A man who suffers from erectile dysfunction (ED) cannot achieve or sustain an erection of sufficient rigidity to have sexual intercourse.

Most men, at some time (s) during their life, experience isolated sexual dysfunction. However, the term erectile dysfunction or impotence is reserved for those men who face erectile failure while attempting intercourse more than 75% of the time.

There are several causes that lead to ED such as high blood pressure, heart disease, high cholesterol levels, clogged blood vessels (atherosclerosis) obesity, and more. Diabetes is by far the most common and potential reason.

So, if you are a diabetic it doesn’t mean that you will develop ED. However, chances are very high that you will. You should, therefore, take preventive steps to ensure that your sex life stays robust. Some effective preventive steps have been outlined below for you to follow.

Studies suggest that the prevalence of ED in men with diabetes, especially diabetes type 2, ranges from 35–75% versus 26% in the general population. Its onset also occurs 10–15 years earlier in diabetic men than it does in men without diabetes.

Erectile dysfunction and diabetes often co-exist.  Diabetes is one disease, which can have adverse effects on various systems of your body. A number of complications can develop if you do not keep your diabetes sugar levels under check.

These complications arise due to improper control of diabetes. About 80% of diabetics suffer from erectile incompetence, while only 20% of the non-diabetic males suffer from erectile dysfunction.

However, if you consistently have your blood sugar in check, you need not worry about these complications. Just follow a disciplined lifestyle: stick to the diabetic diet, exercise regularly, and get proper sleep. The benefits of exercise and the importance of proper sleep cannot be over-emphasized.

Erectile dysfunction is one of those complications of diabetes that can embarrass you during those delicate moments. It can make you and your partner feel frustrated.

So, take measures to deal with erectile dysfunction and get your sex life back on track.

Uncontrolled diabetes often results in clogging of the arteries and damage to the nerves, called atherosclerosis and diabetic neuropathy respectively. These are the two ways by which diabetes makes you sexually incompetent.

How does an erection occur? Physiology

To understand the pathophysiology of ED, you should first know the physiology of how your penis becomes erect. It is a combination of the involvement of the nerves and arteries.

It starts with the transmission of an impulse from the brain (caused by a stimulating thought, a stimulating sight, or touch) to the penis via the spinal cord, then through the nerves in the pelvis that come out from the spinal cord, and finally through the nerves supplying the penis.

With the impulse, a chemical called nitric oxide is released into the bloodstream from the endothelium present in most blood vessels.

Nitric oxide causes the arteries and the muscles of the penis to relax (expand). The corpora cavernosa in the penis relax or expand, because of which blood flows into them through the arteries supplying the penis. Corpora cavernosa are two chambers that run along the length of the penis and contain spongy tissue. Blood flows in and fills the open spaces in this spongy tissue to create an erection.

Why diabetics suffer from ED? Pathophysiology

In diabetes, due to atherosclerosis, there is clogging of the arteries, and due to diabetic neuropathy, there is damage to the nerves.

As a result of the damaged nerves, the impulse from the brain does not get transmitted to reach the penile area, and due to the clogged arteries caused by atherosclerosis, there is insufficient blood flow to the penis. Both these conditions cause impairment of erection.

This erectile dysfunction may be total or partial, depending on the extent of damage to the nerves and blood vessels. This damage will again depend on the duration of uncontrolled diabetes.

Obesity is another common cause of erectile dysfunction. The reported prevalence of obesity in men with type 2 diabetes is 60%–90%. You should therefore take steps to get rid of those extra pounds.

How diabetics can prevent erectile dysfunction?

So what should you, as a diabetic, do?

As a diabetic, take preventive and/or curative measures, which will reduce your risk of developing ED or help you cure it.

Improve your glycemic index

  • Exercise regularly
  • Eat enough fiber
  • Manage carb intake
  • Stay well hydrated
  • Choose foods that have a low glycemic index
  • Lose those extra pounds
  • Manage stress
  • Check your blood sugar levels regularly

With co-existing hypertension

  • Exercise regularly
  • Do not smoke
  • Maintain a healthy weight
  • Eat healthy. Follow the DASH diet.
  • Cut down on your salt (sodium)
  • Limit alcohol intake.
  • Manage stress

Keep a watch on your medicines

There are certain medications that contribute to developing ED. If you are on any of them besides your diabetes medicines, consult your doctor who will avoid and substitute them. Here is a list of some of them:

  • Diuretics (pills that cause increased urine flow)
  • Antihypertensives for high blood pressure
  • Antiarrhythmics used for irregular heart action
  • Antiarrhythmics drug used for irregular heart action
  • Antihistamines used for allergies, insect bite reactions, and motion sickness
  • Antidepressants
  • Parkinson’s disease drugs
  • Tranquilizers
  • Muscle relaxants

Manage obesity if you are obese

  • Consume less “bad” fat (saturated fats) and more “good” fat (unsaturated fats)
  • Avoid processed and sugary foods.
  • Eat more servings of vegetables and fruits.
  • Eat plenty of dietary fiber.
  • Focus on eating low–glycemic index foods such as whole grains and cereals, vegetables and fruits, low-fat dairy
  • Engage in regular aerobic activity.
  • Keep a watch on your calories. Burn more of them than you consume to reduce your weight.

Stop smoking

Cigarette smoking damages the inner lining of the blood vessels and can interfere with cardiovascular function. It is an established independent risk factor for the development of erectile dysfunction in men of all ages including the young.

Tobacco smoke contains many toxins that damage the blood vessels, narrows and hardens them, and reduces blood supply to the body including the penis. This makes getting an erection difficult.

Male smokers are about twice more likely to develop ED than nonsmokers. Men who smoked more than 20 cigarettes daily faced a 60% higher risk of developing erectile dysfunction than men who never smoked.

Smoking cessation will improve your erectile power and your cardiovascular health.

Limit alcohol intake

Chronic and heavy consumption of alcohol is a high risk factor for long-term erectile dysfunction. Those dependent on alcohol have a high chance, as high as 70% of suffering from sexual dysfunction. This can include erectile dysfunction, premature ejaculation, and loss of sexual desire.

Alcohol affects the key factors that bring about sexual stimulation and erection, blood flow and sensitivity of the nerves.

How does it do that?

  • When you are sexually aroused, the brain sends impulses to the penis that make it erect. Alcohol intoxication interferes with these impulses and the penis fails to become erect.
  • Alcohol causes dehydration, which results in reduced blood volume and circulation. This has an adverse effect on penile erection.
  • Dehydration also increases the levels of the angiotensin hormone. This causes vasoconstriction, which adversely affects erection.

Treatment options

The good news: ED is one of the most treatable complications of diabetes.

There are several treatment options and one that fits best for people with diabetes is the use of oral pills that will give you a good hard-on.

The most well known among these pills is Viagra. However, there are four drugs currently approved by the Food and Drug Administration for the treatment of ED.

  • Avanafil (Stendra)
  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra)

These drugs are taken one hour before sexual intercourse and taken only when needed. They are Phosphodiesterase Type 5 (PDE5i) inhibitors.

They block the action of PDE5 enzymes and thereby they enhance the vasodilator effect of cyclic guanosine monophosphate (cGMP).

This causes more blood flow to the penis giving you a rigid erection. There is a difference in the duration of their action in the body. Viagra action lasts for 4 hours, while Cialis acts for 36 hours.

You must consult your doctor if you have a heart problem or are on nitrates before taking these pills

Other treatment options

There are other treatment options, which you can read in this post.