What are the complications of diabetes? Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it’s an important source of energy for the cells that make up your muscles and tissues. It’s also your brain’s main source of fuel.

If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the causes may differ. Too much glucose can lead to serious health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes — when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes — and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered.

Symptoms

Diabetes symptoms vary depending on how much your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, symptoms tend to come on quickly and be more severe.

Some of the signs and symptoms of type 1 and type 2 diabetes are:

• Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there’s not enough available insulin)
• Fatigue
• Irritability
• Blurred vision
• Slow-healing sores
• Frequent infections, such as gums or skin infections and vaginal infections

Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it’s more common in people older than 40.

When to see a doctor

• If you suspect you or your child may have diabetes. If you notice any possible diabetes symptoms, contact your doctor. The earlier the condition is diagnosed, the sooner treatment can begin.
• If you’ve already been diagnosed with diabetes. After you receive your diagnosis, you’ll need close medical follow-up until your blood sugar levels stabilize.

Causes

To understand diabetes, first you must understand how glucose is normally processed in the body.

How insulin works

Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).

• The pancreas secretes insulin into the bloodstream.
• The insulin circulates, enabling sugar to enter your cells.
• Insulin lowers the amount of sugar in your bloodstream.
• As your blood sugar level drops, so does the secretion of insulin from your pancreas.

The role of glucose

Glucose — a sugar — is a source of energy for the cells that make up muscles and other tissues.

• Glucose comes from two major sources: food and your liver.
• Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
• Your liver stores and makes glucose.
• When your glucose levels are low, such as when you haven’t eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.

Causes of type 1 diabetes

The exact cause of type 1 diabetes is unknown. What is known is that your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.

Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what many of those factors are is still unclear.

Causes of prediabetes and type 2 diabetes

In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it’s needed for energy, sugar builds up in your bloodstream.

Exactly why this happens is uncertain, although it’s believed that genetic and environmental factors play a role in the development of type 2 diabetes. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.

Causes of gestational diabetes

During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin.

Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can’t keep up. When this happens, too little glucose gets into your cells and too much stays in your blood, resulting in gestational diabetes.

Risk factors

Risk factors for diabetes depend on the type of diabetes.

Risk factors for type 1 diabetes

Although the exact cause of type 1 diabetes is unknown, factors that may signal an increased risk include:

• Family history.Your risk increases if a parent or sibling has type 1 diabetes.
• Environmental factors. Circumstances such as exposure to a viral illness likely play some role in type 1 diabetes.
• The presence of damaging immune system cells (autoantibodies). Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes autoantibodies. If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But not everyone who has these autoantibodies develops diabetes.
• Dietary factors. These include low vitamin D consumption, early exposure to cow’s milk or cow’s milk formula, and exposure to cereals before 4 months of age. None of these factors has been shown to directly cause type 1 diabetes.
• Geography. Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes.

Risk factors for prediabetes and type 2 diabetes

Researchers don’t fully understand why some people develop prediabetes and type 2 diabetes and others don’t. It’s clear that certain factors increase the risk, however, including:

• Weight. The more fatty tissue you have, the more resistant your cells become to insulin.
• Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
• Family history. Your risk increases if a parent or sibling has type 2 diabetes.
• Race. Although it’s unclear why, people of certain races — including blacks, Hispanics, American Indians and Asian-Americans — are at higher risk.
• Age. Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.
• Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you’re also at risk of type 2 diabetes.
• Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
• High blood pressure. Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.
• Abnormal cholesterol and triglyceride levels. If you have low levels of high-density lipoprotein (HDL), or “good,” cholesterol, your risk of type 2 diabetes is higher. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know what your cholesterol and triglyceride levels are.

Risk factors for gestational diabetes

Any pregnant woman can develop gestational diabetes, but some women are at greater risk than are others. Risk factors for gestational diabetes include:

• Age. Women older than age 25 are at increased risk.
• Family or personal history. Your risk increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You’re also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.
• Weight. Being overweight before pregnancy increases your risk.
• Race. For reasons that aren’t clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

Complications

Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:

• Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you are more likely to have heart disease or stroke.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
• Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
• Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
• Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
• Hearing impairment. Hearing problems are more common in people with diabetes.
• Alzheimer’s disease. Type 2 diabetes may increase the risk of Alzheimer’s disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.

Complications of gestational diabetes

Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.

