American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Reference from the Diabetes Experts


Men’s Health

• Male Sexual Health

• Sleep

• Cardiovascular Disease and Obesity

Historically, men have not discussed their health as much as women. However, times are changing. Men are encouraged to talk about their physical and emotional health as much—if not more—than women.

Men with diabetes are in a position of power to advocate for their health. After all, you probably have a health care team in place—or you are assembling one at the moment. Your health care providers are there to help you prevent and treat diabetes complications. In this chapter, you can find out about the conditions that specifically affect men and how to discuss them with your health care provider.

Male Sexual Health

Many men are not comfortable with the idea of discussing their sex life with a doctor or nurse. But the truth is that diabetes can affect your sexual performance and how you respond to aging and sex. It is important to open the lines of communication with your health care team. They will not be shocked by your questions, and there are ways of coping with any problem you might face.

For men with diabetes, the major concern is erectile dysfunction (ED). Men with diabetes can also have low testosterone. Other important topics in sexual health are birth control and safe sex.

Don’t face these important issues alone just because they concern your sexual life. Sex is a part of each of our lives as humans and belongs in a healthy life.

Erectile Dysfunction

Among men, the diagnosis of diabetes brings with it the concern about impotence or ED. But, are problems with erections really more common in men with diabetes than in men without diabetes? Because so many men suffer from this condition in silence, it’s difficult to count how many men with and without diabetes actually have a problem.

ED Facts

• ED is age related. It is primarily a problem among men over 40, with and without diabetes.

• Of all men with diabetes over the age of 50, it is estimated that 50–60% have some degree of ED.

• Some studies have suggested that the risk of ED is much higher in men with diabetes.

• ED has a range of severity. The above statistics include all types of ED, from occasional to complete. Complete ED (the complete inability to have an erection) occurs much less often.

So just what is ED? Having ED means that most or all of the time, the penis fails to become or stay hard enough for sexual intercourse. If you have ED, you can’t achieve or maintain a satisfactory erection.

If, on occasion, you fail to maintain or achieve an erection, you do not have ED. You also do not have it if you experience a decrease in sexual desire, have premature ejaculation, or if you fail to ejaculate or reach orgasm.

Causes of ED

Physical or psychological factors—or both—can cause ED. Figuring out why ED occurs can be complicated. Sexual desire begins in the brain, and signals are sent through the nervous system to the blood vessels to trigger an erection. The male sex hormone testosterone is also involved in sexual desire and achieving erections.

The most common causes of ED in men with diabetes are blood-vessel and nerve-related damage. Neuropathy and cardiovascular disease put you at risk for ED.

Blood vessel damage is a common cause of erection problems in men with diabetes. When blood flow to the penis is reduced, the penis can no longer become erect.

Low Testosterone and ED

In rare cases, low amounts of testosterone can cause ED. If it is too low, your problem may be caused by a hormonal problem not related to diabetes. See more about low testosterone in the next section.

Tests for ED

• A frequently used test for blood-vessel damage is an ultrasound study of the penis. Sound waves are used to measure blood flow through the arteries and veins.

• Another test involves injecting a drug or mixture of drugs into the penis to cause an erection. The drug is injected in such a way that it bypasses the penile nerves. If the injection causes you to have an erection, damaged blood vessels are not the cause. If you don’t have an erection, it means there may be some damage to your blood vessels.

Nerve disease is also a culprit in ED. When the nerves that signal the penis are damaged, erection can be impaired. You may be referred to an urologist to find out if the nerves in your penis are affected.

ED caused by physical problems usually comes on slowly and worsens over time. Early symptoms include a less rigid penis during sexual stimulation and when you wake up. Over time, men with ED may not be able to sustain firm erections long enough to enjoy sexual intercourse.

Psychological factors, depression in particular, are also common culprits in men with diabetes. You can read more about depression and its treatment in chapter 14.

Fears that Contribute to ED

• Expecting ED to happen if you know you are at increased risk because of your diabetes may lead to ED.

• You may be unable to have an erection if you feel pressure to perform.

• You may develop a great deal of fear and anxiety after a single erection problem, which can eventually lead to ED.

• Worry and stress can decrease your brain’s response to testosterone.

