This study analyzes the experiences of low-income people living with type 2 diabetes in Lima, Peru. We use a syndemic approach to describe and discuss their challenges in following physicians’ recommendations around medication adherence and dietary changes. We use the concept of “burden of treatment” to analyze patients’ stories and to understand the complexity of medication adherence and dietary changes in a middle-income country where the health system is still unprepared to provide chronic care. Analysis demonstrates that emotional, socioeconomic, and structural components play a role in patients’ capabilities for following the prescribed recommendations. We show that patient’s illness experiences are intimately linked to the capacity of the local health system to attend to their needs but are not always acknowledged when promoting self-management behaviors. Our study shows the relevance of a syndemics approach for understanding the interaction between individual and structural factors to make suggestions for improving the management of diabetes and the overall experience of chronicity. Copyright