Complications in your baby can occur as a result of gestational diabetes, including:

• Excess growth. Extra glucose can cross the placenta, which triggers your baby’s pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to require a C-section birth.
• Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby’s blood sugar level to normal.
• Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
• Death. Untreated gestational diabetes can result in a baby’s death either before or shortly after birth.

Complications in the mother can also occur as a result of gestational diabetes, including:

• Preeclampsia.This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.
• Subsequent gestational diabetes. Once you’ve had gestational diabetes in one pregnancy, you’re more likely to have it again with the next pregnancy. You’re also more likely to develop diabetes — typically type 2 diabetes — as you get older.

Complications of prediabetes

Prediabetes may develop into type 2 diabetes.

Prevention

Type 1 diabetes can’t be prevented. However, the same healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can also help prevent them:

• Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.
• Get more physical activity. Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk. Ride your bike. Swim laps. If you can’t fit in a long workout, break it up into smaller sessions spread throughout the day.
• Lose excess pounds. If you’re overweight, losing even 7 percent of your body weight — for example, 14 pounds (6.4 kilograms) if you weigh 200 pounds (90.9 kilograms) — can reduce the risk of diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

Sometimes medication is an option as well. Oral diabetes drugs such as metformin (Glucophage, Glumetza, others) may reduce the risk of type 2 diabetes — but healthy lifestyle choices remain essential.

Have your blood sugar checked at least once a year to check that you haven’t developed type 2 diabetes.

Source: mayoclinic.org

The post What are the complications of diabetes? appeared first on All About Diabetes.

Type 2 diabetes has several causes: genetics and lifestyle are the most important ones. A combination of these factors can cause insulin resistance, when your body doesn’t use insulin as well as it should. Insulin resistance is the most common cause of type 2 diabetes.

Genetics Play a Role in Type 2 Diabetes

Type 2 diabetes can be hereditary. That doesn’t mean that if your mother or father has (or had) type 2 diabetes, you’re guaranteed to develop it; instead, it means that you have a greater chance of developing type 2.

Researchers know that you can inherit a risk for type 2 diabetes, but it’s difficult to pinpoint which genes carry the risk. The medical community is hard at work trying to figure out the certain genetic mutations that lead to a risk of type 2.

The post What is the leading cause of diabetes? appeared first on All About Diabetes.

Troublesome bladder symptoms and changes in sexual function are common health problems as people age. Having diabetes can mean early onset and increased severity of these problems. Sexual and urologic complications of diabetes occur because of the damage diabetes can cause to blood vessels and nerves. Men may have difficulty with erections or ejaculation. Women may have problems with sexual response and vaginal lubrication. Urinary tract infections and bladder problems occur more often in people with diabetes. People who keep their diabetes under control can lower their risk of the early onset of these sexual and urologic problems.

Diabetes and Sexual Problems

Both men and women with diabetes can develop sexual problems because of damage to nerves and small blood vessels. When a person wants to lift an arm or take a step, the brain sends nerve signals to the appropriate muscles. Nerve signals also control internal organs like the heart and bladder, but people do not have the same kind of conscious control over them as they do over their arms and legs. The nerves that control internal organs are called autonomic nerves, which signal the body to digest food and circulate blood without a person having to think about it. The body’s response to sexual stimuli is also involuntary, governed by autonomic nerve signals that increase blood flow to the genitals and cause smooth muscle tissue to relax. Damage to these autonomic nerves can hinder normal function. Reduced blood flow resulting from damage to blood vessels can also contribute to sexual dysfunction.

What sexual problems can occur in men with diabetes?

Erectile Dysfunction

Erectile dysfunction is a consistent inability to have an erection firm enough for sexual intercourse. The condition includes the total inability to have an erection and the inability to sustain an erection.

Estimates of the prevalence of erectile dysfunction in men with diabetes vary widely, ranging from 20 to 75 percent. Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes. Among men with erectile dysfunction, those with diabetes may experience the problem as much as 10 to 15 years earlier than men without diabetes. Research suggests that erectile dysfunction may be an early marker of diabetes, particularly in men ages 45 and younger.

In addition to diabetes, other major causes of erectile dysfunction include high blood pressure, kidney disease, alcohol abuse, and blood vessel disease. Erectile dysfunction may also occur because of the side effects of medications, psychological factors, smoking, and hormonal deficiencies.

