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.
"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.