Culture gap can make diabetes diet harder

April 29, 2012: In this file photo a woman diagnosed with diabetes gives herself an injection of insulin at her home in the Los Angeles suburb of Commerce, Calif. (AP)

Patients with diabetes must work hard every day to count the carbs they consume, to avoid dangerous spikes or dips in blood sugar.

Learning how to do it can be close to impossible, though, when language and cultural barriers make it difficult for doctors to understand what patients typically eat, a case report in Lancet Diabetes and Endocrinology suggests.

“Carbohydrate counting is critical for accurate management of diabetes,” said co-author Dr. Sumana Narasimhan, a pediatric endocrinologist at Cleveland Clinic Children’s in Ohio.

“If we don’t fix this problem, families of children with diabetes from non-western cultures may continue to guess the carbohydrate count of their ethnic foods, resulting in inaccurate insulin dosing and poorly controlled diabetes,” Narasimhan added by email. “The risk of diabetes complications is higher when diabetes is not managed properly.”

The case report involved a child recently diagnosed with type 1 diabetes, a chronic condition usually diagnosed in children or young adults. With this condition, the pancreas produces little or no insulin, a hormone needed to allow blood sugar, or glucose, to enter cells and produce energy.

People with type 1 diabetes typically have to test their own blood sugar levels throughout the day and inject insulin to manage them. Getting the insulin dose right requires patients to count carbs correctly.

In this case, the child’s mother asked doctors how to count carbs for the traditional Middle Eastern foods she prepared at home.

Doctors found some pamphlets and online resources for following a diabetes diet that were translated into Arabic. But the information was still mostly based on a typical Western or European diet, not on traditional foods like tabbouleh, hareeseh and chicken shawarma that are more common in a typical Middle Eastern diet.

While doctors did eventually find some resources in Arabic based on nutrients common in Middle Eastern diets, it was still difficult to calculate the carbohydrates in an entire meal.

While this is just one case, the patient's experience suggests a need for culturally appropriate food lists and nutrition information in multiple languages, Narasimhan and co-author Dr. Hamza Nasir of Dow University of Health Sciences in Karachi, Pakistan, conclude.

Because type 1 diabetes so often affects kids, the burden of managing their disease falls to parents, often the mothers who prepare their meals, Nasir said by email.

“When this mother asked us about carb content in traditional Arab foods, we were a bit puzzled as the usual patient information pamphlets do not carry this information,” Nasir said.

What this mother experienced speaks to a larger problem people from other cultures may encounter when they seek treatment in the U.S., said Dr. Brigid Gregg, a researcher at C.S. Mott Children’s Hospital at the University of Michigan in Ann Arbor.

“I do think there is a broader problem understanding the nutrient content of certain home cooked ethnic foods as well as home cooked foods in general,” Gregg, who wasn’t involved in the case report, said by email.

“This makes accurate carbohydrate counting difficult and may have the unfortunate effect of encouraging the use of prepackaged foods for better dosing accuracy,” Gregg added.

“Families generally feel more peace of mind when they know the exact carbohydrate count of the foods they are giving their family member with diabetes, and there is a great deal of certainty with food that comes with a label.”