Men who experience erectile dysfunction should consider talking with a health care provider. The health care provider may ask about the patient’s medical history, the type and frequency of sexual problems, medications, smoking and drinking habits, and other health conditions. A physical exam and laboratory tests may help pinpoint causes of sexual problems. The health care provider will check blood glucose control and hormone levels and may ask the patient to do a test at home that checks for erections that occur during sleep. The health care provider may also ask whether the patient is depressed or has recently experienced upsetting changes in his life.

Treatments for erectile dysfunction caused by nerve damage, also called neuropathy, vary widely and range from oral pills, a vacuum pump, pellets placed in the urethra, and shots directly into the penis, to surgery. All of these methods have advantages and disadvantages. Psychological counseling to reduce anxiety or address other issues may be necessary. Surgery to implant a device to aid in erection or to repair arteries is usually used as a treatment after all others fail.

Retrograde Ejaculation

Retrograde ejaculation is a condition in which part or all of a man’s semen goes into the bladder instead of out the tip of the penis during ejaculation. Retrograde ejaculation occurs when internal muscles, called sphincters, do not function normally. A sphincter automatically opens or closes a passage in the body. With retrograde ejaculation, semen enters the bladder, mixes with urine, and leaves the body during urination without harming the bladder. A man experiencing retrograde ejaculation may notice that little semen is discharged during ejaculation or may become aware of the condition if fertility problems arise. Analysis of a urine sample after ejaculation will reveal the presence of semen.

Poor blood glucose control and the resulting nerve damage can cause retrograde ejaculation. Other causes include prostate surgery and some medications.

Retrograde ejaculation caused by diabetes or surgery may be helped with a medication that strengthens the muscle tone of the sphincter in the bladder. A urologist experienced in infertility treatments may assist with techniques to promote fertility, such as collecting sperm from the urine and then using the sperm for artificial insemination.

More information about erectile dysfunction is provided in the NIDDK health topic Erectile Dysfunction.

What sexual problems can occur in women with diabetes?

Many women with diabetes experience sexual problems. Although research about sexual problems in women with diabetes is limited, one study found 27 percent of women with type 1 diabetes experienced sexual dysfunction. Another study found 18 percent of women with type 1 diabetes and 42 percent of women with type 2 diabetes experienced sexual dysfunction.

Sexual problems may include

• decreased vaginal lubrication, resulting in vaginal dryness
• uncomfortable or painful sexual intercourse
• decreased or no desire for sexual activity
• decreased or absent sexual response

Decreased or absent sexual response can include the inability to become or remain aroused, reduced or no sensation in the genital area, and the constant or occasional inability to reach orgasm.

Causes of sexual problems in women with diabetes include nerve damage, reduced blood flow to genital and vaginal tissues, and hormonal changes. Other possible causes include some medications, alcohol abuse, smoking, psychological problems such as anxiety or depression, gynecologic infections, other diseases, and conditions relating to pregnancy or menopause.

Women who experience sexual problems or notice a change in sexual response should consider talking with a health care provider. The health care provider will ask about the patient’s medical history, any gynecologic conditions or infections, the type and frequency of sexual problems, medications, smoking and drinking habits, and other health conditions. The health care provider may ask whether the patient might be pregnant or has reached menopause and whether she is depressed or has recently experienced upsetting changes in her life. A physical exam and laboratory tests may also help pinpoint causes of sexual problems. The health care provider will also talk with the patient about blood glucose control.

Prescription or over-the-counter vaginal lubricants may be useful for women experiencing vaginal dryness. Techniques to treat decreased sexual response include changes in position and stimulation during sexual relations. Psychological counseling may be helpful. Kegel exercises that help strengthen the pelvic muscles may improve sexual response. Studies of drug treatments are under way.

Diabetes and Urologic Problems

Urologic problems that affect men and women with diabetes include bladder problems and urinary tract infections.

