Diabetes is a complex disease and navigating a daily regimen of medications, blood sugar checks, diet, exercise and doctors visits can be overwhelming in the best of times. It's even tougher for immigrants still learning English.
Advocate Sahra Nur works with Somali senior citizens in one Minneapolis building. She's set up a workshop for them with a dietitian who specializes in controlling diabetes. Nur says she felt compelled to start the sessions after witnessing how one diabetic stopped taking care of himself.
"He's a tough one. There are a few tough ones in this building but you have to keep trying," said Nur.
She says he is already missing one leg and is at risk of losing the other to diabetes. Before the workshop, Nur visits the man's apartment to invite him to attend. She knocks for a while. No one answers. When she turns to leave, the door suddenly opens.
"Sorry to bug you, man. Do you want to come to the meeting?" she asks.
"No," he says.
"Just for a few minutes," she asks again.
"No," he emphatically replies.
The man slams the door in her face, saying he can't go.
"We try," she says. "Sounds like an excuse, but you never know. You have to give people the benefit of the doubt."
Frustrated but undeterred, Nur says she is working on new ways to approach diabetics like this man, who are particularly resistant to seeking help.
Downstairs, the bilingual workshop is getting under way. About a dozen mostly Somali women, some of them in wheelchairs, sit around a table in an airy, plant-filled space. They wear traditional full-length dresses, and some wear head scarves.
Dietitian Pamela Gaard holds up plastic models of common American foods to help illustrate healthy portion sizes. She says portion control is key to managing diabetes and obesity.
"Okay, this other small part of the plate is for your starchy foods," she said. "So we are talking about rice, pasta, injera, flat bread, any kinds of breads or crackers."
The traditional Somali diet revolves around pasta, rice, injera bread, meat and tea with lots of sugar. Gaard says it's a diet that, when combined with a more sedentary lifestyle than they had in Africa, can lead straight to diabetes. But resident advocate Nur says it's not easy for older Somalis to expand their palate.
"They won't go outside the box in terms of salmon, shrimp, there is very few who will eat that," she said. "So diet is a huge problem."
Throughout the workshop the women discuss new ways to cook traditional foods and learn about some unfamiliar American fruits and vegetables.
Afterwards, most of them say they are ready to try some of the techniques they've learned. Through a translator Maryn Mohamed says the diet will be very different from what she normally eats.
"Spaghetti or rice, meat, bread or red beans," she said.
Mohamed says she doesn't have diabetes, but she is concerned about being overweight.
Studies show she's right to be concerned. Obesity is a major risk factor for Type II Diabetes. And Somalis have been shown to develop the disease at an even lower weight than the average American. Experts say this group also tends to have a higher rate of Vitamin D deficiency, which has been linked to diabetes.
What's more, Somali women are shown to be at higher risk for obesity than Somali men, and since Somali women typically handle all of the household cooking and shopping, health workers say workshops like these are critical to spreading information about diabetes.
It's an approach that makes sense to Cedar Riverside People's Center physician Eric Hazen. He says diabetics tend to do better when they have a team of experts on their side.
"And also even a chronic disease coordinator who kind of keeps track and makes sure that the person is getting in to see the people that they need to see and maybe calling them if they seem to be dropping out," he said.
People who work with the Somali community say the message about diabetes does seem to be getting out. They say it's due in large part to the community's willingness to hold meetings on important issues.
But they say addressing depression, PTSD and related mental health issues can also help Somalis manage chronic disease.