Dr. Rajiv Kovil

Diabetic men usually are prone to suffering from erectile dysfunction, i.e., they are unable to maintain an erection while having sex. If you are suffering from diabetes for a long time, your nerves and blood vessel might get damaged. That will cause you to suffer from erectile dysfunction. Almost 35% to 75% diabetic men suffer from erectile dysfunction. This situation becomes more serious with age.

Causes

It involves various factors like impairment in the nerves, blood vessels, and also cause problems in proper muscle functioning. You need healthy blood vessels, nerves, as well as healthy male hormones and sexual desire to get an erection. Diabetes damages the nerves and blood vessels responsible for an erection. So even if you have the required amount of hormones and the desire, you might not be able to get a proper erection.

Treatment

If you are suffering from diabetes, and have a condition of erectile dysfunction, then the most common treatment for you is Sildenafil. Other medications, which you can take are tadalafil, avanafil, and vardenafil. But keep in mind that if you have any heart problems, then you should refrain from taking any of these medicines as they will further complicate situations for you. Consult your doctor in this case to know which will be the best treatment for you to cure erectile dysfunction. Other treatment methods are as follows:

1. Intracavernous injection therapy

2. Vacuum erection devices

3. Venous constriction device

4. Intraurethral therapy

5. Penile prostheses

The dosage of these medicines depends upon weight of the patient as well as presence or absence of other co-morbid conditions like hypertension, dyslipidemia, cardiac problems, kidney/liver diseases, etc. Prescription of these medicines also depends on the other medications that the patient is taking as these ED medicines have a lot of adverse drug-interactions. Hence, one must always consult a doctor before starting these medications.

The Role of Counselling for Treating Erectile Dysfunction-

Erectile dysfunction can be caused by psychological factors and once a man experiences erectile dysfunction it can have a major impact on their emotional well-being. A man may feel a loss of manhood, a loss of confidence, low self-esteem, angry and depressed and it may also affect his relationship or sexual encounters. Therefore, counselling is a crucial part of treatment in order to address these issues.
Does psychosexual counselling work?

Psychosexual counselling is most effective when a man's sexual partner is willing to be part of the treatment. Studies have shown that for men with stress-related ED, when the partner is involved in the therapy, the problem is resolved 50%-70% of the time. When the man must go through counselling alone, the results are less successful.

Psychosexual counselling is unlikely to work if a man drops out of treatment after just one or two sessions.

Sometimes, several sessions of psychosexual counselling can be helpful if a man is due to receive medical or surgical treatment for ED. A counsellor can help guide a couple towards agreeing on treatment, or help them improve their sexual communication and lovemaking skills. A man may benefit from counselling on his own regarding how to talk to his partner about penile injections or a vacuum constriction device, which are both treatments for ED.

Before you are affected by diabetes, a condition known as pre-diabetes is experienced, which indicates that a person might develop diabetes soon. In case you have pre-diabetes, your blood sugar level will be higher than the usual, but not as much as during diabetes. The condition is called borderline diabetes. You are more likely to get heart diseases and a stroke because of pre-diabetes. 

Diagnosis There are three primary blood tests, which are used for the diagnosis of pre-diabetes: 

1. Fasting plasma glucose test
   • You should not eat anything for eight hours before this blood test.
   • Blood sugar level is considered normal when it is less than 100.
   • If your blood sugar level is between 100 and 125, you are in the pre-diabetes stage.
   • If your blood sugar level is above 125, you are diagnosed with diabetes. 
2. Oral glucose tolerance test
   • First, you need to have a fasting glucose test done and drink a sugary solution (75 gm glucose dissolve in water) after it.  After two hours, another blood test is taken. 
   • Blood sugar level is considered normal when it is lesser than 140. 
   • If your blood sugar level is between 140 and 199, you are in the pre-diabetes stage. 
   • If your blood sugar level is above 200, you are diagnosed with diabetes. 
3. Hemoglobin A1C 
   • This blood test shows the average blood sugar level for three to four months in the past. It helps to check whether pre-diabetes is in control or not. 
   • Blood sugar level is considered normal when it is 5.6%. 
   • If your blood sugar level is between 5.7% and 6.4%, you are in the pre-diabetes stage. 
   • If your blood sugar level is 6.5% or above, you are diagnosed with diabetes. 
   • The test should be redone for checking or verifying the results. 