Also be aware that certain medications can cause temporary ED. Tell your provider about all the medications you are using—even over-the-counter remedies. Drugs frequently used to treat high blood pressure, anxiety, depression, and peptic ulcers can all be factors.

If you have signs of trouble and suspect that it may be related to a new medication you are using, tell your provider. There may be other medicines you can use. But don’t stop taking the medicine. Smoking and alcohol consumption can also contribute to erection problems.

Prevention of ED

The way to reduce your risk is to keep your blood glucose levels as close to normal as possible. In addition, it will help to quit smoking, decrease your alcohol intake, and keep blood pressure near normal.

Treatments for ED

There are several treatments available. In choosing a treatment, find the one that is most compatible with the needs and desires of both you and your partner.

• Medications. There are several drugs available for treatment, and many men with diabetes have found them to be effective. Sildenafil and vardenafil can help stimulate and maintain an erection 30–60 minutes after taking a pill. Tadalafil is similar but lasts for up to 36 hours. Ask your provider about these drugs if ED is a problem for you. Side effects include headache, indigestion, hearing or vision loss, and an erection that won’t go away. Some people with heart problems, blood pressure problems, eye problems, or a history of stroke may not be able to take these medications. Some medications such as nitrates can be dangerous if taken with ED medications.

• Penis Injection. Another option is to inject a form of the drug alprostadil directly into the penis. This induces an erection that lasts about 30 minutes to 1 hour. Side effects include bruising and prolonged erection. Some men also develop scarring in the penis, which occasionally results in a permanent curvature during erection.

• Vacuum Pump. Another option uses a vacuum pump to create an erection. A cylinder is placed around the penis. A small vacuum pump pulls air out of the container, creating a vacuum. This causes blood to flow into the penis, triggering an erection. To maintain the erection, the container is removed and replaced with a constriction ring. This provides an erection for about 30 minutes. The ring can cause bruising if kept on for more than 30 minutes. Separate constriction rings and external support devices are also available.

• Implant. You can also have a pump device with a penile prosthesis surgically implanted into your body to produce erections. Your best bet is to visit a urologist with experience if you are interested in this type of implant. Be sure to ask about the risks, which can include infection and the need for further surgery in case the device doesn’t work correctly.

• Testosterone. Testosterone injections or patches can be prescribed if a low hormone level is the problem. The injections are usually given every 3–4 weeks. Men should not take testosterone unless they have abnormally low levels and have been evaluated for prostate cancer.

• Psychotherapy. It may also help for you and your partner to work with a therapist who knows how to deal with sexual issues.

All of the treatments for ED have risks or drawbacks. You may decide to seek no treatment. Some men and their partners choose to express their sexuality in ways that do not involve intercourse. If you do want to consider treatment, you need to tell your provider, even if you are not asked about your sexual life. Your provider can only help you if you let him or her know about your concerns.

Low Testosterone

Testosterone is the most important male hormone and promotes the development of male characteristics. It is also tied to sexual desire and mood. Low testosterone is twice as common in men with diabetes as in men without diabetes. It can cause a range of problems, from ED to disinterest in sex to depression. It is estimated that 5 million American men have low testosterone.

Symptoms of Low Testosterone

• Decreased sexual desire

• ED

• Reduced lean body mass

• Depressed mood and lack of energy

Causes of Low Testosterone

Aging is associated with less testosterone. However, just because you are older does not mean that you will have low testosterone or little interest in sex. Low testosterone can be caused by problems with your hypothalamus, pituitary gland, or testes. Some medications such as morphine also contribute to low testosterone.

Treatments for Low Testosterone

You can ask to be referred to an endocrinologist or urologist who specializes in treating men with low testosterone. A simple blood test can be used to detect low testosterone.

Low testosterone can be easily treated with testosterone injections, patches, or gels. Patches and gels can cause skin irritation. Women and children should not touch the applied area. Men with prostate or breast cancer or heart or liver disease may not be able to use testosterone replacement therapy.

Birth Control

Another aspect of men’s sexual health is preventing sexually transmitted diseases and pregnancy. Birth control options are more limited for men than women. Yet, there are still several options.

