Men and Type 2 Diabetes

IN THIS CHAPTER

check Addressing erectile dysfunction

check Understanding the effects of low testosterone

check Seeing the connection between emotional and sexual health

check Taking a quick look at cardiovascular disease

Men with diabetes can live dynamic, productive, and healthy lives. If you’re a man with diabetes, you may want to think about specific issues such as erectile dysfunction and low testosterone. In this chapter, we explore these male-specific concerns and offer suggestions about what you can do about them.

Not every man (or woman) is 100 percent comfortable talking about his health, particularly his sexual health. It’s a taboo topic for some men who consider anything less than perfection a vulnerability or weakness.

However, being thoughtful and proactive about your health are some of the best things you can do for your body and mind. When you’re proactive, you have the opportunity to build a healthcare team that you trust and can rely on for treatments and education. And of course, you should eat healthy foods, exercise, lose or maintain weight, and take medications to better manage your diabetes.

Some of the topics in this chapter may not be easy to discuss or contemplate because they relate to sex. However, keep in mind that you’re not alone. Many men struggle with sexual issues, and the best way to find solutions is to be honest and forthcoming with your healthcare providers. Sex can be a healthy part of anyone’s life, and complications from your diabetes shouldn’t hold you back.

Addressing Erectile Dysfunction

Erectile dysfunction (ED), the inability to get or maintain an erection during sex (also called impotence), can be an uncomfortable topic to bring up because it’s such a personal issue.

However, ED is definitely an issue for men with diabetes. For example, in a 2017 study in Diabetic Medicine, an analysis of previous studies found that erectile dysfunction affected more than half of men with diabetes. And men with diabetes were three and a half times more likely to experience erectile dysfunction than men without diabetes.

ED varies in severity by individual. You may not experience complete ED each time you try to have an erection, but if you consistently have trouble getting or keeping an erection, talk to your physician.

The following sections explain the causes of and treatments for ED and give you some encouragement when you’re ready to talk to your doctor and significant other about the condition.

Considering the causes

ED has more than one cause, which may include physical issues, psychological issues, or both. In other words, your mind and body could affect your ability to have an erection:

Diabetes: Men with type 2 diabetes have a greater risk of nerve damage and blood vessel damage. Both of these things can impact erections.
- Nerve damage: Also called neuropathy, nerve damage can cause ED because it may harm nerves that send signals to the penis. Keeping your blood glucose in your target range helps your nerves stay healthy over time.
- Blood vessel damage: Blood vessel damage can lessen blood flow to the penis and cause ED. Keeping your blood glucose on target, as well as quitting or not starting smoking, exercising, and losing weight can also improve your blood vessels and blood flow.
Medications, alcohol, and other drugs: Some medications — such as antidepressants, antihistamines, blood pressure medicines, and others — can also increase your risk for ED. Ask your doctor about these medications if you’re concerned about ED. Recreational drugs such as alcohol can impact your erections, too.
Low testosterone: Low testosterone, which is discussed later in this chapter, can also contribute to ED.
Your feelings about sex: How you feel about sex can also impact your erections. Stress, anxiety, guilt, depression, or fear about not having an erection can affect your mood and function. Your relationship with your partner and what’s going on with your life together can also affect erections. Don’t discount your feelings about sex or what you think about during sex. These thoughts and feelings may make it harder to get and maintain an erection.
Your age: Your age can also affect how easily you get and maintain an erection. As all men age, not just men with diabetes, their risk of experiencing ED increases.

Treating erectile dysfunction

The good news is that treatments for ED abound. Prescription medications such as Viagra, Cialis, and Levitra can improve blood flow to your penis. The medications can be prescribed on a daily or an as-needed basis. Cialis for once daily use, for example, may be taken daily independent of the timing of sexual activity, whereas Viagra should be taken as needed before sexual activity. These treatments can be safe and effective for many men.

However, when ED drugs and certain medications (particularly nitrates prescribed for chest pain) are taken together, the results can be fatal. Make sure your doctor and pharmacist know about all the medications you take.

A vacuum tube or pump can also draw blood into the penis if these medications don’t work or aren’t a safe option for you. Surgery with a penis implant is another treatment option.

Don’t be embarrassed: Talking to your doctor

Talking to your physician is the best way to identify and treat ED. You may find it embarrassing or hard to admit the problem to someone else, but put aside your shyness. Your physician is on your side. He is a trained professional, and he should be able to offer education about and treatment for ED.

First, start by telling him your symptoms and concerns. He may ask you to describe your erections: their frequency, duration, and firmness. Don’t forget to talk about your emotional health including depression, anxiety or dissatisfaction, or stress with your partner. Also, mention any physical changes you’ve noticed in your body. Be sure to tell your doctor about the medications that you’re taking so you can rule those out as contributors. Lastly, discuss treatment options so you can find something that fits your lifestyle with a minimum of side effects.

If, on occasion, you don’t get or keep an erection, this does not mean you have ED. Most men experience this from time to time — it’s considered a normal part of life.

Tackling the Problem of Low Testosterone

Testosterone is an important hormone for men. It does many things in the body, including regulating sexual desire or libido. In general, testosterone slightly and gradually declines after middle age. Moderate alcohol consumption and regular opioid use may decrease testosterone levels.

Some men have low testosterone, which can contribute to low sexual desire, ED, depression, low energy, increases in body fat, and loss of muscle mass. Men with type 2 diabetes are twice as likely to have low testosterone as men without diabetes. Overweight men are also predisposed to lower testosterone.

Low testosterone shares many symptoms with other problems, but a simple blood test can diagnose it. If you’re experiencing symptoms such as a lower libido, decreased energy and mood, or ED, tell your healthcare provider. A large deficiency in testosterone may cause your doctor to evaluate you for underlying conditions, such as problems with your pituitary gland or other organs, that may have gone unnoticed.

Hormone treatments such as gels, patches, and injections boost testosterone. If you want more details, ask for a referral to an endocrinologist or urologist who specializes in treating low testosterone.