Lifestyle changes required for managing pre-diabetes Lifestyle changes may help people in managing pre-diabetes and for preventing it from developing into diabetes. Here are some changes and habits you need to practice: 

1. Weight control: If you are obese and overweight, the pre-diabetes may turn into diabetes. Hence, losing some amount of body weight, at least 5% to 10%, makes quite a difference. 
2. Exercise: You should perform moderate exercises regularly, such as swimming, cycling or walking briskly. This helps in the management of pre-diabetes. Aerobic exercise increases the heart rate and should be carried out for better benefits. 
3. Nutrition: You must make some dietary changes as well. Consume food items, which contain low-fat protein. Eat a lot of vegetables and whole grains, limit your calorie intake and reduce the amount of sugar and starchy carbohydrates. Increase your intake of fiber-rich food. 

If you experience a rise in your blood sugar levels, you must consult a doctor immediately. With early diagnosis, you can take preventive measures and will be able to prevent pre-diabetes from developing into diabetes.

You pass by that cake shop and happen to glance at a sumptuous chocolate cake, and then realization dawns on you that you are not allowed to eat simple sugar. Why? The answer to it is diabetes, for which you only have your pancreas to blame. Situated behind the stomach in your body, the pancreas is an organ whose role is to produce hormones and enzymes that aid in the digestive process. One of the hormones produced by the pancreas is required by the body to metabolize sugar that is present in various foods.

So, if your pancreas does not produce the required amount of that hormones or fails to utilize the hormones effectively, it leads to accumulation of glucose in your blood. The improper functioning of the pancreas leads to diabetes. There are four types of diabetes and they are classified with respect to the manner in which the pancreas malfunctions: ​

1. Type 1 Diabetes: In this type, the immune system of the body wrongly attacks the hormone-producing beta cells of the pancreas. This impairs the ability of the pancreas to secrete the hormone, thus leading to Type 1 diabetes. However, even after extensive research in this field, the exact triggers haven’t been found yet.
2. Type 2 Diabetes: Type 2 Diabetes develops when the body becomes resistant to the particular hormone. It can either mean that the pancreas is producing less than normal hormone or the body is not being able to utilize the produced hormone effectively. Factors such as a poor diet and lack of exercise increase the risks of Type 2 Diabetes.
3. Pre-diabetes: Pre-diabetes is a condition wherein the blood sugar levels are higher than normal, but not high enough to be considered as ‘diabetes’. It can again occur due to a reduced secretion of hormone or the inability of the body to utilize the hormone effectively.
4. Gestational Diabetes: This type of diabetes can develop only during pregnancy. This occurs primarily as the placenta, that connects the fetus with the body’s blood supply, produces hormones that impair the functioning of this particular hormone. This type of diabetes can affect both the mother and the child.

Another common link
Pancreatitis is a condition that is marked by an inflammation of the pancreatic cells. This inflammation can damage the beta cells that produce hormones, thus resulting in diabetes. Factors that contribute to it are a poor diet, lack of exercise, presence of excessive calcium in the blood or excessive alcohol consumption.

How can you avoid the same?
It is best that you incorporate lifestyle changes if you have any of these disorders, and talk to your doctor about a treatment plan. Making a few simple lifestyle changes such as eating healthy, avoiding smoking and exercising on a regular basis can reduce the chances of you suffering from both diabetes and any other pancreatic problems. 

Diabetes is a systemic disease that affects almost every part of your body. Of these, the digestive system is the most badly affected. While gastrointestinal disorders are commonly experienced by everyone, diabetics have a much higher risk of suffering from indigestion, food poisoning, gallstones and ulcers. Some of the most common gastrointestinal problems experienced by diabetics are:

