Making matters worse, there are a number of common medicines that can contribute to or worsen erectile dysfunction. Many high blood pressure pills, especially those in the families of beta blockers and diuretics, and some antidepressants, can interfere with vasodilation (or the widening of blood vessels). Since both high blood pressure and depression frequently accompany diabetes, it’s common for men with diabetes to be on one or more of these medicines. Lifestyle, too, can increase the risk of erectile dysfunction. For instance, smoking is known to narrow the blood vessels.
High blood pressure can also contribute to erectile dysfunction, as can a build-up of low-density lipoprotein (LDL) cholesterol in the corpora cavernosa supply arteries. How’s that for motivation to take your statin?
The good news is that the drugs Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil) can all help counteract the loss of nitric oxide, helping the blood vessels dilate, and increasing blood flow to the penis. The bad news is that these drugs are less likely to work for men with diabetes. Their method of action is on the hormonal and vascular side of the equation, while the cause of erectile dysfunction among men with diabetes is more often traced to nerve damage, which doesn’t respond to these medicines.
My wife says I get “pissy” when my blood glucose exceeds 250 mg/dl, and she’s not talking about polyuria. The mood-altering effects of high blood glucose are well known to the loved ones of persons with diabetes and well documented by research. But the biological nuts and bolts behind the emotional response aren’t well understood. Also well documented is the fact that high blood glucose causes depression and negatively affects rapid thinking and decision-making skills.
The theories that have been floated to explain the mood-altering effects of high blood glucose range from the mundane theory that because the brain is dependent on a steady supply of glucose for energy, changes in blood glucose concentration rapidly affect cerebral function; to middle-of-the-road theories that high blood glucose affects nerve conduction velocity in the brain; to more exotic theories that the effects are the result of complex relationships between little known hormones and proteins.
But when you consider all the other biological manifestations of high blood glucose — the three polys, infections, slow healing of injuries, itchy skin, blurred vision, headaches, fatigue, and gastro-intestinal distress — is it any wonder we might be irritable?
Getting into control
While the causes that lie behind the symptoms of high blood glucose are fascinating, the real value of symptoms is in the message they carry: Blood glucose is too high. The symptoms are warning signs, and we ignore them at our peril. High blood glucose does more than trigger biological and chemical processes that make you feel crummy; over time, high blood glucose causes permanent damage to the body.
But you have it in your power to make the symptoms go away, and to keep them from coming back, by keeping your blood glucose in control. And you’re not alone in this task. Talk to your doctor. Make time to see a diabetes educator. Ask your family members for their support in helping you to eat right and keep active. Use the tools available to you, such as your blood glucose meter, to see whether your numbers are in target range most of the time. If they are not, talk to your medical team about adjusting your therapy. And keep reading Diabetes Self-Management!