Diabetes: Controlling Blood Sugar levels

Men with diabetes are twice as likely as other men to experience erectile dysfunction (ED). What's more, they tend to develop erection problems 10 to 15 years earlier than men who don't have diabetes. Those numbers may sound grim, but there's hope. You can take control of your sexual health by managing your blood glucose, or blood sugar levels.

If you want to prevent erection problems or keep them from getting worse, you must control your blood sugar and get your numbers as close to normal as possible. That means diligent self-monitoring, taking any diabetes medications your doctor has prescribed, and being committed to healthy living.

The best approach is to follow a healthy diet, get regular exercise, and maintain a normal weight. Some people with diabetes are able to gain control of their blood sugar levels with lifestyle changes alone. Some may need to take medication to keep their numbers as close to normal as possible. But it's important to keep in mind that diabetes medications work best when you make the effort to eat right and be physically active.

The Key to Success in controlling diabetes: Testing Blood Sugar Levels

If you have diabetes and take insulin you should test your blood sugar levels three or more times daily. Home blood glucose monitoring can be done fasting, before or two hours after meals, and at bedtime. Exactly how often you should test your blood sugar and at what times depends on your specific needs and what your doctor tells you to do.

When you're trying to get your levels down to your goal, or if you are changing therapies, it's a good idea to test more often. By testing before and after meals, in the morning, and before bed you can create a detailed picture of how your blood sugar fluctuates throughout the day. That will help your doctor tailor your treatment for the best control.

Everyone with diabetes should know his A1C score. The A1C test measures your average blood sugar levels over three months. If you haven't been doing regular finger-sticks, this test will tell you how well you've been controlling your blood sugar levels.

The A1C test score is given as a percentage, ranging from 6% to 12%. Here's how that relates to average blood sugar levels: A1C % Average Blood Sugar
  5        80
  6      120
  7      150
  8      180
  9      210
10      240
11      270
12      300

A score below 6% is normal for people without diabetes. You should aim for an A1C score of less than 7%. If you have a score any higher than that you are at higher risk for problems like erectile dysfunction. It's best to have your level checked at least twice a year.

Even a 1% drop in your A1C score has a big impact. One of the largest studies so far on type 2 diabetes shows that people who lower their A1C score by 1% have a 35% lower risk for the kinds of complications that cause ED. One study directly linked high A1C scores to erectile dysfunction and low A1C scores to better sexual function.

If at all possible, you should aim to get your A1C score down into the range of 6% or less, where people without diabetes are. Research has shown that there's no floor, so to speak, when it comes to the benefit of lowering A1C.

If your blood sugar levels have been out of control, you should have the test more frequently.

Another important factor is how you take your diabetes medication. Follow directions carefully and don't skip doses. Skipping doses often results in worse blood sugar control and added complications from the diabetes.

Diabetes dominates JAMA

The current issue of the Journal of the American Medical Association (JAMA) focuses on diabetes -- and brings some good news. According to their graph, death rates for diabetes are stable or decreasing among black females, white males, and white females in the United States. The death rate for diabetes among black males has gone up in recent years, but not by much. "People throw around the phrase 'diabetes epidemic,' but I don't see an epidemic here," says ACSH's Dr. Gilbert Ross.

But as Dr. Ruth Kava points out, "The graph shows the death rate, not the incidence rate. Perhaps we are treating the disease better. And if there has been an increase in younger people with type 2 diabetes, incidence might not correlate with the death rate."

Good news for people with type 1 diabetes

Another study in JAMA shows that transplanting stem cells made from individual patients' bone marrow cells may help people with type 1 diabetes go for up to four years without needing to inject insulin. "It's a very small study -- only twenty-three patients -- and the technique sounds pretty labor-intensive. But it's certainly a big step forward for people who would otherwise need to inject insulin two or more times a day," Dr. Kava says. "I bet people will be lining up to participate in further trials."

A third study emphasizes the importance of blood sugar control in older people with type 2 diabetes , since it appears that they are more likely to develop dementia if their blood sugar drops so low that they must go to the hospital.

Dr. Ross points out, "I think this study just measures the tip of the iceberg because many incidences of less extreme hypoglycemia probably occur without the patient or caregiver noticing." Diabetics are generally concerned with their blood sugar going too high, but an unusually low blood sugar can also be dangerous; this study encourages diabetics to aim for a middle ground.
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WebMD Medical Reference

Guide: Diabetes and Sexual Problems
Diabetes: Controlling Blood Sugar for Better Life
Reviewed by Brunilda Nazario, MD.


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SOURCES:

American Diabetes Association, "Implications of the United Kingdom Prospective Diabetes Study,"
Diabetes Care, January 2002. American Diabetes Association, "Standards of Medical Care in Diabetes,"
Diabetes Care, January 2005; vol 28: Supplement 1, p. S11. "Health Insurance Status, Cost-Related Medication Underuse, and Outcomes Among Diabetes Patients in Three Systems of Care,"
Medical Care, 42(2):102-109, February 2004. Miller, T.A., "Diagnostic Evaluation of Erectile Dysfunction,"
American Family Physician, Jan. 1, 2000.
National Diabetes Education Program, "If You Have Diabetes Know Your Blood Sugar Numbers."
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK),
National Institutes of Health (NIH), "Erectile Dysfunction."
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK),
National Institutes of Health (NIH), "Sexual and Urologic Problems of Diabetes."
Romeo, J.H., "Sexual Function in Men With Diabetes Type 2: Association With Glycemic Control,"
Journal of Urology, vol 163: 788-791, March 2000.
UK Prospective Diabetes Study Group, "UKPDS 59: Hyperglycemia and Other Potentially Modifiable Risk Factors for Peripheral Vascular Disease in Type 2 Diabetes,"
Diabetes Care, May 2002. Vinick, A., et al, "Diabetic Autonomic Neuropathy," Seminars in Neurology, 2003; 23(4):365-372.


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