At the Nuuanu YMCA on a recent weekday, Olympic weightlifter Jameson Dahl is hard at work, going through his workout to stay in shape.
The 32-year-old looks like the picture of health.
So you might be surprised to hear he has Type 1 diabetes.
In high school, the San Diego native was an active athlete. "I swam, did water polo, and hockey," Dahl said.
But at 24, he started noticing big changes with his body.
"I started getting really weak. At one point I dropped, in two weeks, maybe from 185 to 140 pounds," he said.
Doctors diagnosed Dahl with Type 1 diabetes, something that shocked him at the time.
"I was terrified. My first reaction was, 'What?'"
He's not alone.
Over half a million people in the islands have diabetes or are pre-diabetic. That's 1 in 3 people.
The vast majority of those diagnosed have Type 2 diabetes, which is linked to obesity and lifestyle choices. Type 1 diabetes is an autoimmune disease.
In both cases, the disease affects the body's production of insulin -- a hormone the body needs to get energy from food.
There is no cure for Type 1 diabetes, but Kourtney Inoue said, a certified diabetes educator at Kaiser Permanente's Moanalua Clinic, said Type 2 diabetes can be managed with diet and exercise.
"It is a serious problem. We are seeing an increase in the number of diagnosis," Inoue said. "We could fill up Aloha Stadium several times with the people who have diabetes or pre-diabetes."
Meanwhile, diabetes is the seventh leading cause of death in Hawaii -- and nationwide.
As for Dahl, he's not letting diabetes slow him down.
He leads an active lifestyle and continues to compete locally and nationally.
And his approach in the gym is the same as with his health. "You can't slack off. You have to be vigilant. You have to be on top of it," he said.
And Dahl wears a pump 24 hours a day to get his body the insulin it needs.
"It goes into an injection site in my abdomen and you move that every three days just so you minimize the risk of infection," Dahl said.
If you have diabetes or if you want to learn more about the disease, a large conference Saturday in Waikiki will focus on the topic. "Take Control of Your Diabetes" runs from 9 a.m. to 5 p.m. at the Hawaii Conection Center.