W.Va. slammed with sugarBELINGTON, W.Va. -- BELINGTON -- Glenda Blake grew up in Barbour County, an ornery little round-faced girl who loved to take care of the animals on her grandparents' farm.Her grandmother, who taught her to cook, had diabetes. Her mom had diabetes. "Everyone in our family had sugar," she said. "It was just something I always knew about."She figured she'd get diabetes too. "People thought, if people in your family have sugar, you will too. We didn't know it could be prevented."As a young woman, she cared for elderly Barbour County diabetics in their homes. For the past 14 years, she has cooked at The Good Samaritan nursing home in Belington. Half the residents are diabetic. "She's the person you'd want cooking for your mother," says administrator Mark Nessman.Now she's teetering on the edge of diabetes herself. Her blood sugar waltzes up to the brink. But she has found she can do something about it. She keeps waltzing it back.Last November, feeling depressed and tired, not sure what was wrong, she trudged into the Belington Clinic, Barbour County's community health center. They told her that her blood glucose had spiked to prediabetic range, between 100 and 125."They told me they had a new health coach who could help me keep diabetes from happening." A half hour later, she was sitting in Jill Weingart's office, spilling out her story.Her son had lost his job and moved in with her. Several nursing home residents were in crisis. "I worry about them all the time," she told Jill."You're always putting other people first, aren't you?" Jill asked gently. As soon as she said that, Glenda burst into tears. Jill handed her a box of Kleenex. "You're a caretaker," she said. As women, we're always putting everybody else first," she said. "It's time for you to think about Glenda too."Glenda wiped her eyes. "Let's make sure you don't get diabetes," Jill said. "We can take it step by step," Glenda looked at her, dabbing her eyes. "My services are free," Jill said. That's true at all community health centers. As the diabetes epidemic grows in West Virginia, many have started diabetes prevention services, sometimes classes, sometimes coaches.Glenda has no insurance. She makes $350 every two weeks. If she were diabetic, she could get insulin free through the clinic if she needed it, but not the diabetic finger sticks and testing strips, which cost about $45. "I can't afford to get diabetes," she said, as if talking to herself."To keep from getting diabetes, you'll need to lose 5 to 7 percent of your weight," Jill said. "That's going to be 20 pounds. You can do that. Maybe lose a pound or two a week. You don't need to do it tomorrow. It's not safe to lose fast.For 45 minutes, they talked about what Glenda eats and how her day goes and plotted ways she can make small, manageable changes.Jill showed her the "My Plate" way to think about food. "That was the most helpful thing for me," Glenda said later. "It's a picture of a plate with four different sections on it. It shows you how to divide your food, to keep yourself from getting in trouble. One portion is your meat and one your rice or white stuff. Then the other two, you fill them with vegetables or fruits."Jill said exercising would be important. Glenda said she could walk by the river. Health counselors help people make a plan, then help them figure out what things might get in the way. They talked about ways Glenda could eat a healthier diet on her budget. Go light on potatoes, Jill said. "They metabolize into sugar". Try brown rice instead of instant white. "It takes a little longer to cook, but it's better for you, and you can eat more without problems." Then they walked down the hall to weigh her.In following month, Glenda kept checking in with Jill. She was writing down what she ate and drank. They talked about things that get in the way of her walking, teenagers racing up and down the road in cars, for instance. "It helped a lot, knowing I'd be talking with her," Glenda said.Five weeks later, she was standing on the scale, looking at a needle that said she'd lost 15 pounds.That night at the nursing home, she was handing out hugs at one wheelchair after another. "You sweet thing," a white-haired woman hollered from her bed as she passed down the hall.In the dining room, a man in a wheelchair banged his cup on a table. "You're ornery!" Glenda said, bending down to hug him. He turned pink.With a bounce in her step, she went into the kitchen to puree the vegetable soup and fix the salad. "I lost 15 pounds," she told a friend. "I'm going to beat diabetes!"She bought an exercise bike, she said. This summer, she might get a real one.By the end of March, Glenda had lost 25 pounds. "And more to come," she said. Her blood sugar is mostly below 100, she said. "It spiked up high a couple of times, but I knew what to do."She had connected with Jill Weingart by luck. More than half of West Virginia's quarter million diabetics have never had a chance to work with somebody who teaches them how to manage their diabetes, according to a Centers for Disease Control survey.Many, like Glenda, don't realize they can prevent diabetes. Many have little idea where to look to find help.People can find diabetes classes or counselors at most community health centers, a few public health departments, most hospitals, some private clinics. Some are free. Some are not. Nobody keeps a statewide list of diabetes prevention/control programs. People like Glenda may have a hard time finding them. Or they may get lucky like she did."I help people figure out how to eat healthy even if they don't have a lot of money," Jill said. "We talk about practical things, where you can get the best deals, how to get a ride to the grocery. Whatever stands in their way. I teach them how to evaluate their food, how to count carbs."The Belington Clinic offers Weingart's services free because the community health center is federally funded."It's a no-brainer for us," said Debbie Schoonover, clinic administrator. Diabetes, at the end of life, can cost more than $100,000 a year, if the person is on dialysis, she said. "It costs a lot less to keep Glenda from getting diabetes than it would cost for her to have it the rest of her life.""I thought I knew all about diabetes before I went to Jill," Glenda said. "After all, I'm a cook. My grandmother and mother had diabetes. But I've learned so much from her, I call her my lifesaver.Her blood sugar still teeters back and forth between normal and prediabetic. "I don't know what's going to happen, but I know now there are things I can do, and that helps."Reach Kate Long at firstname.lastname@example.org or 304-348-1798."The Shape We're In" was written with the help of the Dennis A. Hunt Fund for Health Journalism, administered by the California Endowment Health Journalism Fellowships at the University of Southern California's Annenberg School for Communication and Journalism.