Abstract Background Our aim was to explore patients’ perceptions of changes in diet and physical activity in people with type 2 diabetes mellitus and/or arterial hypertension in two low-income districts of Ecuador. Methods We carried out a qualitative study of 19 telephone interviews in August–September 2020 with people with type 2 diabetes mellitus and/or arterial hypertension. Interviews were recorded, anonymized and transcribed verbatim for analysis using the social ecological model. Results Within the context of poor access to the health services, participants identified a lack of social policies to address food insecurity and income stability. Food insecurity was related to mobility restrictions and loss of income, particularly among vulnerable populations, such as migrants and women. Changing work environments influenced physical activity patterns and food availability. Family support was crucial to overcome economic shortfalls allowing for better eating habits. Despite recognizing overeating as detrimental to disease management, participants reported increased desire to binge eat due to emotional distress and anxiety. Conclusions The lack of social policies dealing with poverty and food insecurity during the pandemic made non-communicable disease self-care with physical activity and diet challenging for vulnerable populations.