What is diabetes?
Diabetes is a condition where you have too much sugar (specifically, a sugar called glucose) in your blood.
Insulin is the hormone that lowers your blood sugar levels. Diabetes develops when the pancreas, (the gland that makes insulin), can’t make insulin, or when your body doesn’t respond to insulin. Without enough insulin, blood sugar levels rise, which then leads to diabetes.
If it goes undetected or isn’t controlled, diabetes can cause serious short term and long term health complications.

What are the different types of diabetes?
There are two main types of diabetes.
Type 1 diabetes can begin at any age, but often starts in childhood or young adulthood. If you have type 1 diabetes, your body can’t make enough insulin, and you must take extra insulin every day.
About 85% of people with diabetes have type 2 diabetes. Type 2 diabetes is linked to diet, lack of exercise, being overweight, and family history. If you have type 2 diabetes, your pancreas doesn’t produce enough insulin, and the insulin it does produce doesn’t work properly. This means your body can’t control its blood sugar levels.

How can I prevent diabetes?
Type 1 diabetes cannot be prevented. However, type 2 diabetes can be prevented by a healthy lifestyle, including regular physical activity, a balanced diet, and keeping weight in a range that’s healthy for you.
What health problems are caused by diabetes?
If diabetes isn’t detected, or it isn’t controlled, it can reduce your lifespan.
Diabetes can cause blindness, kidney failure, nerve damage, reduced blood circulation and can increase the chance of heart attack and stroke. If you have diabetes, you also have a higher chance of developing sexual and reproductive health problems, including:
• Erectile dysfunction
• Low levels of testosterone
• Low sex drive
• Semen flowing back into the bladder (retrograde ejaculation)
• Inflammation of the head of the penis (balanitis).

What can I do?
Speaking to a doctor about sexual and reproductive health problems is particularly important if you have diabetes. You can talk with your doctor about lifestyle changes or other ways to control your blood sugar levels. Your doctor might refer you to a specialist or sexual therapist if it’s suitable for you.

Diabetes and erectile dysfunction
If you’re having difficulty getting or maintaining an erection, this is called erectile dysfunction. It’s not a disease, but a symptom of another problem, which might be physical, psychological, or a mixture of both.
Erectile dysfunction is very common.

How common is erectile dysfunction in men with diabetes?
Erectile dysfunction is more common in men who are overweight or who have heart disease, high blood pressure, or high cholesterol. These are all common conditions in people with diabetes.
If you have diabetes, you’re twice as likely to experience erection problems.

How can I prevent erectile dysfunction with diabetes?
Erectile dysfunction is more likely to happen when blood sugar levels aren’t well controlled. Keeping blood sugar and blood lipids (cholesterol and triglycerides) normal is important to prevent nerve and blood vessel damage to the penis.
Not smoking and drinking less alcohol can also help prevent erection problems.

How is erectile dysfunction treated with diabetes?
First, you need to focus on your diabetes and any other related conditions, such as high blood pressure.
Once your diabetes is properly controlled, the first treatment for erection problems is usually an oral medication, such as Viagra. If you’ve got diabetes, this medication has about a 50% chance of working. If oral medicines don’t work, there are other treatments that you can explore, including penis injections and surgery.

Diabetes and low testosterone
Low testosterone (or testosterone deficiency) is when your body isn’t able to make enough testosterone to function normally. Testosterone is a key hormone that is important for normal reproductive and sexual function.
If you have type 2 diabetes, low testosterone levels are a common problem. You’re more likely to have testosterone problems if you’re diabetic and also overweight.
Low energy levels, mood swings, irritability, poor concentration, reduced muscle strength and low sex drive might be symptoms of low testosterone. These symptoms often overlap with those of other illnesses.

How does diabetes cause low testosterone?
There is a hormone made in the brain called luteinizing hormone (or LH) that the testicles use to make testosterone. The high levels of blood sugar in men with diabetes can impact the amount of LH that the brain releases, which means that the testicles can’t make enough testosterone.

Can low testosterone be prevented in men with diabetes?
Keeping a healthy weight and doing regular exercise to control blood sugar levels can keep your testosterone levels normal.

How is low testosterone treated in men with diabetes?
If you’ve got diabetes and low testosterone, you should get treatment for the diabetes and any other illnesses first, as this might return your testosterone levels to normal.
If you’re overweight, weight loss might help.
For men with diabetes and low testosterone caused by genetic disorders or other conditions, your doctor might recommend testosterone therapy.

Diabetes and low sex drive
Low sex drive (low libido) is the term used to describe a lack of interest in sex.
Sexual desire is different for each person, and might change over time depending on what’s happening in your life. Some people aren’t concerned about having low sex drive. However, if you lose interest in sex for no apparent reason, and it’s a concern for you, talking to a doctor can help.

How can diabetes cause low sex drive?
Diabetes can cause low testosterone levels, which leads to low sex drive. On top of this, other problems sometimes caused by diabetes, such as difficulty getting an erection, can lower your interest in sex.

How is low sex drive treated in men with diabetes?
The treatment for low sex drive for diabetics varies from person to person.
Controlling your blood sugar levels can help improve your interest in sex. If you have low sex drive because of low testosterone, then you might need testosterone therapy. Counselling can also be helpful for finding out whether there are psychological or relationship issues that could be affecting your interest in sex.
The best way to figure out how to deal with low sex drive is to speak to a doctor.

Diabetes and retrograde ejaculation
Retrograde ejaculation is when the muscle at the opening of the bladder, which usually stops semen from entering the bladder when you orgasm, doesn’t close properly. This causes semen to flow back into the bladder.
If, when you orgasm, you ejaculate little or no semen, retrograde ejaculation could be the problem. Your urine might also be cloudy when you first urinate after orgasm.

How does diabetes cause retrograde ejaculation?
If you have diabetes, the high levels of sugar in your blood can damage the nerves and muscles that open and close the neck of the bladder (external sphincter muscle). This muscle usually stops semen from entering the bladder when you orgasm — so if it isn’t closing properly, semen flows back into the bladder instead of being ejaculated.

How is retrograde ejaculation treated in men with diabetes?
If retrograde ejaculation is caused by diabetes, controlling blood sugar levels and making lifestyle changes can help. Often, you won’t need treatment. However, retrograde ejaculation can make it more difficult for you to have a baby. If you have retrograde ejaculation and you’re trying to conceive, you might need the help of assisted reproductive technologies such as in-vitro fertilisation (IVF).

Diabetes and balanitis
Balanitis is a common infection that causes inflammation at the head of the penis (glans penis). It can affect you at any age.

What are the symptoms?
If you have balanitis, you might not be able to pull back your foreskin over the head of the penis. You might have itchiness, a rash, redness, swelling, or discharge from the penis. Because these symptoms can also indicate other problems, it’s important to speak to your doctor.

How can diabetes cause balanitis?
Sometimes after urinating, urine gets trapped under the foreskin. If you have diabetes, the sugar in your urine can encourage bacteria to grow in the moist area under the foreskin, leading to infection (balanitis).
One of the groups of medicines used to treat diabetes could also increase the risk of balanitis.

What treatments are there?
Washing your penis and the inside of the foreskin with soap and warm water is important. Talk to your doctor about controlling your blood sugar levels, and they might prescribe antibiotics or antifungal medication to help clear up the infection.

This content is modified from Healthy Male: healthymale.org.au. This information has been provided for educational purposes only. It is not intended to take the place of a clinical diagnosis or proper medical advice from a fully qualified health professional. Healthy Male and International Society of Andrology both urge readers to seek the services of a qualified medical practitioner for any personal health concerns.

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