows his food Bright Spots and avoids his Landmines.

Mindset
Brown’s approach to mindset is that a better attitude helps not just with mental well-being but also motivation to manage the more physical aspects of diabetes management. By treating blood glucose measurements as neutral information that helps make decisions—rather than as “good” or “bad” grades or “tests”—he says people with diabetes can avoid feeling like “failures” for having out-of-range measurements. Seeing blood glucose as simply a number as well as relying on loved ones for help with management, finding online or in-person support communities, and reflecting often on what’s positive in one’s life, are strong mindset Bright Spots.

Exercise
The chapter on exercise provides an in-depth look at how activity positively affects blood glucose and how to deal with barriers to regular exercise. He encourages readers to find activities they look forward to, build them into their routine, and remove as many barriers to that exercise as possible.

Brown also emphasizes adjusting insulin and carbohydrate intake based on activity. An in-depth section at the end of the chapter covers how blood glucose is likely to change during different activities, as well as how to maintain healthy blood glucose levels before, during, and after exercise.

Sleep
Brown begins the chapter on sleep by explaining why sleep is so important. Numerous studies point to a connection between sleep and diabetes, and poor sleep is associated with more hunger, depression, weight gain, and lower quality of life. “Sleep is a highly underrated diabetes tool, especially because it is changeable almost immediately: I can almost always get more sleep tonight if I make it a priority,” he writes. Brown finds that getting at least seven hours of sleep is associated with more next-day blood glucose measurements in range, less need for insulin, more energy, better mood, and less hunger.

Conclusion: ‘Tying It All Together’
To wrap up the book, Brown summarizes his Bright Spots and Landmines for each lifestyle category, as well as the process for finding one’s Bright Spots and Landmines in quick-reference sheets. He also takes a moment to reemphasize the importance of mindset and support from loved ones; in large, colorful text, he writes: “Don’t do diabetes alone.” Brown’s farewell chapter offers inspiration and well wishes to the reader for better diabetes management and a happier, healthier, more positive life.

Bright Spots & Landmines is a fantastic resource for RDs to use while working with their clients with diabetes and to recommend to patients. At roughly 230 pages, it’s shorter than many works of nonfiction, includes a palette of colorful visual aids, and is written to be accessible to laypeople. At the same time, it includes a sizeable list of references, many of which are studies published in high-quality journals, which is of interest to RDs and more scientifically literate clients. While Brown’s measurements are technically only one case study, his behaviors generally adhere to reputable national and international guidelines for diabetes management and overall health, though long-term evidence on the efficacy of taking a high-fat, low-carb approach is still being researched.

Any chapter can stand alone, so even if a client doesn’t relate to Brown’s dietary strategies, they still can give his evidence-based tips on sleep, mental and emotional wellness, and exercise—as well as his sunny outlook—a try. What person with diabetes—or any person, for that matter—couldn’t spend a little more of life on the bright side?

— Hadley Turner is the associate editor of Today’s Dietitian and RDLounge.com, the blog written for RDs by RDs.