A slew of surprising complications arise when diabetes is poorly managed. One of them may be hearing loss.

According to the American Diabetes Association (ADA), hearing loss often sneaks up on individuals because the condition can develop slowly. “In fact, family members and friends sometimes notice the hearing loss before the person experiencing it,” says the ADA.

Right now, it’s unclear how diabetes may negatively affect hearing. But findings show that hearing loss is twice as common in those with the illness. In addition, among the 84 million U.S. adults with prediabetes—higher blood glucose levels that aren’t high enough to merit a diabetes diagnosis—the rate of hearing loss is 30 percent higher than for those with normal blood sugar levels.

So what do experts advise? First, regulate your diabetes. Then talk to your doctor, visit a hearing specialist and get a complete exam, evaluation and treatment plan.