Bladder Problems

Many events or conditions can damage nerves that control bladder function, including diabetes and other diseases, injuries, and infections. More than half of men and women with diabetes have bladder dysfunction because of damage to nerves that control bladder function. Bladder dysfunction can have a profound effect on a person’s quality of life. Common bladder problems in men and women with diabetes include the following:

• Overactive bladder. Damaged nerves may send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. The symptoms of overactive bladder include
  • urinary frequency-urination eight or more times a day or two or more times a night
  • urinary urgency-the sudden, strong need to urinate immediately
  • urge incontinence-leakage of urine that follows a sudden, strong urge to urinate
• Poor control of sphincter muscles. Sphincter muscles surround the urethra-the tube that carries urine from the bladder to the outside of the body-and keep it closed to hold urine in the bladder. If the nerves to the sphincter muscles are damaged, the muscles may become loose and allow leakage or stay tight when a person is trying to release urine.
• Urine retention. For some people, nerve damage keeps their bladder muscles from getting the message that it is time to urinate or makes the muscles too weak to completely empty the bladder. If the bladder becomes too full, urine may back up and the increasing pressure may damage the kidneys. If urine remains in the body too long, an infection can develop in the kidneys or bladder. Urine retention may also lead to overflow incontinence-leakage of urine when the bladder is full and does not empty properly.

Diagnosis of bladder problems may involve checking both bladder function and the appearance of the bladder’s interior. Tests may include x-rays, urodynamic testing to evaluate bladder function, and cystoscopy, a test that uses a device called a cystoscope to view the inside of the bladder.

Treatment of bladder problems due to nerve damage depends on the specific problem. If the main problem is urine retention, treatment may involve medication to promote better bladder emptying and a practice called timed voiding-urinating on a schedule-to promote more efficient urination. Sometimes people need to periodically insert a thin tube called a catheter through the urethra into the bladder to drain the urine. Learning how to tell when the bladder is full and how to massage the lower abdomen to fully empty the bladder can help as well. If urinary leakage is the main problem, medications, strengthening muscles with Kegel exercises, or surgery can help. Treatment for the urinary urgency and frequency of overactive bladder may involve medications, timed voiding, Kegel exercises, and surgery in some cases.

Urinary Tract Infections

Infections can occur when bacteria, usually from the digestive system, reach the urinary tract. If bacteria are growing in the urethra, the infection is called urethritis. The bacteria may travel up the urinary tract and cause a bladder infection, called cystitis. An untreated infection may go farther into the body and cause pyelonephritis, a kidney infection. Some people have chronic or recurrent urinary tract infections. Symptoms of urinary tract infections can include

• a frequent urge to urinate
• pain or burning in the bladder or urethra during urination
• cloudy or reddish urine
• in women, pressure above the pubic bone
• in men, a feeling of fullness in the rectum

If the infection is in the kidneys, a person may have nausea, feel pain in the back or side, and have a fever. Frequent urination can be a sign of high blood glucose, so results from recent blood glucose monitoring should be evaluated.

The health care provider will ask for a urine sample, which will be analyzed for bacteria and pus. Additional tests may be done if the patient has frequent urinary tract infections. An ultrasound exam provides images from the echo patterns of sound waves bounced back from internal organs. An intravenous pyelogram uses a special dye to enhance x-ray images of the urinary tract. Cystoscopy might be performed.

Early diagnosis and treatment are important to prevent more serious infections. To clear up a urinary tract infection, the health care provider will probably prescribe antibiotic treatment based on the type of bacteria in the urine. Kidney infections are more serious and may require several weeks of antibiotic treatment. Drinking plenty of fluids will help prevent another infection.

The following NIDDK health topics provide additional information about urologic problems:

• Bladder Control for Women
• Cystoscopy and Ureteroscopy
• The Kidneys and How They Work
• Imaging of the Urinary Tract
• Nerve Disease and Bladder Control
• Pyelonephritis (Kidney Infection) in Adults
• Urinary Incontinence in Men
• Urinary Tract Infections in Adults
• Urodynamic Testing
• What I need to know about Urinary Tract Infections
• Your Urinary System and How It Works

Who is at risk for developing sexual and urologic problems of diabetes?

Risk factors are conditions that increase the chances of getting a particular disease. The more risk factors people have, the greater their chances of developing that disease or condition. Diabetic neuropathy and related sexual and urologic problems appear to be more common in people who

• have poor blood glucose control
• have high levels of blood cholesterol
• have high blood pressure
• are overweight
• are older than 40
• smoke
• are physically inactive

Can diabetes-related sexual and urologic problems be prevented?

People with diabetes can lower their risk of sexual and urologic problems by keeping their blood glucose, blood pressure, and cholesterol levels close to the target numbers their health care provider recommends. Being physically active and maintaining a healthy weight can also help prevent the long-term complications of diabetes. For those who smoke, quitting will lower the risk of developing sexual and urologic problems due to nerve damage and also lower the risk for other health problems related to diabetes, including heart attack, stroke, and kidney disease.

