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If you have diabetes, you have at least twice the chance of experiencing hearing loss than someone who does not have the condition, according to the American Diabetes Association.

If you have prediabetes, your risk for hearing loss is 30 percent higher compared with those who do not have diabetes. Two other things that can increase the chance that you’ll experience hearing loss are age and smoking.

So just why are people with diabetes at a higher risk for hearing loss? “We believe it’s years of poorly controlled blood sugar,” says Dr. Deena Adimoolam, an endocrinologist and assistant professor of diabetes, endocrinology and bone disease at the Icahn School of Medicine at Mount Sinai in New York.

In short, the effects of high blood glucose over time can damage your hearing. “Although the exact reason for diabetes-related hearing loss is unknown, it’s suspected that there are two major causes,” says Dr. Jagmeet S. Mundi, an ear, nose and throat specialist with Mission Hospital in Mission Viejo, California. “This includes damage to the small blood vessels that provide blood flow to the inner ear and direct nerve damage to the inner ear structures. The combination of the two leads to hearing loss in these patients.”

Hearing loss is also influenced by changes to your brain over time. “There’s a lot of focus on what’s happening in the ear, but we’re also looking more at what happens in the brain,” says Dr. Dawn Konrad-Martin, an ear, nose and throat specialist with the Oregon Health & Science University School of Medicine in Portland and the U.S. Department of Veterans Affairs’ National Center for Rehabilitative Auditory Research. Your brain plays an active role in your ability to hear.

Although hearing loss is easier to spot in older patients, research shows some differences in younger patients with diabetes as well, Konrad-Martin says. However, the changes can be so minor that they might not be noticed until there’s a lot of hearing loss.

“There are also reports of hearing loss occurring in younger patients and at lower frequencies than found in similar patients without diabetes,” Mundi says.

Symptoms of Diabetes-Related Hearing Loss

For the most part, the symptoms of diabetes-related hearing loss will be like those of everyone else. One difference is that hearing professionals can track a consistent difference in the ability of those with diabetes to hear low- or middle-frequency sounds. However, that may not be something you notice. In fact, you may not detect any difference at all, at least not for a long time.

“People are notoriously bad at noticing the problem. It takes an extremely long time for people to blame [hearing loss] on themselves,” Konrad-Martin says.

It may be a loved one observing that your hearing is not that great anymore in certain situations, such as at a noisy restaurant or even in a quieter environment.

Other hearing loss symptoms include:

• Thinking that people talking are mumbling
• Not hearing when people speak directly to you
• Turning up the volume on devices frequently
• Speaking more loudly than necessary
• Increased sensitivity to loud noises (this also could be the sign of a condition called hyperacusis)
• A ringing sound in the ears (this also is associated with a hearing problem called tinnitus)
• Feeling as if you can hear what someone says, but it’s not as clear as you’d like. “Think of it like a picture going out of focus,” Konrad-Martin says.

Although hearing loss is common as you get older, hearing professionals often find that the degree of hearing loss in someone with diabetes is more severe than someone of the same age who does not have diabetes.

Diabetes-Related Hearing Loss: Treatment and Prevention

If you think you are experiencing hearing loss, talk to your health care provider or schedule a visit to an audiologist. An audiologist specializes in hearing loss and can screen you with a full hearing exam.

Many people with hearing loss use a hearing aid. If that sounds intimidating to you, don’t worry. Today’s hearing aids tend to be smaller and easier to use than in the past. “People are generally happy with their hearing aids now,” Konrad-Martin says.

Depending on the circumstance, hearing loss can sometimes be reversed with the use of steroids, Mundi says.

An audiologist can also help coach you on ways to hear better in specific situations, such as in a noisy room.

Hearing loss can make life more challenging, so it’s important to try to prevent it. One additional reason to prevent it when you have diabetes is that you’re also at higher risk for vision loss. So, if you experience both hearing and vision loss, you’re hit with a sensory double whammy.

One way to prevent hearing loss related to diabetes is to keep your blood sugar under control. Take your medications as your doctor prescribes, stay physically active and make healthier food choices. These are all basic but important ways to improve your health and cut the risk for diabetes complications. “If you can maintain control of your blood sugar, you can prevent worsening of hearing loss,” Adimoolam says.

Another preventive step is a regular hearing exam. If you’re under age 50 and relatively healthy, a full hearing exam once every five years should be enough, Konrad-Martin says. If you’re over age 50 or 60, you likely already have age-related hearing loss, so you’ll want to get your hearing checked more frequently. Hearing professionals are promoting regular screening more often these days, as hearing exams are often overlooked.