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173 8 ManwithDiabetesandHypertension A Case Story Blia Vang was a fifty-two-year-old man who had lived in the United States with his wife and ten children for about fifteen years. He and his wife lived with three of their children and he helped care for his grandchildren while his married children worked and attended school. Concerned about his increasing fatigue, weakness, and weight loss over a period of about eight months, his wife and son brought him to the clinic for a routine fifteen-minute appointment. They implored the doctor to find the cause of his problems and cure him. While they had taken him to see several doctors and Hmong healers, he was still losing strength every day and was losing his ability to work. After a complete physical exam,the doctor diagnosed diabetes mellitus,prescribed a diabetic diet and exercise, and scheduled him to see the diabetes educator. Over several sessions, a Hmong diabetes educator taught Mr. Vang, his wife, and his son about the physiology of glucose, the pathophysiology of diabetes, the technique of monitoring blood glucose, and the dietary restrictions and exercise regimens. Weeks later, when he returned to see the doctor, Mr. Vang explained problems he was having with the recommended diet and exercise. He was having difficulty following the diet, which included only a cup of rice at each meal. He felt as though he were starving, just as he had for the two years when he and his family lived off the food they could gather in the forest as they fled from the communist soldiers in Laos. He was having trouble exercising,too; even walking aggravated an old back injury. Years ago, while running from the soldiers, he had fallen while carrying his two-yearold daughter and a heavy backpack. Later his daughter had died.Also, he was afraid to go outside his apartment because of the gangs in the public housing project. Finally, his family thought he was already too skinny and losing weight would make him even sicker. They asked the doctor whether there was a medicine he could take to improve his diabetes, make him gain weight, and increase his strength. The doctor prescribed an oral diabetes medicine, referred him back to the diabetes educator, and made a referral to a psychologist to evaluate him for possible depression and posttraumatic stress disorder. Over the ensuing months, Mr. Vang’s blood sugars remained high and he was started on insulin.The diabetes educator reported that while Mr.Vang seemed capable of taking care of himself,one of his married sons was going to his house twice a day to 174 Chronic Disease give him the insulin and monitor his blood sugar. A month later, neither his blood sugars nor his fatigue had improved, so a public health nurse started making daily visits to monitor compliance with the regimen.In the ensuing month,his blood sugar levels did improve and the patient and his son reported that they liked checking his blood sugar and knowing when his blood sugar was high or low. When a diabetes support group was started at the clinic, the Hmong nurse educator asked him to join and help others adjust to the demanding regimen. At the first meeting, as people shared their miseries regarding diabetes and their frustration with a lack of cure, one man reported that Thai people had a medicine to cure diabetes. By the end of the meeting, another man stated he would go to Thailand and bring back the cure for everyone. Mr.Vang listened intently. He knew that he could not afford to go to Thailand to obtain the cure but was interested in learning more about the medicine . Despite improvement in his blood sugars, Mr. Vang continued to feel “not right.” The doctor diagnosed hypertension, reiterated the importance of diet and exercise, and prescribed an oral medicine. Mr.Vang was perplexed at the diagnosis, wondering how his blood pressure could be high when his blood sugars were low. Besides, only sometimes did he feel as though his body were under increased pressure. After he attended the funeral of an elderly man who had died from a cerebral hemorrhage brought on by uncontrolled hypertension,he found that whenever his head felt heavy he would feel better after he took the blood pressure medicine. So he started a pattern of taking the medicine when either his blood sugar was high or his head felt heavy. Still,he continued to feel...

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