Despite what the movies say, sex is rarely carefree and easy. And this is especially true for people with type 1 diabetes. For the insulin-dependent, an activity which is often easiest to enjoy when inhibitions are low and spontaneity is high must share headspace with worries about blood sugar management and how to position bodies to protect a continuous glucose monitor or insulin pump.

To help, we’ve canvassed a team which includes three diabetes care and education specialists (DCES), a psychologist with type 1 diabetes, and a vlogger with type 1 diabetes, among others, to provide some suggestions on ways people with T1D can increase their chances of having a satisfying sex life.

As you read this, keep in mind that there is no consensus on what exactly constitutes a healthy sex life with type 1 diabetes, or a healthy sex life at all. Many of those who shared advice for this article emphasized that letting go of the concept of a storybook sexual encounter and finding your own ways of navigating sexuality are the best paths to increasing your sexual enjoyment.

Consider expert advice as a starting point for your own explorations, suggest Janis Roszler and Donna Rice, two diabetes care and education specialists who authored Sex and Diabetes: For Him and For Her.

“Use your imagination and explore,” they say. “Open up yourself to new ways to connect sexually.”

As UK-based diabetes vlogger Jen Grieves points out in a funny informational video, “Sex, if you’re doing it right, is exercise,” and exercise can often cause blood sugar levels to drop.

It’s a sometimes unpredictable kind of exercise — one that could fluctuate widely in intensity and duration. That’s just the beginning of the variables to consider, according to Alicia McAuliffe-Fogarty, a clinical psychologist in New York who lives with type 1 diabetes herself.

“It often can vary from day to day depending on what you ate, how much you exercised previously, how stressed you are, where in a female’s menstrual cycle one is, how turned on you are, and about one hundred other factors,” McAuliffe-Fogarty says.

Also, there is one big difference between sex and jogging to consider — you don’t often have a drink before going jogging. Alcohol is part of the experience for many when it comes to sex, and that can complicate blood sugar management further, Roszler notes.

“Alcohol can initially prompt a person to feel more relaxed, but drinking too much could cause a low,” Roszler said.

And it’s not just lows that people with type 1 diabetes need to consider. The jitters and excitement of a new partner or experience could cause blood glucose levels to climb, said Roszler. Also, some sexual roleplay encounters designed purposely to induce fear or adrenaline theoretically could cause a blood sugar rise due to the body’s stress response, said Gary Scheiner, a diabetes care and education specialist and director of Integrated Diabetes Services in Pennsylvania.

Hyperglycemia (high blood sugar) can sap your energy, dehydrate you, and increase the urge to urinate, which can all possibly derail a sexual encounter, he notes.

No one is suggesting people with type 1 diabetes should avoid sex, but it just may require a little bit of preparation to increase your chances of the act being consistently pleasurable.

Maggie, a woman with type 1 diabetes who asked that her real name be withheld, said she tries to always check her blood sugar before things get too steamy. She also believes it’s important to be open with her partner about how she’s feeling.

“I think this is all about communication. Low blood sugar during sex has the potential for ruining the entire experience, so it is important to plan ahead for it,” she said.

Just like with any other physical activity, people with type 1 diabetes should consider taking mental stock of their blood sugar trends, from how much they ate to how much insulin they may have on board, said Scheiner. This will help them anticipate what is going to happen within the next hour or two.

If such advice might at first feel unsexy, it’s important to remember how many other seemingly “unsexy” trends people easily incorporate into sex life, from the ritual of “slipping into something more comfortable” to the process of finding and applying a condom or lubricant. The more you practice an act right before good sex, the more likely that act will become connected with the good feelings of sex for you and your partner — think of it as a Pavlovian response, creating a habit that becomes ‘natural.’

You should of course try to treat hypoglycemia as soon as possible, even if it means pausing sex. Have low snacks nearby and speak up if you feel the symptoms and/or if an alarm signals that your blood sugar is dropping.