The most popular is the condom, a thin sheath that is placed over the penis before intercourse. It prevents the sperm from entering the woman’s vagina. When used correctly and along with a spermicide, the condom is 85–90% effective in preventing pregnancy. The condom should be put on before intercourse and can be removed soon afterward. Condoms also help prevent the spread of several sexually transmitted diseases, including gonorrhea, chlamydia, and AIDS.

Men who are certain they do not want to father any or any more children can opt for a vasectomy. This is a simple procedure that prevents the release of sperm into the seminal fluid. When the man ejaculates, the semen contains no sperm, but men still experience the full pleasure of intercourse.

However, it is very difficult and expensive to reverse a vasectomy, and you’ll need to be certain about your decision. Some men opt to store some of their sperm before vasectomy for possible in vitro fertilization or artificial insemination, should they decide they want children at some later time.

Low Blood Glucose during and after Sex

Sex, like any physical activity, can lead to low blood glucose. If you use insulin, you’ll want to monitor and manage your blood glucose with this in mind. Taking steps beforehand can also help you enjoy and feel more relaxed during sex. See more about avoiding lows during and after sex in chapter 8.

Talk about Your Sexual Health

Diabetes can affect sexual functioning and fulfillment for both men and women. The good news is that sexual health is getting more attention, and there is more help available.

If you are having any problems related to sexual issues and you want help, talk to your health care team. If you don’t feel comfortable talking with your provider, find a health care professional with whom you do feel comfortable discussing personal matters.

Your provider will evaluate your concerns and help you sort out the causes. There are many factors that influence your sexual health, including medications, hormonal changes, your diabetes, and your emotional health.


Everyone knows it’s important to get your zzzz’s. But if you’re like many Americans, you’re probably not getting enough sleep. Sleep disorders are more common than you think. The Institute of Medicine estimates that 50–70 million Americans have a sleep disorder. Many men with diabetes have sleep disorders such as sleep apnea.

Sleep Apnea

Have you ever been accused of loud snoring? Have you ever been woken up by your own snoring? Loud snoring is a symptom of sleep apnea. Sleep apnea is the most common sleep disorder. It occurs when breathing is briefly and repeatedly interrupted during the night. It is more common in men than women.

Sleep apnea can make you tired during the day, and it can also lead to more serious complications such as cardiovascular disease. Talk to your health care provider if you have difficulty sleeping, are drowsy during the day, or your family members complain about your snoring.

Preventing and Treating Sleep Apnea

Weight is a major risk factor for sleep apnea. So losing weight is one of the best ways to prevent sleep apnea.

Continuous positive airway pressure (CPAP) is one of the most common treatments for sleep apnea. At night, you wear a mask that is hooked up to a machine that circulates air through the nose and mouth. Surgery can also be used to open the airways.

Cardiovascular Disease and Obesity

Having diabetes makes you two to four times more likely to have a heart attack or stroke than someone without diabetes. Cardiovascular disease is the number one killer of men with diabetes.

Therefore, it’s important to advocate for your cardiovascular health at your regular checkups. Make sure that your health care provider checks your cholesterol and blood pressure, which are two contributors to cardiovascular health. Ask whether you are meeting the recommended goals for blood pressure and cholesterol (as discussed in chapter 14).

Roughly one-third of American men are obese. Obesity is a major risk factor for type 2 diabetes and cardiovascular disease. If you’re overweight, ask your health care provider about healthy steps that you can take to lose weight and reduce your risk for cardiovascular disease and other diabetes complications.

Getting regular physical activity and eating a healthy diet will help you lose weight and prevent obesity. Exercising will also help you lower your blood glucose and increase your insulin sensitivity. Read more about physical activity in chapter 11.

Quitting smoking and drinking less alcohol will reduce your risk for cardiovascular disease, ED, and a host of other health problems.

Unhealthy Habits: Smoking and Drinking

Men are more likely to smoke, and men are more likely to drink alcoholic beverages than women. Twenty-three percent of American men (over 18) smoke, and 31% of American men had 5 or more drinks per day during the past year.

Talk to Your Health Care Provider

In general, men are less likely to seek medical advice from their health care providers than women. However, men with diabetes should have more reason than anyone to reverse this trend. There are real ways to prevent and treat men’s health issues such as cardiovascular disease, ED, and sleep apnea. Listen to your body and talk to your health care providers about your concerns.

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