More information about preventing diabetes complications is provided in the NIDDK health topic, Preventing Diabetes Problems.

Points to Remember

The nerve damage of diabetes may cause sexual or urologic problems.

• Sexual problems in men with diabetes include
  • erectile dysfunction
  • retrograde ejaculation
• Sexual problems in women with diabetes include
  • decreased vaginal lubrication and uncomfortable or painful intercourse
  • decreased or no sexual desire
  • decreased or absent sexual response
• Urologic problems in men and women with diabetes include
  • bladder problems related to nerve damage, such as overactive bladder, poor control of sphincter muscles, and urine retention
  • urinary tract infections
• Controlling diabetes through diet, physical activity, and medications as needed can help prevent sexual and urologic problems.
• Treatment is available for sexual and urologic problems.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov

Alternate Versions

• PDF Version (PDF, 236 KB)
• Spanish Version

Additional Links

• Bladder Control Problems in Men
• Bladder Control Problems in Women
• Erectile Dysfunction
• Nerve Disease and Bladder Control
• Urinary Tract Infections in Adults

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

Source: niddk.nih.gov

The post Diabetes and Sexual and Urologic Problems appeared first on All About Diabetes.

And, truth is, many doctors don’t feel comfortable prodding patients for details on sexual function. It’s why the newly diagnosed quickly learn about eye, nerve, kidney, and heart damage from uncontrolled diabetes, but hardly ever hear how diabetes affects sexual health. It is important for people to be open and honest with their doctors regarding all health concerns—even problems with sexual function. Problems with sexual performance and satisfaction can signal other health issues.

Many men with erectile dysfunction, for instance, later learn that they have diabetes. For people who already have diabetes, sexual problems can indicate nerve damage, blocked arteries, and even out-of-whack hormones. Though there’s a lot yet to learn about sexual dysfunction in people with diabetes, researchers are certain of one thing: Chronic high blood glucose is behind many sexual problems people face, and the first line of action is to improve glucose control.

Honey, Not Tonight

Low libido, or sexual desire, is a real problem, one that affects people with diabetes more than those without. Men and women experience low libido as a result of poorly controlled diabetes. If your sex drive is stalled, first look to your diabetes control and take steps to lower your blood glucose levels. Then consider your medications. Certain drugs, such as antidepressants, can lower sexual desire, so talk to your doctor.

Researchers theorize that inflammation may also dampen desire. “Sexual desire is a brain-driven event,” says Stacy Tessler Lindau, MD, MAPP, director of the Program in Integrative Sexual Medicine at the University of Chicago. “If inflammatory molecules cross the blood-brain barrier and circulate in the area where there is sexual desire, then it’s plausible the desire for sex may be affected.” Another possible culprit: low testosterone, which often affects men and women with diabetes.

Him:

Studies have shown that men with diabetes, especially those who have type 2 or are overweight, or both, have about twice the risk of low testosterone as their peers without the disease, which can affect a man’s passion for sex. “The treatment is to give testosterone, and it’s amazing how that can work in diabetes,” says Irwin Goldstein, MD, director of San Diego Sexual Medicine at Alvarado Hospital and editor in chief of The Journal of Sexual Medicine. When low testosterone is treated through losing weight and/or testosterone therapy, many men have a renewed desire for sex.

Her:

Treating women isn’t quite as simple. (Get used to hearing that.) Some studies suggest that taking testosterone can increase sexual desire in women—a 2008 article in the New England Journal of Medicine found that post-menopausal women had a greater sexual appetite after taking testosterone for almost six months—but the treatment is still understudied, particularly its long-term effects on women’s health. Not only that, but it’s hard for researchers to determine whether a particular woman’s low libido is a result of diabetes, emotional issues, or something else because low libido is common in women regardless of the presence of diabetes.

Let’s Get It On—Or Not

Here’s the difference between desire and arousal: First, sexual desire must occur; the body then responds, signaling arousal. That is, if everything’s working properly. Both men and women with diabetes may feel desire but struggle with arousal problems, though the mechanisms behind this sexual dysfunction are better studied and understood in men. For both men and women, a good place to start looking for possible causes is your medicine cabinet. Some blood pressure–lowering medications, for instance, can contribute to erectile dysfunction. When meds aren’t behind a person’s hampered arousal, diabetes may be to blame. Poor diabetes control over time can damage the blood vessels and nerves—as it does in heart disease and neuropathy (nerve damage), other complications of the disease—that make arousal possible.

