amputations, renal failure), and macrovascular complications (e.g., heart attack, stroke). Relatives‘ complications could not be attributed entirely to poor self-management, because economics played a significant role in access to food, health-care services, and medications in the countries of origin for many participants‘ family members. However, poor
management modeled by family members clearly guided some of the participants‘ self- management practices:
Sometimes I lay down, and I forgot to take my medicine, so I remember when my dad got sick. I remember that when we got my dad out of bed, he could not even move. Because he was not taking his medicine. So then, I get out of bed to go take my medicine. (Isabel)
My mother-in-law died from diabetes, so, well, then you try to do what you are told, and well, if you are able to achieve it, then you do it. . . . The memory from my mother-in-law is that her body would swell up a lot. . . . And what she was told was not to drink soda. Because when she was drinking soda, she would swell up more. People would tell her, ―Don‘t drink that. It is going to hurt you; drink something else.‖―No! Anyways, I am going to die,‖ she would say. ―At least, I will die drinking it.‖ That‘s not a solution. What you try to do when you have diabetes. . . I mean you are told not to do something, and then you do the contrary. . . . You must try not to do it. (Nadia)
Other reports of poor self-management by family members and friends included not seeking regular medical care, using home remedies, using alcohol, and not taking medications:
I have lots of friends who have diabetes, too. Some treat themselves, and others say, ―I don‘t know.‖ That‘s a different way of thinking than me, I don‘t know. I have a friend who is very sick, and he does not want to take the pill he is being given because he does not like them or for other reasons or not liking an injection. (Roberto)
Well, my sister, the one who died, she used to complain a lot, that she was really thirsty and that her vision was very blurry sometimes and she really wanted to go to the bathroom. . . . I would tell her, and . . . my mom would tell her—‖Daughter,‖ she would say, ―I am going to take you to the doctor to see, to get your blood checked out to see if it is the same illness your uncle has.‖ And she started arguing; you could not even tell her that. She would grab her purse and went to her place. She never let them cure her, or take her to the doctor. She never let them do it. (Melida)
My other brother, he does not take care of himself. He drinks and smokes. He is almost dying, and then he doesn‘t see it. The other one . . . he drinks, he watches what he eats and what he does. (Carlos)
Well, she said she had it [diabetes], too, but that she was not treating it. I asked her why she does not treat it, and she said that she did not like to take medications. (Alicia)
There was also a propensity for managing diabetes through recurrent hospitalizations. This pattern occurred when the participants‘ friends or family members with diabetes
engaged in minimal to no self-management behaviors; thus, the only time their condition was managed was when they were hospitalized. There was obvious frustration on the part of participants due to this practice because of the poor self-management habits it represented, as can be seen in the following excerpts:
No, they [her nieces and brother] still don‘t. These are people who are always in the hospital. Their diet is really bad. Yes, they eat a lot of fat and a lot of candy. . . . There are some people who are always in the hospital. (Angelica)
It [blood glucose level] gets really high, and she [her sister] has to go to the hospital, but she is not careful. And when she gets there, she is told her sugar is really high and they don‘t let her go until they see she is taking insulin. She just gets it while she is in the hospital. When she leaves, she stops using it; that‘s why she gets sick again. I told her to take metformin because that‘s the one the doctor gave her, but she said her stomach didn‘t tolerate it. So she isn‘t doing anything. When she goes to the hospital, it takes a while for her to get discharged, but she still doesn‘t pay attention. (Angela)
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I speak with my sister, and I explain to her. She tells me, ―I forget to take my medicine,‖ so I tell her, ―That‘s the problem! When you eat a big plate of a kind of food you know you are not supposed to eat and you do not take your medicine, then you need to have an insulin shot. Your levels go down, but the following day, it is the same thing. Or tell the doctor that he prescribes you insulin if you cannot take pills.‖ She always is at the hospital. It is very expensive in Mexico. . . . Each time I talk to her, she has been admitted at the hospital. I tell my mom, ―I do not understand why, I have never [emphasis hers] been admitted to the hospital because of my diabetes.‖ (Isabel)
She [her sister] is, she is controlling it . . . but she goes to the hospital often. . . . Because it goes up, it goes down sometimes. (Pilar)
Question 7B: Status of family members’ health. Family members‘ health statuses were unknown in some cases because many of them did not receive regular medical care in the absence of symptoms, and even with the presence of symptoms, they may not have sought medical advice. Alta said, speaking of her siblings, ―Well, who knows? I don‘t know since they have not been checked out. I cannot tell you whether they are okay or not.‖ In other cases, there were obvious health issues for family members:
She [her sister] tells me she feels really badly. She throws up, she has nausea, she is dizzy. She has lost weight. Her diabetes is quite bad. (Sylvia).
He [her father] does not say much, either. I know he gets sick sometimes in Mexico. . . . He is very, very skinny now . . . and something happened one day, and he was hospitalized very ill because he got something like diabetic shock or something like that? (Felipa)
In the end, he [her father] had to have dialysis. He lost his vision, and more than anything, that last thing was when they did the . . . dialysis. . . . He lasted over a year but . . . he would get sick very often. (Angela)
Question 8A. Diabetes practices learned from family members. Two themes emerged when the participants were asked what they learned from family members about caring for diabetes: positive and negative.
Theme 1: Positive. Some of the positive lessons participants‘ took from their family