FirstMed Consulting Blog

Diabetes is a disease marked by raised levels of sugar (glucose) in the blood. It can be caused by a lack of insulin (a hormone produced by the pancreas to regulate blood sugar), resistance to insulin, or both.

To understand diabetes, it is important to understand the normal process of food metabolism (breakdown). Many things happen when food is digested:

* Glucose (sugar) enters the bloodstream. Glucose is a source of fuel for the body.
* The pancreas (an organ in the body) produces insulin. The role of insulin is to move this glucose from the blood into muscle, fat, and liver cells, where it can be used as fuel, this helps to reduce blood glucose levels.
People sufferring with diabetes have high blood glucose levels. This is due to their pancreas not being able make enough insulin or their muscles, fat, and liver cells not responding to insulin normally (resulting in a poor uptake), or both.
There are three major types of diabetes:
* Type 1 diabetes is usually diagnosed at a young age (childhood). The body makes little or no insulin, and daily injections of insulin are required to sustain life. Without proper daily management, medical emergencies can arise.
* Type 2 diabetes is far more common than type 1 and makes up 90% or more of all cases of diabetes. It usually occurs at an older age. Here, the pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older people with increasing obesity, and lack of exercise.
* Gestational diabetes is high blood glucose that develops at any time during pregnancy in a person who does not have diabetes.

High blood levels of glucose can cause several problems:

* Microvascular complications (affecting small blood vessels), these can cause retinopathy, neuropathy and nephropathy.
* Macrovascular complication (affecting Large blood vessels), these can result in problems such as Ischaemic heart disease, cerebrovascular complications, renal artery stenosis and peripheral vascular disease.
* Metabolic complications – lactic acidosis and hyperosmolar problems.
* Treatment itself can lead to complication such as hypoglycaemia

It is the Vascular complications of diabetes which can cause erectile dysfucntion. In patients with poorly controlled diabetes there is a high blood glucose level. Glucose is very reactive and is normally converted by the body into less reactive products. Constant raised levels of blood glucose associated with diabetes mellitus results in the glucose in the blood reacting with the proteins in the blood vessel walls often damaging small blood vessels and nerves throughout the body (since the functioning and survival of nerves depends on small blood vessels called Vasa nervorum), which can impair nerve impulses and the blood flow necessary for erection.

Since Diabetes can cause neuropathy (damage to nerves throughout your body including the nerves of the penis). It leads to nerves which are unable to function properly. So even though you might be emotionally stimulated to have intercourse, the nerve damage means that information isn’t passed along to the penis, and so the penis doesn’t respond.

Neuropathy can also damage and narrow blood vessels, including those that supply the penis, impairing circulation. Poor circulation means blood can’t flow in and out of the penis effectively to achieve or maintain an erection.

In addition, poor blood sugar control can inhibit nitric oxide production. Lack of nitric oxide can prevent the pressure of blood in the corpora Cavernosa from rising enough to close off penile veins, allowing blood to flow out of the penis instead of remaining trapped for an erection.

Diabetes can also result in the hardening of blood vessel walls, when this happens in the arteries supplying blood to the penis or pelvic area, sexual function may be impaired.

About 60% of men with diabetes experience impotence.