Connecting Culture and Health: 3 Ways to Enhance Diabetes Visits

Do You Bring a Shopping List to the Supermarket?

If so, pat yourself on the back! Some studies show that people who bring a list to the store are more likely to:

  • Stick to a budget
  • Purchase the foods they need
  • Reduce impulse buying
  • Save money
  • Save time
How Does This Translate to Doctor’s Visits?

Well, how often do you bring a list to your diabetes appointments? If it’s only once in a blue moon, you’re not alone. In a study published in the New England Journal of Medicine, Dr. John F. Burnum reported that only 8% of patients brought a list of their medical concerns. Why do I underscore the importance of bringing a  list to your diabetes appointments? For the same reason, I encourage grocery shopping lists – because we forget the important stuff! It’s one thing to forget the mozzarella for your lasagna, but forgetting to tell your doctor that you no longer take metformin because it gives you a stomachache could be detrimental to your health.

Managing diabetes is complex, and if you are from a different cultural background, that brings another level of complexity. Consider your favorite cultural foods. How often have you been given a diabetes food list that did not include them? What if you want to celebrate a religious holiday that requires you to fast – have you ever had a conversation with your provider about how to fast safely with diabetes? You can share these concerns with your healthcare team to make sure you’re including your cultural needs in your diabetes management.

The Following Tips Will Help You Make the Most Out of Your Diabetes Visits:
  1. Explain your symptoms
  2. Share alternative medicine treatments with your healthcare team
  3. Discuss your cultural food preferences and holidays
Explain Your Symptoms

Doctors have been trained to assess, diagnose, and treat medical conditions. They conduct a physical exam, evaluate test results, and assess symptoms to diagnose and develop a treatment plan. For persons of other cultures, the health assessment may not be as straightforward.

There are two types of communication styles: linear and circular. I tend to be circular. A few years ago, I was not feeling well and I shared a litany of complaints with the specialist. “I feel horrible. I don’t ever remember feeling this way before.” She turned to me and said, “Tell me your symptoms.” That is a concrete, direct, fact-collection style of communication.

Some cultures, such as Asian, Latin, and many African cultures, favor a more circular style of communication that is indirect and more relationally engaged. Time is spent discussing someone’s general wellbeing before focusing on the disease.

So how can we bridge these two communication styles? Here are some ideas:

Write down your symptoms so you can share them with your healthcare team. Instead of saying, “I don’t feel like myself anymore,” be more specific. “I don’t feel like myself because over the last three weeks I can’t walk for over five minutes without having to stop because of pain in my calves.”

Are there other changes you need to address? Do you have any new medical concerns? If so, write them down:

  • When did it start?
  • What are the symptoms?
  • How long does it last?
  • What has changed? Your appetite, blood glucose, sleep habits, etc.

Also, if you speak a language other than English, make sure you inform your team ahead of time so they can arrange for a medical interpreter.

Being from a culture of circular communicators, it’s a bit more challenging to get to the point. Having this information written down before your visit will ensure your healthcare team has the information they need to provide you with optimal health care.

Share Your Alternative Treatments

One of my patients told me recently that she eats nopal to lower her blood sugar. She said she likes it because “it’s natural”. I’m all for natural, but then I remember that poison ivy is natural too, and it’s not a pleasant experience. Alternative treatments to manage diabetes abound. Nopal has been shown to lower blood glucose levels. That’s great, right? Well, let’s take a closer look. Studies show that you need to eat between 100g to 500g (3oz to 15oz) of raw or steamed nopal every day to lower your blood sugar 17% to 46%. If your blood glucose is 200mg/dl after eating nopal, it may decrease to approximately 166 mg/dl to 92mg/dl, respectively. That is a lot of nopal to eat! If you’re eating nopal every day and taking your medication, you may experience hypoglycemia. If you stop eating nopal for a few days, your blood glucose will rise. So be sure to list all over-the-counter medications and other foods, herbs, vitamins, or supplements you take. Some of these may interact with your prescribed medications or alter test results. If you have been curious about trying a new alternative treatment, ask your doctor and other members of your health care team if they are familiar with it. If not, ask them for a referral to an expert.

Share Your Cultural Food Preferences and Holidays

If you enjoy cultural foods that don’t appear on the traditional diabetes food lists, talk to  your registered dietitian nutritionist (RDN).

  • If you love cultural food (arepas are one of my favorites – see recipe below!) ask your RDN how best to incorporate it in your diabetes meal plan. Tell the RDN how you prepare them. Are they baked? Fried? Stuffed? Discuss how you can create healthier versions. You can even bring in the recipe – knowing the ingredients will allow the RDN to recommend healthy substitutions.
  • Bring empty packages of your cultural foods. The RDN will use the ingredient list and the nutrition label to give you recommendations.

Prepare for your diabetes visit by bringing a list of your current medications, symptoms, and questions about your treatment. I often remind my patients to bring paper and pen to their visits to write down the most important information. Reviewing the information in the comfort of your home will help you follow your treatment plan.

Here is one of my favorite recipes for Colombian corn arepas: Arepas Recipe






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