Medication

Oral hypoglycaemic agents and a diabetes diet can control diabetes in many patients. Those who need insulin should be offered biosynthetic human insulin as pork-derived

Table 18.2 Dietary restrictions practised by religious and ethnic groups

HINDUS

No beef

Mostly vegetarian; fish rarely eaten; no alcohol.

Periods of fasting common.

MUSLIMS

No pork

Meat must be 'Halal'; no shellfish eaten; no alcohol.

Regular fasting, including Ramadan for 1 month.

SIKHS

No beef

Meat must be killed by 'one blow to the head'; no alcohol.

Generally less rigid eating restrictions than Hindus and Muslims.

JEWS

No pork

Meat must be kosher; only fish with scales and fins eaten.

Meat and dairy foods must not be consumed together.

RASTAFARIANS No animal products, Foods must be 'I-tal' Food should be 'organic'. except milk may be or alive, so no consumed. canned or processed foods eaten; no salt added; no coffee or alcohol.

RASTAFARIANS No animal products, Foods must be 'I-tal' Food should be 'organic'. except milk may be or alive, so no consumed. canned or processed foods eaten; no salt added; no coffee or alcohol.

Halal meat must be bled to death and dedicated to God by a Muslim present at the killing. Kosher meat must be bled to death in the presence of a Rabbi and then be soaked and salted. Orthodox members may adhere to all the restrictions of their religion or ethnic group. Others may adhere to only the major restrictions, especially where they are immigrant in a foreign country. Reproduced from Table 32, Manual of nutrition (1985), HMSO.

or beef insulin may be against their religious beliefs. Even insulin itself may be viewed as inappropriate and stopped. This can lead to repeated admissions with severe hyperglycaemia as the patient may not wish to upset the doctor by telling him that they have not taken the treatment.

Many Asian patients will also consult an alternative practitioner. Western doctors should not take offence as alternative medicine is usual in the East and implies a 'belt and braces' approach to health care rather than lack of trust in a doctor's treatment. A variety of approaches include the advice of a hakim or vaid, Ayurvedic medicine, Hikmat, astrotherapy, urinotherapy (drinking urine is thought to help diabetes), herbal medicine, and homeopathy. Problems may arise when the alternative practitioner advises stopping the Western medicine so it does not interfere with his medicine (or vice versa), or when the alternative medicine causes toxic effects or interacts with the Western pharmaceuticals. Ask the patient what other treatment he or she is taking.

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