Yes, of course that is easier said than done, as few people picture a sexual encounter involving a juice box. It might be tempting to forgo the possible awkwardness of stopping to treat your low, but that would be a mistake.

By now, you probably already know the dangers of untreated hypoglycemia. You should also factor in that sex when low just isn’t going to be nearly as much fun. Severely out of range blood sugar could lead to impaired sexual ability, and probably a much diminished chance of a satisfying finish, said Scheiner.

“It is unlikely that a person will be able to reach orgasm when hypoglycemic, so continuing when the blood sugar is known to be low may just become a ritual of frustration,” he said.

To dispel any potential feelings of awkwardness if a low needs to be treated, communication is key. A low doesn’t necessarily have to be viewed as a full stop, but could in fact be viewed as “a compliment for the workout” that has occurred up to that point, Roszler says.

“You could say to your partner, ‘Wow. You are wearing me out! Let’s break for a minute.’ Or use your low to shift from an energized activity to a more passive one, like sipping juice while you massage your partner,” she suggests.

Some people even plan for the fact that lows might be a regular part of sex to navigate. After all, sex is exercise, and people with type 1 diabetes could be forgiven from being distracted from the task of keeping blood sugar in range during foreplay. If this is regularly the case, Roszler suggests eating something first or making food part of sex play.

The decision to keep a diabetes-related device, like an insulin pump or a CGM, attached during sex is a personal one, and it might come down to a game-time decision. Maggie, for example, says she sometimes keeps her pump attached if she needs insulin to cover carb intake from earlier, but other times she’ll detach.

Keeping a device like an insulin pump with tubing attached can leave people with type 1 diabetes feeling a bit more encumbered during sex, but it needn’t be a major obstacle to a good time, says Roszler.

“When it comes to devices, crazy things can happen. Alarms may go off, tubing may get tangled, and more. Bring your sense of humor to the bed with you!” she says.

If you choose to detach your pump, and if your blood sugar levels are in range when you detach, you likely are good for an hour or two before needing to reattach, especially given the possible blood sugar drop from the exertion of sex. However, be careful to reattach before falling asleep when the fun is over.

Surveys have shown that the vast majority of people (especially women), both with and without diabetes, think they look better with their clothes on rather than off. People with T1D of course face additional self-criticism due to the devices on our bodies, scars and bruises from said devices and injection sites, and bumps caused by built-up of fat deposits under the skin from injections (lipohypertrophy).

While rotating injection sites can help prevent fat deposits, the overarching strategy for dealing with body image issues comes back to communication, Roszler says. She recommends using “I” language statements to open the discussion of hard-to-talk-about body image issues and to ask for what you need to feel comfortable. An example would be, “I feel embarrassed when I take off my clothes in front of you because I have so many bruises from my infusion sites. I feel more comfortable keeping my T-shirt on during sex.”

Perspective helps as well, she says. It’s healthy for everyone to realize we may all be holding ourselves up to unrealistic ideals. “No body is perfect. Don’t use porn/movie stars as role models — what you see is fantasy,” Roszler reminds us.

Still, some people with T1D can’t help worrying about how a device on your birthday suit might look jarring to a partner who’s not used to such sights. Patient vlogger Grieves said in her video that the best strategy might be to “mentally own the fact that the devices are keeping you alive and healthy,” and that such a sight won’t put off any partner who is worth your time in the bedroom. She says that her partner has handled it well.

“He assured me that any medical equipment is the last thing he’s paying attention to, if you know what I mean,” she joked.

It might be tempting to not mention type 1 diabetes to a new partner, or discuss how your blood sugar is doing at the moment with a steady partner, for fear of killing the mood, but Scheiner believes you should resist that temptation.

“Not talking openly about it can lead to stigmas and unfortunate misunderstandings,” he said. “I’ve always felt that transparency is the best policy.”

How in depth you go into the subject may depend on personal preference or the situation. If you’re in the midst of a spontaneous encounter with a new partner, it’s okay to condense the conversation down to a few bullet points. If you have a history of going low during exercise, you should at least let your partner know what symptoms to look for, said Rice. Having a long-term partner might warrant a longer conversation over time.

