Culture gap makes carb counting harder for people with Type 1 diabetes

Families of children with diabetes from non-western cultures may continue to guess the carbohydrate count of their ethnic foods.

There is a broader problem understanding nutrient content of home cooked ethnic foods

Thomson Reuters Posted: Aug 15, 2016 1:00 PM EDT | Last Updated: August 15, 2016

Pamphlets on dietary advice for people with diabetes were based on a typical Western or European diet, not on traditional foods common in a Middle Easter diet. (CP Images)

Patients with diabetes must work hardevery day to count the carbs they consume, to avoid dangerousspikes 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 new case report suggests.

"Carbohydrate counting is critical for accurate managementof diabetes," said co-author Dr. Sumana Narasimhan, a pediatricendocrinologist at Cleveland Clinic Children's in Ohio."If we don't fix this problem, families of children withdiabetes from non-western cultures may continue to guess thecarbohydrate count of their ethnic foods, resulting ininaccurate insulin dosing and poorly controlled diabetes,"Narasimhan added by email. "The risk of diabetes complicationsis higher when diabetes is not managed properly."

The case report in Lancet Diabetes and Endocrinologyinvolved a child recently diagnosed with Type 1 diabetes, a chronic condition usually diagnosed inchildren or young adults. With this condition, the pancreasproduces little or no insulin, a hormone needed to allow bloodsugar, or glucose, to enter cells and produce energy.

People with Type 1 diabetes typically have to test their ownblood sugar levels throughout the day and inject insulin to

manage them. Getting the insulin dose right requires patients tocount carbs correctly.

When this mother asked us about carb content in traditionalArab foods, we were a bit puzzled as the usual patientinformation pamphlets do not carry this information.-Dr.HamzaNasir

In this case, the child's mother asked doctors how to countcarbs for the traditional Middle Eastern foods she prepared athome.

Doctors found some pamphlets and online resources forfollowing a diabetes diet that were translated into Arabic. But

the information was still mostly based on a typical Western orEuropean diet, not on traditional foods like tabbouleh, hareesehand chicken shawarma that are more common in a typical MiddleEastern diet.

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

While this is just one case, the patient's experiencesuggests a need for culturally appropriate food lists andnutrition information in multiple languages, Narasimhan andco-author Dr. Hamza Nasir of Dow University of Health Sciencesin Karachi, Pakistan, conclude.

Nutrients in home cooked food

Because Type 1 diabetes so often affects kids, the burden ofmanaging their disease falls to parents, often the mothers whoprepare their meals, Nasir said by email.

"When this mother asked us about carb content in traditionalArab foods, we were a bit puzzled as the usual patientinformation pamphlets do not carry this information," Nasirsaid.

What this mother experienced speaks to a larger problempeople from other cultures may encounter when they seek

treatment in the U.S., said Dr. Brigid Gregg, a researcher atC.S. Mott Children's Hospital at the University of Michigan inAnn Arbor.

"I do think there is a broader problem understanding thenutrient content of certain home cooked ethnic foods as well ashome cooked foods in general," Gregg, who wasn't involved in thecase report, said by email.

"This makes accurate carbohydrate counting difficult and mayhave the unfortunate effect of encouraging the use ofprepackaged foods for better dosing accuracy," Gregg added.

"Families generally feel more peace of mind when they know theexact carbohydrate count of the foods they are giving theirfamily member with diabetes, and there is a great deal ofcertainty with food that comes with a label."

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Type 1 diabetes: the need for culture-appropriate nutritional information for carbohydrate counting

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Culture gap makes carb counting harder for people with Type 1 diabetes

There is a broader problem understanding nutrient content of home cooked ethnic foods

Nutrients in home cooked food

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