Please imagine a simple graph.
The Y axis runs vertically up, from non-smoker to smoker.
The X axis runs horizontally across, from actively managing your diabetes seriously, to not managing it seriously (talking here about meds and lifestyle).
You DON'T want to be in the upper right quadrant. That's the perfectly bad storm, where a loved one is, and it's a bad, pretty much irreversible place. This loved one has been lying in a hospital bed for about half a year, and is now legless.
Think about that when you take your Ultrarunning for granted.