The patient is a 44-year-old of mixed Native American and European descent, and a new mother.

The patient is a 44-year-old of mixed Native American and European descent, and a new mother. She is concerned that she is not recovering from gestational diabetes. The baby is 10 weeks old. The patient is trying to recover, but her blood sugar remains abnormal fasting 150-200, non-fasting over 200. The patient eats three small meals a day and stopped drinking juice and soda. She doesn’t think her blood sugar has improved like her OB/GYN wants it to be, but the doctor said it will turn back to normal after her pregnancy. The patient refused insulin, after getting advice from her mother and friend who culturally believe insulin is made of animal hormones.  She doesn’t want to believe insulin is her only option.

How do I develop a plan of communication and teaching to the patient and her family regarding compliance to insulin therapy while  keeping in mind their cultural background?