A 2008 Centers for Disease Control report put the estimated rate of diabetes in Logan County at 14.8 percent, the highest in the United States. And no family has been hit harder than the Blankenships.
"Well, my mom, she had it. My oldest brother Norville's got it, Buddy's got it slightly," said Ranny Blankenship, 55. "Arlen my brother, Tammy my sister. Emmeline my sister had it. Imogene my sister's got it.
"Darlene's got it, my sister. Donna Ray's got it, my sister. And Vicky my sister's got it. My niece Sherri's got it. I mean, there's a lot of us in the family that has it."
All 10 siblings in the Blankenship family have been diagnosed with Type 2 diabetes, or adult-onset diabetes.
"Who's going to get it next?" asked Susie Blankenship, Ranny's wife. "That's what you think about. What's going to happen to who next?"
Ranny Blankenship has been retired since breaking his back in a coal mining accident. He describes himself as a guy who keeps moving. He's been working on an extension to his house, and he says he takes long walks down the highway several days a week.
He's from a family where diabetes seems inevitable. He got his diagnosis 15 years ago. The way he handles it, mostly, is by trying not to think about it much.
But diabetes does tend to take over. In diabetics, the pancreas is unable to produce enough insulin, the hormone that cells need to convert sugar into energy. In the absence of insulin, blood sugar levels -- normally measured at 80-120 -- skyrocket, which can cause blackouts, comas, even death.
Life becomes a relentless regimen of self-injections with artificial insulin. That means keeping a constant watch on blood sugar levels.
Testing their levels, the Blankenship get readings that are far above normal.
"Right now it's 276," said Ranny.
"You see, it's 333 and I haven't even ate anything but a small apple today," said his sister Tammy.
"One-forty -- that's not bad," said Norville Blankenship.
Arlen Blankenship showed a 172. "That's a whole lot better than it's been," he said.
Tammy Maynard, the youngest sister at age 50, has the worst case in the family. The disease consumes her whole life, she said.
'It's So Confining'
"I can't walk," she said. "Normally I can't eat unless it's maybe one meal a day and then I usually throw that up. I'm on 16 different medications."
Complications from diabetes have caused problems with her vision, kidney failure and nerve damage that in turn has caused gangrene to form and spread in her right foot, which will be amputated.
"People can step on my foot and I wouldn't know it," Maynard said. "The nurse told me Monday the foot would go. Might be all the way up to my knee."
She is transported by ambulance for dialysis treatments three times a week.
"It's so confining," she said of the treatment. "You have to lay there like this, in a chair, for three hours and 45 minutes."
Dan Hurley is the author of "Diabetes Rising." A diabetic himself, he set out to learn why West Virginia and the country at large have seen such an increase in Type 2 diabetes over the past 30 years. In 1975, there were 10 million people in the United States with diabetes. There are now 23 million.
"Diabetes is going the wrong way down a one way street," he said.
"Not only is it an epidemic, but epidemiologists who I've spoken to say it's a pandemic," Hurley said. "It is the leading cause of kidney failure, of non-traumatic amputation, blindness, nerve damage to your fingers -- it's really a very, very serious disease."
Hurley says genetics is one way people can get diabetes, in addition to a poor diet, which Susie says is the biggest challenge where her family lives.
"We don't have a lot of options here," said Susie Blankenship. "Wendy's, McDonalds in Logan. In the Man area, we have Wendy's, Hardee's. And pizza, lots of pizza parlors."
'He'd Rather Have Eggs'
Two of Ranny and Tammy's older brothers, Norville and Arlen Blankenship, who live in Ohio, are doing whatever they can to stay healthy.
"I check my sugar every morning and a lot of times I will check it around noon, then I will take it in the evening," said Norville Blankenship. "With a needle in my hand, take the sugar that way. But I take my insulin twice a day."
To stay active, Norville rides an exercise bike several times a week. His wife, Janice, tries to cook healthier, not that Norville is always pleased about it.
"Well, there's times I will give him things he doesn't really like," she said. "Like a couple days ago I gave him oatmeal for breakfast and he doesn't like that. He'd rather have eggs."
"And," added Norville, "some good gravy, biscuits, bacon. I can't help it, I love it. I am an eater, I have always been one and I still will be one, but I am trying to watch my sugar, and I am working at it right now, get it on down."
Last year, their sister Emmeline died from diabetes complications. Arlen Blankenship thinks she was in denial about how severe her disease was.
"She didn't take care of herself either," he said. "Blind and everything else. Got down so she couldn't walk and stuff. They just don't want to face the facts that stuff is going to happen to them and they let it go until it's too late."
The brothers worry their siblings in West Virginia are doing the same.
"They should listen to their doctor and try to go with that because it will help them," said Norville.
Hurley talked about living with diabetes.
"Diabetes doesn't hurt," he said. "Someone once said to me, if diabetes hurt, I would take it more seriously. You don't feel it. What you don't realize is that this high blood sugar level is wreaking havoc all throughout your body."
Despite the diagnosis, and seeing how sick his brothers and sisters were getting, Ranny hasn't change his eating habits, or followed his doctor's orders.
He said he didn't test himself daily, although he was supposed to multiple times a day.
"I might do it once in a month," he said.
Part of what makes diabetes so difficult is the constant monitoring, the constant diet control. Those measures are life-prolonging, but for some diabetics, it's just too hard to keep on track.
And in advanced cases, such as Maynard's, the routine gets even more difficult. During dialysis, her blood is cleaned by machine, because the kidneys can't do it.
She said what keeps her going is her 9-month-old grandson, Jeremy Sean.
"I would have done gave up" if not for the child, she said, crying. When it comes to diabetes, she hopes her grandson's generation will have it better.