Several years ago, at Schmidt's instigation, state lawmakers required the state Department of Health and Human Resources to provide all doctors with CKD diagnosis training, so they could spot it before it was too late.
However, the Legislature provided no money to pay for the campaign. "The best we could do was put a CKD module on our online education program," said Gina Wood, diabetes program manager.
"It's not yet a lost cause," Schmidt said. "But it soon could be, if we don't get on the ball."
West Virginia leads the nation in diabetes and high blood pressure, the two main causes of kidney disease.
Why not laugh? I'm not afraid to die.
Kittle, 77, remembers the Belington diner she used to own. "People always had a good time at my diner, and I never let a person go away hungry," she said.
Now she can't walk by herself. Diabetes has wrecked the blood vessels in her legs.
She laughs a lot. "There's nothing I can do, so why not laugh?" she says. "I'm a Christian. I'm not afraid to die."
Kittle and her husband took in a disabled man when he was a child. Now that man helps care for her at home. Home health aides come every day. That costs too. Diabetes is not cheap.
She resisted dialysis till the last minute, when she was being hauled to the hospital in kidney failure. "When I knew I was going to die, that's when I started coming."
Wright, 63, the former Forest Service scientist, had to give up his job and most of his pastoring. "All I pastor now is my group at Huttonsville prison, and sometimes I'm so sick, I can't go to that."
He carries non-sugar candy in his pocket. "It's too late, but I try anyhow," he said.
"I was sitting all day."
Hall said in November that, when he was young, his doctor told him, "'Bill, there's diabetes all through your family, so you'll probably get it. It isn't going to get you for a long time, so you might as well go ahead and have a good time.' So I took his advice on that."
"Bad advice," Weaner said.
Wright, on the other hand, knew he shouldn't be eating sugary things. "It didn't seem to hurt me," he said, "as long as I had a job out in the field, where I could be walking around all day and burn off the sugar. But soon as they promoted me to a desk job and I was sitting all day, I started to go downhill. I was still eating the sugar, but I wasn't burning it off. It didn't balance anymore."
Kittle knew she had diabetes years before she did anything about it, she said. She says she never tried to eat a non-diabetic diet. "I was running a diner! I just figured God would decide when I'd die, and there was nothing I could do about that."
"If a patient believes it's going to happen, no matter what, why would they try to prevent it?" asked Dr. Frank Schwartz, director of the Appalachian Regional Health Institute Diabetes Center in Athens, Ohio.
"We have these cultural beliefs in Appalachia that, once you get diabetes, there's nothing that you can do to prevent losing your leg or going blind and your kidneys shutting down. That's the dominant story that's out there, that those things are inevitable, once you get sugar."
"We've got to find a way to reverse the belief that there's nothing you can do," he said. "We're not going to make real headway till we do."
About 25 West Virginia health clinic and public health departments offer American Diabetes Association-approved diabetes coaching, aimed at preventing dialysis and other complications, but there are more programs. All 28 community health centers and most hospitals also have health-coaching programs.
Kittle, Hall and Wright never got solid, detailed advice, much less a coach.
"I wish I had had one," Wright said. "I want to see my grandkids grow up."
Reach Kate Long at katel...@wvgazette.com 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.