Him:

One of the main sexual problems men with diabetes face is the inability to have an erection. Damage to the vascular system can impair blood flow. If the blood vessels aren’t functioning properly or if an artery is blocked, not enough blood will travel to the penis, making it difficult to get an erection.

Nerve function plays a role, too. If the brain isn’t properly communicating with the nerves in the sexual organs, the body might not be able to shuttle blood there, impairing a man’s ability to get an erection. The ability to keep an erection can also be affected, because the brain must communicate with the nerves to hold blood in the penis. (Keep in mind: A man’s ability to get and hold an erection typically wanes with age.)

Fortunately, there are plenty of treatment options. Neither men nor their partners should accept male sexual dysfunction, says Janis Roszler, RD, CDE, LDN, a certified diabetes educator and author of the book Sex and Diabetes: For Him and for Her. “For men, there absolutely is a treatment that will work.” Options include PDE5 inhibitors, such as Viagra and Cialis, which improve blood flow; testosterone injections or gels (if testosterone levels are low); injectable medications or suppositories; constriction rings that sit at the base of the penis; vacuum pumps that draw blood into the penis; support sleeves that hold the penis in place during sex; and penile implants.

Her:

Nerve damage may also cause vaginal dryness, which is twice as common in women with diabetes as it is in women without diabetes. It’s also a result of aging. “Vaginal dryness is very common among women who are menopausal or post-menopausal,” says Lindau. In those cases, a lack of estrogen is behind the dryness, and problems may be treated with prescription estrogen, available in pills, a patch, or a cream used in the vagina.

Because researchers don’t understand exactly why women’s bodies lose the ability to self-lubricate when menopause isn’t the cause, treatment options are slim. Most experts recommend using store-bought lubricant.

Women with diabetes are also prone to the same blood-flow issues men face because of nerve or blood vessel damage. Diabetes complications may make it difficult for blood to move to the vagina and clitoris. “The question we have, as far as women go, is that there are women with excellent A1Cs who don’t have any blood vessel issues,” says Roszler. “They don’t have any neuropathy. But they still have sexual problems.”

Because studying female arousal problems is difficult for many reasons—women may have a hard time determining just how turned on they are, and there’s less of a physical sign of arousal in women than there is in men—treatments are few. But Goldstein says research is promising.

A small study in the August issue of The Journal of Sexual Medicine found that women with type 1 diabetes who took 5 mg of tadalafil (Cialis) for 12 weeks reported an improved quality of life, greater arousal and orgasm, more enjoyment and satisfaction from sex, and more frequent sex. This doesn’t mean you should start sneaking your partner’s pills—please don’t: The treatment is unapproved in women, dangerous in some people with heart problems, and generally unsafe until proved otherwise. But it does show promise for female treatments of the future. As for the present, Lindau says some women use clitoral pumps to aid blood flow but notes that the device isn’t for everyone.

The Big O

An orgasm is a sought-after sexual reward, but for people with diabetes it can feel like an unattainable goal. And, yes, we’re talking about women and men here. Both can struggle with the elusive O, and the first thing they and their doctors should check are the medications they take, such as antidepressants.

Her:

Though women in general report more difficulty having an orgasm than men, those with diabetes have even greater difficulty. Sure, a woman’s inability to climax often has to do with her mental or emotional state (more on that later), but diabetes may be in play, too. According to a study published this August in the journal Obstetrics & Gynecology, middle-aged women whose diabetes requires insulin are 80 percent more likely to report trouble reaching an orgasm than women without diabetes.

“To the best of what we know now, the neurovascular system is necessary for arousal and orgasm,” says Lindau. “If the small nerves are not working properly, then you can have sensation problems. In order for the clitoris to have the engorgement it needs to orgasm, it needs to have the blood flow and sensation.”

A hormone imbalance may be to blame, Roszler says. Some scientists studying women’s ovulation cycles hypothesize that off-balance hormones, and not just testosterone, may be behind women’s decreased arousal and orgasm, but the research is in its infancy.

Him:

Having an orgasm is usually pretty easy for men, which is why it can be so frustrating if a man’s unable to finish. Like women, men suffering from neurovascular damage—and the lack of blood flow and/or sensation it creates—can have a hard time reaching an orgasm. Men can get around erectile dysfunction with a variety of treatments, ranging from medications to vacuum pumps, but these treatments will not fix neuropathy.

