A note from our veteran type 1, diabetes author and community educator Wil Dubois: Today's post is Rated PG-13. Actually, the weekend edition of Ask D'Mine is always Rated PG-13, and I don't think today's post is any further across the Rubicon than we usually go. But people get funny talking about reproductive issues, so forewarned is forearmed: Today we gotta talk about male "thingies" to answer a reader's question. Read on at your own risk!

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}


Howard, type 1 from Ohio, writes: Is there any truth to the fact that there's some sort of neuropathy that can cause a guy to... How do I say this? Shoot blanks (if you know what I mean)?

Wil@Ask D'Mine answers: Neuropathy is an equal-opportunity destroyer of nerve cells, and you'd be surprised at all the obtuse parts of your body that need happily functioning nerves to work as designed. When it comes to neuropathy most people only think of their feet, but there are a host of neuropathies that can affect body systems as diverse and wide ranging as your optic nerve, your intestines, your sweat glands, your lungs, your heart, and more. In fact, depressingly, neuropathies can affect literally every organ system in your body.

So it should come as no surprise that neuropathy can also effect your bladder. And that gets to the root of your question, Howard. Firing blanks is medically known as retrograde ejaculation, and understanding it requires a brief discussion of how the male plumbing is designed, and how a male orgasm works. (Ah. Thus our reminder above to read my column to yourself before reading it out-loud to your kids.)




Let's talk male orgasms first. Most men would agree that this is a good way to start the day. The end by-product of a male orgasm, biologically, is semen. Semen has sperm in it, but it's quite a bit more than just sperm.

Now sperm is made in the testicles, but semen is not. Ha! I bet even most of you guys didn't know that. Yep, all that comes from the family jewels are those squiggly cells. They get shuttled up a delivery tube called the vas deferens, kinda like those pneumatic tubes at the drive-through bank. The tube goes up and around the top of the bladder and back down to the base, where it and hooks into the seminal vesicle, which is basically part of the prostate gland. Here the spermies get mixed with fluids from both glands to make semen. If you want to get all medical about it, the process is called spermatogenesis.

Trivia tip: the white stuff in ejaculate is largely sperm food, and includes fructose!

Once the sperm cells (180 million potential babies in a typical ejaculation) are mixed in with the seminal fluids in the vicinity of the prostrate, they are shot up the urethra to their ultimate destination.

Uh... Wait a minute. Isn't that the same tube guys pee through? Yes. Hasn't it ever occurred to you to wonder why a guy doesn't pee when he cums? It's the same pipe after all. The urethra is the only tube in the penis.

May I introduce you to the bladder sphincter? It's a muscle group used to close off the bladder-end of the urethra. It holds urine in the bladder when you're not peeing, and also keeps the door to the bladder closed when a man is having an ejaculation.

Unless neuropathy is effecting it, keeping it from closing properly. Then, thanks to fluid dynamics, the semen takes the path of least resistance. If the bladder sphincter is open, the ejaculation takes a wrong turn after leaving the prostrate and goes up and into the bladder rather than up the penis and out of the body. So there you have it. High blood sugar can quite literally cause you to screw yourself instead of your partner.

Actually, the whole thing isn't as bad as it sounds. The poor guy still has an orgasm, and still feels like he had one, but nothing comes out. For this reason, retrograde ejaculation is sometimes called dry orgasm. It's actually quite harmless except perhaps to your ego, your career as a male porn star, or to family planning—as it's a cause of male infertility. Oh, and the semen gets mixed in with the contents of the bladder and gets peed out later as cloudy urine.

(Can you believe that I actually get paid to talk about male orgasm before breakfast??)

Because of its biologically harmless nature, retrograde ejaculation is generally left untreated unless a couple wants kids. At that point the first option is to take some drugs before sex to try to tighten up the bladder sphincter. There are three broad categories, and interestingly, they fall into the families of tricyclic antidepressants, antihistamines, and decongestants. Surgery is sometimes, but rarely, done to try and fix the problem, while artificial insemination of one sort or another is generally considered the best workaround when meds fail to fix the problem.

So there you have it. Strange but true. Diabetes (uncontrolled) can cause a guy to shoot blanks.


Veronica, pre-diabetic from Hawaii, asks: If I eat any type of starch my blood sugar rises,  b ut if I eat things with sugar in them it doesn't, in fact my blood sugar goes down. Is that normal?

 Wil@Ask D'Mine answers: In my deepest heart of hearts I believe there's nothing "normal" about diabetes. But, seriously, here's what I've observed about food and blood sugar. Mind you, this isn't some clinically validated study from the Ivory Tower folks, but in my six years of working with around 300 people with pre-diabetes and diabetes, I've noticed that most of us can "handle" three of the following five groups of "white" foods:

  • Non-liquid sugar (candy bars, doughnuts, etc)
  • Potatoes (including fries, chips, and baked)
  • Rice (including chips and flour)
  • Flour (including pasta, damn it!)
  • And corn (including fresh, tortillas, and chips)

Don't ask me why this is. I don't know, and I don't even have a theory. Some people can eat a plate of spaghetti just fine, but a baked potato will knock them on their asses. For someone else, the potato causes no problem but walking past an Italian restaurant will spike their blood sugar. Even very small quantities of these personalized "bad" foods will send someone sensitive to them sky-high. Myself, I seem to be overly sensitive to flour. One single frickin' Zesta cracker can send me to 350 mg/dL, even with the proper insulin dosed for it.

So I've seen for myself that different broad categories of food effect different PWDs differently -- generally either having major upwards effects, or very little effect at all on blood sugar. But lowering your blood sugar by eating sugar?

That's a bit different.

Are you a skinny pre-diabetic, perchance? The reason I ask is that in skinny people who don't generally eat a lot of sugar, we sometimes see an over-production of insulin in response to a sugar load. I can recall two cases off the top of my head. In one case a girl who had an oral glucose tolerance test passed out from a low about an hour later. Her body over-pumped her full on insulin in response to the flood of sugar we poured down her gullet.


In the other case, a guy went to an all-you-can-eat waffle breakfast with his new girlfriend, pigged-out and also consumed quite a bit of maple syrup, and went hypo. Just the opposite of what you'd expect, or what he deserved.

Neither person took any diabetes meds. It was just a case of their bodies over-reacting. Kinda uncommon, but it happens. So I'm thinking that might be the case with you and sugar. Your body freaks out when you eat sugar, squirts out more insulin than it can normally muster, and Presto, Change-O! Your blood sugar drops.

But, normal? No. That makes you a very abnormal kind of person with diabetes—one who can treat her high blood sugar by eating sugar. So for you, it might be like taking a nip of the hair of the dog that bit you.

You lucky dog, you.



This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.