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Diabetes is an extremely common condition that affects more than 400 million people globally and counting. The most common type of diabetes is type 2, which accounts for more than 90% of diabetes. This is the form of diabetes most commonly seen with obesity and age.(1)

Diabetes is a serious condition that can cause a range of issues such as heart disease, nerve damage and – in extreme cases – loss of limbs.

For men with diabetes, the likelihood of developing erectile dysfunction (ED) is also increased and about half of men with diabetes have ED to some extent.(2)

Why are ED and diabetes connected?

Diabetes develops when a person’s body loses the ability to produce enough insulin or respond adequately to the insulin it is producing. This is important because insulin is the hormone that causes your body to remove sugar circulating in the blood. Without a normal insulin process, the sugar in the blood can build up, causing damage to the circulatory system – the heart, veins and arteries – as well as the nervous system.

For a normal erection to occur and be maintained, the penis requires an adequate supply of blood as well as a clear nerve signal from the brain – both of which are negatively affected by diabetes.

Can I reduce the impact of diabetes on ED?

The best way to reduce the impact of diabetes on ED is to practice good management of blood sugar. This can be achieved through a combination of lifestyle changes and diabetes treatment. All diabetics in the UK should have a diabetes care plan, developed in partnership with their GP or specialist (usually an endocrinologist or diabetologist). When properly managed, most diabetics can achieve good and consistent sugar control that will slow and limit long-term damage that contributes to ED.

It is important to understand that the risk and severity of ED have been directly linked to poor sugar control and failure to manage blood sugar effectively will worsen ED over time.(5)

For more information and guidance on living with diabetes, visit the Diabetes UK website: https://www.diabetes.org.uk/guide-to-diabetes

Sex and diabetes(6)

While it is the effect of too much sugar in the blood that causes lasting damage, diabetics can also suffer from dangerously low amounts of sugar in the blood – known as hypoglycaemia and often shortened to ‘hypo’. Hypo’s can be caused by exercise as well as some diabetes treatments, such as injected insulin.

As sex is a form of exercise, it is important for people with diabetes to practice sex responsibly. Taking a blood sugar reading before and after sex is a good idea, as well as keeping a high-sugar snack handy if needed. If you are concerned about the timing of your medication and how this affects your sex life, you should discuss this with a member of your diabetes care team. It is generally not a good idea to alter the timing of doses of your medication without discussing it first.

Is ED an indication that I could have diabetes?

If you are experiencing ED but are not diagnosed with diabetes, it is possible that you are diabetic. This will be more likely if you are older, overweight, regularly drink alcohol, don’t exercise much and have a high-sugar diet.

Common symptoms of diabetes include increased thirst, tiredness and frequently urinating. If you are worried that you might have diabetes, you should make an appointment to discuss this with your GP. Diabetes is most damaging when it is not managed – if you are given a diagnosis of diabetes your GP will be able to help you manage this effectively.

Read more about the signs and symptoms of diabetes here: https://www.diabetes.org.uk/diabetes-the-basics/diabetes-symptoms

The key numbers:

• Diabetes affects more than 400 million people globally.(1)
• Type 2 diabetes makes up more than 90% of all cases.(1)
• It is estimated that there are 1 million people in the UK who have type 2 diabetes but haven’t been diagnosed.(3)

Is it safe for diabetics to use Viagra® (sildenafil)?

A recent (2018) meta-analysis, a type of study that combines the results of lots of other studies, showed that Viagra® (sildenafil) remained effective and safe for men with diabetes. It is important to note that the use of any medication includes risks and no medication can be viewed as 100% safe.(1)

Getting help and support

The UK has an extensive network of medical professionals and organisations that offer people with diabetes information, support and help. Dealing with diabetes in combination with ED is difficult and can affect people’s mental health. It is important to know that this is a common situation which you are not facing alone and that with the right support and treatment, you are likely to be able to improve both your diabetes and your ED.

Diabetes UK is a charity which offers free advice and support: https://www.diabetes.org.uk

Diabetes UK also offers a helpline which you can use to talk to someone experienced and knowledgeable in the challenges people with diabetes face:

How to contact Diabetes UK:

• Call: 0345 123 2399*, Monday to Friday, 9am to 6pm
• Email: helpline@diabetes.org.uk
• If you’re in Scotland: Call: 0141 212 8710*, Monday to Friday, 9am to 6pm.
• Email: helpline.scotland@diabetes.org.uk

REFERENCES:

1. Shah PC and Trivedi NA. A meta-analysis on efficacy and tolerability of sildenafil for erectile dysfunction in patients with diabetes mellitus. Indian J Sex Transm Dis AIDS. 2018 Jan-Jun;39(1):1-6.

2. DeLay, KJ, Haney N and Hellstrom WJG. Modifying risk factors in the management of erectile dysfunction: a review. World J Mens Health. 2016; 34(2): 89-100.

3. Diabetes UK. Diabetes: the basics. Available at: https://www.diabetes.org.uk/diabetes-the-basics Accessed February 2019.

4. Erectile Dysfunction. British Association of Urological Surgeons. Leaflet No: 16/079. Available at: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Erectile%20dysfunction.pdf Accessed February 2019.

5. Maiorino MI, Bellastella G, Esposito K. Diabetes and sexual dysfunction: Current perspectives. Diabetes Metab Syndr Obes. 2014; 7: 95–105.

6. Diabetes UK. Sex and diabetes. Available at: https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/sex-and-diabetes Accessed February 2019.