Putting On The Brakes

Sex is supposed to bring you and your partner pleasure, so pain is an indication that something isn’t right. Even if you’re shy, it’s important to discuss issues of painful sex with a doctor. “See a doctor who is familiar with taking care of sexual problems because we can rectify problems in [most] patients, especially people with diabetes,” Goldstein says.

Him:

Men with diabetes are at an increased risk for developing Peyronie’s disease, a condition in which scar tissue inside the penis causes a curved and painful erection. Before you worry, take heart: Penises all vary in shape, and a little curve isn’t a big deal. With Peyronie’s disease, the curve or bend is significant and can make having sex and getting or keeping an erection difficult and painful. A doctor can advise whether you should wait it out, take medication, or have surgery.

Her:

Having sex with too little lubrication can make a woman scream—and not in a good way. Vaginal dryness is one of the main reasons women with diabetes have pain during sex, and better lubrication is the answer. Whether that comes in the form of estrogen therapy for women whose dryness is a side effect of menopause or over-the-counter lubricants, the goal is to be well lubricated before sex.

Women with diabetes are also at a greater risk for urinary tract infections (UTIs) and vaginal yeast infections, which in turn may lead to painful sex. (Rest assured, though, that people with diabetes are at no greater risk of sexually transmitted diseases than those without the disease.) Lower your chances of getting a UTI or yeast infection by keeping your blood glucose under good control, and head to the doctor at the first sign of discomfort.

Sexual Healing

So maybe your sex life isn’t where it should be. If you can admit that to your health care provider, you’ve already fought half of the battle. Depending on the extent of your sexual dysfunction, you may be able to see improvement by getting your blood glucose in control. Even if the complications are too severe to reverse with better diabetes control alone, keeping your blood glucose levels in line can help to prevent further damage. Another tip: Quit smoking. It’s linked to sexual problems, and it’s all-around bad news for the rest of your body.

There are several approaches that both men and women benefit from, including seeing a doctor who specializes in sexual medicine and talking with a mental health professional. The latter is an important step because relationship problems, body issues, stress, and a host of other emotional baggage can affect all aspects of your sex life. You may be too self-conscious to get in the mood or get aroused, or maybe you’re too stressed to have an orgasm.

A counselor can also help you and your partner work out any strain your sexual dysfunction may have caused. “It creates such emotional tension in a relationship that it permeates the entire relationship, not just in the bedroom,” Roszler says. So talk it out and find a way to work around your sexual problems.

Finally, consider making lifestyle changes. Managing your diabetes well, including eating healthfully, exercising regularly, and reducing stress, will benefit your entire body, not just your nether regions. “I think it’s very likely that a good sex life leads to better health,” says Lindau. “And better health leads to good sex.”

Source: diabetesforecast.org

The post Sex and Diabetes: What You Wanted to Know appeared first on All About Diabetes.

Chronically high blood sugar (glucose) levels can be associated with serious complications in people who have diabetes. The feet are especially at risk. Two conditions called diabetic neuropathy and peripheral vascular disease can damage the feet (and other areas of the body) in people who have diabetes.

What is diabetic neuropathy?

Chronically high sugar levels associated with uncontrolled diabetes can cause nerve damage that interferes with the ability to sense pain and temperature. This so-called “sensory diabetic neuropathy” increases the risk a person with diabetes will not notice problems with his or her feet. Nearly 10% of people with diabetes develop foot ulcers due to peripheral vascular disease and nerve damage. People with diabetes may not notice sores or cuts on the feet, which in turn can lead to an infection. Nerve damage can also affect the function of foot muscles, leading to improper alignment and injury.

What is peripheral vascular disease?

Diabetes is associated with poor circulation (blood flow). Inadequate blood flow increases the healing time for cuts and sores. Peripheral vascular disease refers to compromised blood flow in the arms and legs. Poor blood flow increases the risk that infections will not heal. This, in turn, increases the risk of ulcers and gangrene, which is tissue death that occurs in a localized area when there is an inadequate blood supply.

What are common foot problems of people with diabetes?

The following images show common foot problems

Athlete’s foot

that anyone can get; however, those with diabetes are at increased risk for serious complications associated with these conditions, including infection and even amputation.