1. Gastroparesis: High blood sugar levels can damage the vagus nerve that controls the emptying of the stomach. As a result fo this damage, the muscles of the stomach and intestines do not work optimally leading to a condition known as Gastroparesis. This is a condition where the stomach is not able to empty itself properly and the digestion process is slowed down. Gastroparesis can cause bloating, nausea, pain in the abdomen, heart burn and a loss of appetite. It can also cause undigested food in the stomach to harden and form lumps that block food from moving into the intestines. This disease cannot be cured but can be managed with medication and a special diet.
2. Ulcers: Stomach ulcers can be described as open sores that develop on the inner lining of the stomach, oesophagus and beginning of the small intestine. These ulcers form as a result of bacterial infections. Diabetes weakens a person’s immune system thus reducing their ability to fight these infections and increasing the risk of developing ulcers. Diabetes also increases the risk of bleeding from these ulcers and secondary infections that may arise from it.
3. Yeast infections: Diabetics are extremely vulnerable to yeast infections. This is aggravated by fluctuation in blood sugar levels and can extend from the mouth to the oesophagus. Common symptoms of this type of yeast infection are pain in the throat and difficulty swallowing. It may also cause heartburn and intestinal bleeding if left untreated.
4. Celiac sprue: This condition creates gluten allergies and causes the inflammation and thinning of the small intestine’s mucosa. In some cases, this condition may interfere with the absorption of food and lead to diarrhoea and weight loss.
5. Diabetic diarrhoea: Patients who have been suffering from diabetes for a few years may experience an increased urge to pass stools frequently. This is usually related to gastric problems in the colon which cause fluids to move at a faster than normal speed through the small bowel and colon. It may also be caused due to the secretion of fluids in the colon and improper absorption of food.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Diabetes is growing to be the epidemic of modern days. The challenge here is it is not just about managing your sugar levels, but the whole lot of symptoms that diabetes brings with it. From bones to teeth to kidneys to wounds, diabetes affects all body systems. It is therefore very essential to watch out for symptoms of diabetes and curb it in its early stages. This will help control diabetes significantly along with its effects on the whole body.

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:

1. 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.
2. Nerve damage. 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. Left untreated, you could lose all sense of feeling in the affected limbs. 
3. Kidney damage. 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.
4. Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. 
5. Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. These infections may ultimately require toe, foot or leg amputation.
6. Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
7. Hearing impairment. Hearing problems are more common in people with diabetes.
8. Alzheimer's disease. Type 2 diabetes may increase the risk of Alzheimer's disease. 

The following are some of the basic must do's if you have diabetes. These can go a long way in preventing adverse diabetic side effects.

1. Diet: Whether diabetic or not, it is always important to watch your diet. You are what you eat. Eat what your body needs, reduce refined foods, processed foods and increase the amount of whole grains and fruits and vegetables. Eating small frequent meals goes a long way in managing sugar levels than binging at one meal and starving the rest of the day. Reduce intake of saturated fats; include more lean meats. Choose grilling and steaming over frying and roasting. Diet is very important in diabetes. Recommended foods - Healthy carbohydrates, Fiber-rich foods, Heart-healthy fish and Good fats. Foods to avoid - Saturated fats, Trans fats, Cholesterol and Sodium
2. Exercise: Every week, make sure about 2 hours is dedicated to physical activity. This could include any exercise of your choice, brisk walking, swimming, cycling, aerobics, hiking, jogging, skipping, gymnastics, or playing games like football or basketball. While in most cases, the person can do these on their own, in some people, supervision may be required.
3. Watch your weight: For a diabetic person, controlling weight to a desirable level of BMI of 18 and 23 is very important. Obesity is one of the predisposing factors for diabetes, and reducing weight controls the onset of diabetes and helps the progression of symptoms in diabetics.
4. Smoking: Another risk factor for diabetes onset, quitting is the best option. If not feasible, reducing smoking and gradually quitting should be aimed at. Not just diabetes, the effects on overall health will be evident almost immediately after quitting.
5. Stress management: One of the main risk factors for diabetes, there is no getting away from stress. Everybody has their stresses but the trick is to manage it well. Whether it is music or meditation or medication or counselling, make sure stress levels are managed. This also helps prevent diabetic complications like heart disease and stroke and promotes well-being.
6. Constant Checkups: Periodic check-up of blood sugar levels, cholesterol levels, eye exam, dental checkup, foot checkup to test for nerve damage are all extremely important. Take your medications regularly without fail.

Diabetes requires a change in lifestyle, which may seem tedious initially. But after a while, it will become the norm and then diabetic control does not feel like something additional that is to be done.

There are numerous conditions that can arise when the body does not process the dietary glucose properly. Hypoglycemia, otherwise called as low blood sugar, is when the blood sugar level in a person’s body decreases than normal value. Individuals with diabetes can get hypoglycemia (low blood sugar) when their bodies do not have enough sugar to use as fuel. It can happen for a few reasons, including diet, few medications and conditions, and exercise. 

In case you get hypoglycemia, record the date and time when it happened and what you did. Give the record to your specialist, so he or she can search for a pattern and adjust your medications accordingly. The most widely recognized reason for hypoglycemia includes medicines used to treat diabetes mellitus. 

