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Hyperglycemia does it by increasing the rate of transformation of NAD to NADH. Hypoxia makes it difficult for cells to turn NADH back to NAD. In both conditions the increased NADH is recycled back to NAD by processes that produce free radicals, chemically reactive compounds that can damage tissue. Williamson and his coauthors propose that long-term use of these processes causes the damage seen in diabetes.
Insulin is the hormone that allows the sugar to get to the cells and provide them with energy. Uncontrolled diabetes can frequently result in many complications which cause damage to important body organs like the liver, kidneys, eyes and nerves. It can also result in other conditions like heart disease and stroke. It can lead to diabetic ketoacidosis as the body fats are being used for energy.