Question

If you were working with a client with diabetes from a culture that values their elders, and the group or family as a whole, over the individual, how could you make your counseling culturally relevant to this client? Identify at least two specific things that you would do.

Answer 1

This question brings to me a important aspect that is Fasting and the food preference. A diabetic client most often is advised not to fast as the production of insulin is decreased when fasting. a few points that could be considered when couselling a client is

• the importance of glucose monitoring during fasting and non-fasting hours,
• when to stop the fast,
• meal planning to avoid hypoglycemia and dehydration during prolonged fasting hours,
• and the appropriate meal choices to avoid postprandial hyperglycemia.

The educational program should include advice on the timing and intensity of physical activity during fasting. Certainly, it is important that use of diabetes-related medications and their potential risk during fasting are also discussed.

Important points to discuss with the patients

• Consider modifying the time and intensity of physical activity
• Ensure fluid intake – in the form of juices, coconut water

Patients treated with metformin alone may safely fast because the possibility of severe hypoglycemia is minimal. However, perhaps the timing of the doses should be modified.

A structured patient education program that includes a better understanding of fasting and diabetes, individual risk quantification, and options to achieve safer fasting should be included.