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 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.
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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.”
SOURCE: http://bit.ly/2bkw0y9 The Lancet Diabetes and Endocrinology,
online July 25, 2016.
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