It’s especially important to discuss the above issues if you are going to engage in role play or physical restraint that can leave one partner dependent on the other for their physical well-being. In such cases, be sure all parties agree on a safe word and boundaries beforehand and know what hypoglycemia looks like, Roszler recommends.

This article is broken into sections for a reason, and if you don’t feel that it’s the right time to read this section on sexual dysfunction and type 1 diabetes, you are welcome to skip it and come back to it as needed.

For those reading on, let’s get to the two most important pieces of information of this section first:

*If you have type 1 diabetes and are experiencing some form of sexual dysfunction, you are not alone. It is very common for both men and women with type 1, of all ages.

*There are numerous treatments available that can help.

People with type 1 diabetes are more prone to sexual dysfunction than the average population mainly because of blood sugar swings, increased chances of cardiovascular and circulatory issues, and the added mental and emotional pressures of living with a chronic condition. Blood sugar swings can cause nerve damages to sensitive nerve endings, change body chemistry to make sex less pleasurable, and increase the chances of depression.

Roszler and Rice list the following problems that may occasionally or frequently inhibit the sex lives of people with type 1 diabetes:

There is often more than one option to help with sexual dysfunction, but the best way to make progress is to discuss the issue with your health care provider and/or your mental health care provider. Suggested treatments may be as simple as allowing time and space for more foreplay, lubrication, and communication, or as involved as treatment for depression or medical aids to help with erection issues.

Chronic high blood sugar levels can cause changes in body chemistry, and can lead to vaginal dryness in women with type 1 diabetes. This can even occur when fully aroused. Because of this, Roszler believes lubricants should be a go-to tool for a healthy sex life with T1D.

“Use them! There are many types — warming, scented, flavored, etc. If you don’t like one, try another. Search for what works for you,” she says. These resources can help in your research:

Scheiner says he hasn’t heard of any blood sugar issues resulting from using various types of lubrication, but he does warn that using them could accidentally interfere with checking your blood sugar readings with a fingerstick meter.

“I suppose one should make sure their fingers are clean after using them before checking the blood glucose level,” he said.

When it comes to creating a healthy sexual relationship, it usually takes two to tango (and, in some cases, more). While no one can fully take over the blood sugar management concerns that a person with type 1 diabetes faces, a thoughtful and caring sexual partner can make a big difference.

One of the most important things the sexual partner of a person with type 1 diabetes can do is to not take any mishaps in the bedroom personally, Roszler said. There’s never a gaurantee of good sex for anyone, and it’s good to remember that T1D simply puts a few more hurdles in the way of a happy ending.

“Understand that your partner’s erection or orgasm problem has nothing to do with you and is no one’s fault,” Roszler said.

While any good partner should be ready and willing to help in case of a blood sugar management issue, another admirable trait is to give your partner the space and trust to handle their own type 1 diabetes. For Jeff (last name withheld by request), that’s an important part of supporting his partner with type 1 diabetes.

“I trust that she is aware of her blood sugar level, and in the event that she isn’t, I’m always ready to react and grab something if she’s going low,” Jeff said. “Even though you want to be considerate… asking about blood sugar may not help with setting the mood.”

Sex is a good thing, one that healthy adults (including those with type 1 diabetes) should enjoy. Roszler and Rice believe that there is nothing inherent about life with T1D that should hold you back from a healthy sex life. If your health care provider can’t help support you in this, then it might be time to find another provider.

Just as you should let go of any expectations that you can’t have a healthy sex life, you should also let go of as many preconceived notions as you can of what you’re sex life should look like, they say. Life with type 1 diabetes is different than the average life; the same holds true for sex when you have type 1 diabetes.

“Your sex life may be a bit different, you may need to take more time or use a lubricant or medication, but you can certainly enjoy intimacy,” they state.

Craig Idlebrook is a past editor for various diabetes publications and online communities. He currently serves as social media coordinator for DiabetesMine. You can find him on Twitter at @craigidlebrook.