I took Nellie to the doctor's yesterday. She has had a chronic infection in her foot for a month now despite a regimen of oral antibiotics or "the biotics that are making me sick" as she says.

It isn't the "biotics" that are making her sick. It is the fact her daily glucose levels are close to 300 and have now started to fluctuate wildly from that high down to 50. I've gotten to where I can look at her and run for the orange juice without even testing. She is adamant that her diet makes no difference and eats whatever she wants.

I have been preaching to her for weeks now, using a combination of scare tactics and sweet talk. It is finally beginning to sink in. Unfortunately, she interpreted it as food being the enemy and will hardly eat anything now which of course causes her glucose levels to skyrocket.

However, after continuous nagging, I got her to agree to a whole new diet that does not include fried food and white bread and biscuits and cake and candy.

It has turned out to be too late. She has deteriorated rapidly over the past week to the point where she could not get out of bed into her wheelchair without assistance and complained that she hurt all over and lapsed into a lethargic state.

The doctor took one look at her foot and went to write an order to admit her to the hospital. That woke her up. She started yelling she wasn't going in the hospital. The doctor, who has always been sweet to her, got very angry and said, "It's your body. If you want to lose your foot, I can't stop you. I expect to see you in that hospital tonight."

She insisted she go home first. So we went. As we went up the drive she marveled at her tulips which she hasn't even been outside to see. Once inside, she started crying and saying her life was over. I explained for the one hundredth time that she was feeling so bad because her uncontrolled diabetes was finally catching up with her. She was still skeptical. She insisted she was a burden on everyone and wanted to die.

These flowers are from her garden. She's been too depressed to let me take her outside on these beautiful warm spring days. They're for her. Along with a prayer that the damage is minimal and that a course of "biotics" and a carefully monitored diet will soon have her home, her old feisty self.

WV has the fourth highest rate for diabetes in the country. No one knows why. It tends to manifest itself in older, females with less education. The hardest population to work with as I've discovered. It is very difficult to convince them how dangerous it is and how a complete diet change is in order.

It is so bad here that whenever I go to a new patient the first question I ask is "Do you have sugar?" and the answer is usually yes. The state has started an agressive education program. However, the targeted population is the most resistant to change. They tend to hear only the parts they want to. For example, one woman who hasn't had a pop in years sent me to Dairy Queen for a Moo Latte.

Unfortunately, it seems the only things that makes an impression are when parts of their feet are amputated or they go into diabetic comas a few times.