The risk is more noteworthy in diabetics who have eaten very less than what is required, exercised more than expected, or have had excessive alcohol. Other reasons for hypoglycemia incorporate kidney failure, certain cancers, liver sickness, hypothyroidism, hunger, an inherent error of digestive system, extreme diseases, receptive hypoglycemia, various medications and liquor. The vast majority feels the symptoms of hypoglycemia when their glucose is 70 milligrams per deciliter (mg/dL) or lower. Every individual with diabetes may have distinctive symptoms of hypoglycemia depending on their age, stage and other factors. You will figure out how to recognize yours. 

Some of the most common symptoms are: 

Early indications include: 

1. Confusion 
2. Drowsiness 
3. Shivering or shaking 
4. Hunger 
5. Irritation 
6. Headaches 
7. Pounding heart 
8. Racing pulse 
9. Pale skin 
10. Sweating 
11. Trembling 
12. Weakness 
13. Nervousness 

Anxiety Without treatment, you may get more serious side effects, including: 

1. Poor coordination 
2. Concentration issues 
3. Numbness in mouth and tongue 
4. Nightmares 
5. Unconsciousness 
6. Trouble talking, impaired speech 
7. Ataxia, incoordination, mistaken up for being drunk 
8. Central or general motor deficiency, loss of motion, hemiparesis 
9. Migraine 
10. Trance, coma like state, strange breathing 
11. Seizures Individuals with hypoglycemia unawareness do not have any idea about their glucose level drops. 

In case you have this condition, your glucose can drop without you noticing it. Without quick treatment, you can pass out, encounter a seizure, or even go into a state of extreme coma. In case somebody is having an extreme reaction, for example, unconsciousness, it is imperative to inject a specific drug and contact the hospital quickly. People who are at danger for low glucose need to speak with their specialist about getting any injection.

You should never give an unconscious individual anything by mouth, as it could make them choke. Hypoglycemia should not be ignored. Depending upon the type of symptoms you are witnessing, you should immediately rectify or consult with you specialist before it gets severe. In case you have a concern or query you can always consult an expert & get answers to your questions!

Diabetic neuropathy is a nerve disorder caused by diabetes. The high blood sugar from diabetes affects the nerves and over time increases a person's risk for nerve damage. Keeping blood sugar levels within the target range recommended by your doctor helps prevent diabetic neuropathy.

Types of Diabetic Neuropathy
Diabetic neuropathy can be classified as Peripheral, Autonomic, Proximal, or Focal. Each affects different parts of the body in various ways..

• Peripheral neuropathy, the most common type of diabetic neuropathy, causes pain or loss of feeling in the toes, feet, legs, and hands.
• Autonomic neuropathy affects the nerves that control involuntary body functions such as digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes. Autonomic neuropathy can also cause hypoglycemia unawareness, a condition in which people no longer experience the warning symptoms of low blood glucose levels.
• Proximal neuropathy causes pain in the thighs, hips, arms, or buttocks and leads to weakness in the legs and hands, resulting in difficulty in walking, standing, picking up objects, buttoning your clothes, etc.
• Focal neuropathy results in the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain. Any nerve in the body can be affected.

How Diabetes Causes Damage to the Nervous System?
There are several factors that are likely to contribute to nerve damage through diabetes...

1. High blood glucose, a condition associated with diabetes, causes chemical changes in nerves. These changes impair the nerves' ability to transmit signals. 
2. High glucose levels affect many metabolic pathways in the nerves, leading to an accumulation of a sugar called sorbitol and depletion of a substance called myoinositol. These changes are the mechanism that causes nerve damage. Nitric oxide dilates blood vessels. In a person with diabetes, low levels of nitric oxide may lead to constriction of blood vessels supplying the nerve, contributing to nerve damage.
3. Presence of mechanical injury like carpal tunnel syndrome in a diabetic patient worsens its symptoms and prognosis
4. Inherited traits increase susceptibility to nerve disease
5. Lifestyle factors, such as smoking or alcohol use

Symptoms:
1. Numbness, burning sensations, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
2. Either hypersensitivity to touch or insensitivity, even to hot and cold temperatures
3. Weakness in muscles and loss of reflexes
4. indigestion, nausea, or vomiting
5. diarrhea or constipation
6. dizziness or faintness due to a drop in blood pressure after standing or sitting up
7. problems with urination
8. Changes in gait and balance
9. Injuries that are taking longer to heal and are more prone to infections

Prevent Diabetic Nerve Damage-
Keeping your blood sugar levels in your target range, set with your doctor, may help prevent nerve damage from ever developing. The best way to do this is by checking your blood sugar and adjusting your treatment. It is also important to get to and stay at a healthy weight by exercising and eating healthy foods. In case you have a concern or query you can always consult an expert & get answers to your questions!