Diabetes is actually the eighth leading cause of death in the United States, according to the American Diabetes Association, killing 100,000 people in both 2021 and 2022. It is the most common underlying condition of disease in the U.S., according to report in the journal BMJ, and some 40% of people who died of COVID-19 had diabetes. 

Other celebrities living with diabetes include Tom Hanks, Nick Jonas, Randy Jackson, Halle Berry, and Sherri Shepherd. 

Actress and producer Penny Marshall died of complications from the disease in 2018 at age 75, as did country singer Waylon Jennings, musician Curtis Mayfield, actor Carroll O’Connor and jazz singer Ella Fitzgerald. 

But what does it mean to die of diabetes complications? And how common is it? 

What is diabetes?

More than 38.4 million Americans—11.3% of the population—have diabetes, including 8.3 million who have not had it diagnosed but meet the lab criteria, according to the Centers for Disease Control and Prevention (CDC).

It’s a condition caused by a person’s blood glucose, or blood sugar—a body’s main source of energy—being too high, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Glucose is both made by the body and provided by consuming food.

To help glucose travel into a body’s cells to be used for energy, it needs the hormone insulin, which is made by the pancreas. A person with diabetes does not make a sufficient amount (or any) insulin, or doesn’t use it properly, meaning it stays in the blood without reaching cells.

There are several types of diabetes, according to the NIDDKD: Type 1, typically occurring in children or young adults but possible at any age, means the body makes little or no insulin, and that a person must take insulin every day to stay alive. Type 2, the most common type, often caused by being overweight or other risk factors, means the cells in one’s body don’t use insulin properly. Gestational diabetes develops during pregnancy, and the rare monogenic diabetes is caused by a mutation or change in a single gene. 

Having diabetes raises the risk of other health issues, including damage to eyes, kidneys, nerves, and heart, as well as some types of cancer. But preventing or managing diabetes— by taking medications and monitoring glucose levels, blood pressure, and cholesterol levels—may lower that risk.

How does one die of diabetes complications?

“Diabetes-related deaths are far more common than people realize,” Dr. Robert Gabbay, American Diabetes Association chief scientific and medical officer, tells Fortune. That’s because the disease “can cause a number of complications that can lead to death.” 

That includes high blood glucoses leading to diabetic ketoacidosis—when the liver breaks down fat for fuel to compensate for the lack of insulin, leading to a dangerous buildup of acids called ketones. That has a “significant mortality rate,” Gabbay says. 

Other complications, he explains, might include severe low blood glucose—hypoglycemia—which can lead to coma and death. In addition, he says, “Cardiovascular disease, stroke, and kidney failure can all be caused by diabetes and lead to death.”  

Dying from any of these complications, Gabbay notes, “doesn’t necessarily tell you much about how the disease was being managed.” 

Still, those living with the condition needn’t panic, as “keeping blood glucose in range can lower the risk” of severe complications, he says.

To stay on top of your health as a person with diabetes, Gabbay stresses, “Work with your health care professional to try to keep your blood glucose levels in a healthy range,” something most often done with monitoring—including continuous glucose monitors—medications, and diet and exercise, “along with regular health screenings to watch for the beginning signs of complications.”