Athlete’s foot

Fungal infection of the feet is called athlete’s foot. Cracked skin, itching, and redness are associated with the condition. Fungus enters cracks in the skin causing an infection that must be treated with antifungal medications. Oral medications or topical creams may be used to treat athlete’s foot.

Fungal nail infection

Thick, brittle, yellow-brown, or opaque nails are common with fungal nail infections. The infected area may crumble or seem to pull away from the rest of the nail. Fungus thrives in the warm, moist, dark environment created by wearing closed-toed shoes. Nail injury also increases the risk of fungal nail infection. These infections are difficult, but not impossible, to treat. Oral medications work best to treat fungal nail infections. Topical treatments are only effective for a few types of fungal nail infections. Sometimes, surgery is necessary to remove infected areas of the nail.

Calluses

Calluses are hard areas of thickened skin that build up on the bottom of the feet. Uneven weight distribution, a skin abnormality, or ill-fitting shoes may cause calluses. Use these tips to care for calluses:

• Rub the area with pumice stone after a shower or bath. Ask your doctor the best way to do this.
• Place cushioned insoles or pads in shoes.
• Ask your doctor about prescription medication to soften calluses.

It’s normal to have some calluses. It’s important to never try to cut a callus using a sharp object. Doing so can cause serious injury.

Corns

A corn is a thickened, button-like area of skin that builds up between the toes or near a bony area of a toe. Pressure and friction cause corns. Use these tips to care for corns:

• Rub the area with a pumice stone after a shower or bath. Consult your doctor before doing this.
• Avoid over-the-counter corn removal treatments.
• Never try to cut the corn with a sharp object. Doing so can cause serious injury.

Blisters

Blisters are raised, fluid-filled areas of skin that form due to friction. Popping a blister is not a good way to treat it since the skin covering the area helps guard against infection. To care for a blister, keep the area clean, apply antibacterial cream or ointment, and cover it with a bandage to reduce the risk of infection.

Bunions

A bunion is a sore, red, callused area that forms on the outside of the joint of the big toe. Bunions make the big toe angle inward. They may appear on both feet and tend to run in families. Wearing high-heeled shoes with inadequate toe room increases the risk of bunions by pushing the big toes into an unnatural position. Covering the bunion with padding or a foam cushion helps protect it. Special toe separators and other devices may be used to keep the toes in proper alignment. If the bunion is very painful or unsightly, surgery may be used to alleviate the symptoms.

Dry skin

Dry, cracked skin allows bacteria and other germs to enter your body, potentially causing an infection. Moisturizing soaps, lotions, and other products can help keep the skin barrier soft, intact, and healthy.

Foot ulcers

Foot ulcers are dangerous wounds that can affect people with diabetes. When a minor scrape, skin break, or sore on the foot becomes infected, a sore can result. In people who have diabetes, sores heal slowly or fail to heal. Early diagnosis and treatment are necessary to reduce the risk of complications. Your doctor is the best source of information on how to properly care for a foot sore.

Hammertoes

Weakened muscles in the toes contribute to the curled appearance known as “hammertoes.” This weakness shortens the tendons in the toes, causing them to contract. Hammertoes can be hereditary. They can also be caused by wearing shoes that are too small and provide inadequate toe room. Hammertoes can cause foot problems such as calluses, sores, blisters, and difficulty walking. Corrective footwear and splints can help reposition and treat hammertoes. Sometimes surgery may be needed to straighten the affected toes.

Ingrown toenail

Ingrown toenails derive their name from growing into the skin along the edges of the nail. An ingrown toenail may cause pain, pressure, and even cut into the skin leading to an infection. Wearing tight or ill-fitting shoes increases the risk of ingrown toenails. High-impact activities such as running and aerobics may contribute to the problem. Walking, toe crowding, and inadequately trimmed toe nails may also cause ingrown toenails. The best way to prevent ingrown toenails is to keep the nails trimmed. Professional medical treatment is necessary if an ingrown toenail is severe or if there is an infection. Sometimes surgery is necessary to remove the affected part of the nail and the growth plate from which the nail grows.

Plantar warts

Thickened areas on the soles of the feet that have small black spots or pinholes are likely plantar warts. Plantar warts are caused by a virus. The affected patches of skin are painful and may occur alone or in clusters. It’s a bad idea to use over-the-counter remedies to treat a wart. When in doubt, a doctor can determine if a lesion is a callus or a plantar wart.

Can these foot problems be prevented?

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