Nicholas Gibson is a 20-year type 1 diabetic and sociology Ph.D. student and Instructor at the University of Hawai’i at MÄnoa. He has 5 years of management experience at diabetes summer camps for kids, and over a year of clinical research oversight at the University of California Irvine Medical Center.

His current research interests include the intersection of technology and self-care, and the impact of knowledge and technology on patient self-concept. He joins us today for our 411 series on diabetes complications to fill us in on one of the “touchier subjects,” which seemed especially appropriate for February, the month of love.

Special to the ‘Mine by Nick Gibson

Aloha DiabetesMine readers! I’m appearing here to talk about something almost every single healthy, or unhealthy, male PWD deals with: Erectile Dysfunction (ED). As a twenty-year type 1 diabetic veteran (and 29-year-old guy) I’ve had my share of conversations with my numerous doctors and endocrinologists about the risks of diabetes mismanagement. I have absolutely had those fearful flashes of “what if I can’t get it up?” Dealing with the day-to-day aspects of diabetes self-care is difficult enough without worrying about potentially speeding up the loss of function in our lower half.

Conversations about ED with our docs are not always pleasant, as they can be uncomfortable, worrisome, and at times scary. That said, advice from medical professionals at the Joslin Diabetes Center and the Mayo Clinic seems to follow some distinct patterns, and these patterns are quite hopeful. Seriously guys, the earlier you bring this up with your medical professionals, the better by far. So, let’s talk.

What is ED?

The intersection of romance, sex and diabetes is nothing new here at the ‘Mine. Today’s 411 topic, Erectile Dysfunction (ED), is defined by the NIH as “a consistent inability to have an erection firm enough for sexual intercourse. The condition includes the total inability to have an erection and the inability to sustain an erection.” I would add “sexual intercourse and other erection-required sexual activity.”

Many people experience ED whether diabetic or not; however, those living with diabetes are at higher risk. One important concept to keep in mind: ED, like other diabetes-related complications, has been shown to respond positively to healthy living choices aside from living with diabetes. Luckily for us, healthy living choices and positive diabetes management outcomes tend to go hand-in-hand.

Talking is Key

One major piece of advice is of course to talk to your medical professional about this. First, if you or a loved one who happens to live with diabetes is experiencing ED, talking to your friendly (or at least knowledgeable) health professional may help sort our whether or not the ED in question is actually a case of a diabetes-related complication; it may not be. Further, opening lines of communication with your doctor and endocrinologist can allow for a full range of treatment options to be explored, giving you (and me!) the best chances for successful diabetes management.

Once you know what’s going on, talk to your partner (or possibly partners) to fill them in. It’s not like they won’t notice, and trust me, up front and honest is much more helpful to everyone involved.

When discussing ED, it’s important to not only cover the strictly medical aspects of the “what’s going on here?” continuum, but also your practical experiences. This goes for discussions with your partner as well as your doctor. While romantic (and often times sexual) relationships are made up of many building blocks including open and honest communication, emotional and social support, and fun — sex and sexual function are topics of many a conversation regarding romance and relationships of all kinds.

The Role of Nitric Oxide (NO)

Researchers as far back as 1998 were fairly clear on the causes of, and reasonably successful pharmaceutical treatments for, ED. Nitric Oxide (NO), as discussed here on DiabetesMine and over at Diabetes in Control extensively, is mighty important in the ED conversation.

Those way, way back researchers described its vital role in blood circulation and the

process of attaining an erection: “The smooth muscle is normally in a contracted state, restricting blood flow to a mere trickle. When NO activates the cGMP system, the smooth muscle of the blood vessels, as well as that in the body of the shaft of the penis, is relaxed, allowing blood to fill the spaces. The engorged corpora pinch off the blood vessels draining the penis, trapping the blood in the corpora and producing an erection.”

With the potent (punny?) mix of long-term damage to the circulatory and nerve systems in us folks with diabetes, it is estimated that this complication can affect anywhere from 25-95% of male patients with diabetes, given the context of aging; the older we guys are, the more likely it is we will experience ED, according to the NIH, the journal Diabetes Care, and the American Journal of Cardiology.

Nitric Oxide isn’t the only culprit regarding ED in males with diabetes. Other factors include hypoglycemia (we knew our friendly low blood sugars would come say hi, didn’t we?), diabetic neuropathy resulting in failed neural transmission through the spinal cord, drug treatments associated with ED such as beta-blockers and diuretics, along with a host of other related causes. ED is no simple issue.


We all know that one key to preventing as many complications as possible is tight blood sugar control. My advice: make sure you are clear about how aggressive you want to be with your blood sugars, work with your medical team to make sure you aren’t missing anything, and then go for it. In order to keep the blood flowing, we’ve got to keep the insulin, carbs, exercise, lifestyle, and everything else as balanced out as possible. No small feat.

Medical Treatments

Medical interventions include oral medications (Viagra, Cialis, Levitra and their counterparts), and other medications such as penile suppositories or injections, vacuum-constriction devices, and penile implants. Some of these kinda hit the “oh no way” button in me, but all have been found to work relatively well in patients who have implemented them correctly.

Things to keep in mind here are some minor side effects that can occur, as described by the Mayo Clinic: headaches, flushing or redness, indigestion, stuffy or runny nose, back pain and muscle aches (with Levitra), and temporary vision changes, including “blue vision” (with Viagra). In a small number of cases, men taking Viagra, Levitra or Cialis have reported more serious side effects such as hearing loss or vision loss. If you’re taking one of these medications for ED and have sudden loss of hearing or vision, seek medical help right away.

Finally, there’s the relatively uncommon and very wiggy side effect is an erection that doesn’t go away on its own. Called priapism, this rare condition can be painful and requires medical treatment to avoid damage to your penis. If you have an erection that lasts more than four hours, seek medical attention. Please! Seek the attention!

Herbal Treatments

Some herbal remedies have shown very promising results too. These include Dehydroepiandrosterone (DHEA) which might interfere with the natural balance of sex hormones; Epimedium (horny goat weed) which may thin the blood or lower blood pressure; Folic acid and vitamin E with little to no side effects in small to medium dosages; Ginkgo which may increase the risk of bleeding (yikes!); Ginseng which may lower blood sugars, and has been seen to cause mania when taken with some anti-depressants (oh, heck no; actually just stay cautious); Yohimbe with possible increased heart rate, blood pressure or anxiety; and Zinc which can be dangerous in larger than necessary doses.

Further Prevention Tips

For the lifestyle component, prevention and even treatment measures include regular exercise, even slight improvements in dietary choices (the more improvements the better), stress-relief such as relaxation techniques or a regular trip to your friendly neighborhood massage therapist, eliminating all tobacco use, lightening alcohol intake, and resting well. This may seem like an exhausting list, but all of these methods go towards not just preventing or treating ED, but living a healthy, enjoyable and rewarding life as a person with diabetes.

In summary, there are numerous ways to prevent the onset of ED, and treat it if and when we find our lower parts compromised. The big ideas? Talk to your health professionals, keep open lines of communication between you and your partner(s), and learn what it feels like to work on being a healthy person living with diabetes. Here’s to long (more punny?), healthy, and happy (sex) lives for all of you.

Big thanks to Nick for taking on this sensitive topic!