Type 2 diabetes disproportionately affects individuals in Appalachia. This study investigated discourse among friends and family with different diabetes risk levels in Central Appalachia. Eighteen semistructured, in-depth interviews were conducted with Appalachian Kentuckians. Thematic analysis revealed 2 dialectic tensions centered on disease management (health as a personal problem vs diabetes management requiring social support) and disclosure (openness vs closedness). Health professionals should consider the powerful influence of speech with respect to family relations and support, along with the need to communicate early, clearly, and often in a manner that emphasizes family, friends, and connectedness.