I am currently within three weeks of my 42nd birthday and was diagnosed with type 2 diabetes at the age of 38. I am a male and becoming very concerned with the nerve damage that seems to be leading to impotence. What is it? Can it be arrested and or reversed?

Impotence is common with diabetes, especially if the diabetes is poorly controlled or has been present for longer than ten years. One of the difficult things about treating nerve problems is that when nerves become damaged, they very often do not repair themselves leaving a permanent neurologic problem. The situation with diabetes is that the nerves which are involved help to signal and allow blood to enter the penis, causing the erection. When these nerves do not work, there is no erection at the time of sexual arousal. Fortunately, there are treatments for this problem. Medications like Viagra help patients with erectile dysfunction have erections appropriate for intercourse. However, even with Viagra, there has to be normal blood flow to the penis so that the blood cavities in the penis will fill with blood.

The best you can do is approach your blood sugars with the intention of keeping them under good control and minimizing further damage to the nerves. If you continue to have erectile dysfunction, you will have to work with your physician to find treatment that will help you have more normal erections.

JTL
Additional comments from Betty Brackenridge, diabetes dietitian:
Forgive me for adding what may seem like a very simplistic comment, but it is my experience that many people with type 2 diabetes have not been advised about exactly what constitutes “good control.” In order to protect nerve function, as Dr. Lane suggests, it is advisable to get your
HbA1c level at 7% or below. This reflects pre-meal and fasting blood sugars in the 80-120 mg/dl
[4-7 mmol/L] range and after meal blood sugars no higher than 180 mg/dl [10 mmol/L]. This is very achievable, but in someone with your duration of type 2 diabetes, it is likely to require multiple medicines, and perhaps insulin as well. This does not mean your diabetes is “worse,” but simply reflects the progressive nature of this disease and the multiple factors that contribute to glucose elevation. Regular blood testing and learning to manage foods to work with your medicines are also important parts of the picture. If your physician does not have a full diabetes team in his office, ask for a

referral

to one in your community who can help you with your total diabetes control picture.

I would also suggest that you have your doctor or a urologist do a complete workup for your sexual dysfunction at the same time as you begin to work on your diabetes control. Although impotence is common in men with diabetes, it is not always caused by the diabetes. All the same, things that can interfere with sexual function in nondiabetic men are a possibility as well.

BB