Diabetes doubles or even triples the chance that you'll have erectile dysfunction (ED) and that you could develop it a decade earlier than other men. In fact, the two conditions are so closely linked that some experts believe that for men younger than 45, impotence, or ED, could be an early warning sign of diabetes. The good news is that diabetes treatment, especially if you identify type 2 diabetes early, can also ease ED.

Connecting Erectile Dysfunction and Type 2 Diabetes

At first glance, it's not obvious why higher than normal levels of blood sugar would cause erectile dysfunction. However, the relationship is undeniable: Somewhere between 20 and 75 percent of men with diabetes also have erectile dysfunction.

The problem is that uncontrolled high blood sugar damages the blood vessels, big and small, throughout your body. The blood vessels in the penis are already very tiny, so when uncontrolled diabetes starts to undermine your blood vessels, your penis may experience the consequences early on.

And diabetes affects more than the blood system. "Diabetes also results in nerve dysfunction and, in the penile shaft, [eventually] the muscle starts to atrophy and is replaced by scar tissue or collagen rather than smooth muscle. That's the ultimate end result in men," explains urologist Ajay Nehra, MD, professor of urology at the Mayo Clinic in Rochester, Minn. That scenario ? damage to all the tissues that support your penis ? is what could happen if you do not get and keep your diabetes under control.

Are You at Risk for Impotence?

Knowing your risk factors will help you make the best health decisions. Men who are most at risk for erectile dysfunction related to type 2 diabetes:

• Have high blood sugar (glucose)
• Know they have diabetes, but are not meeting the goals for their A1C, or average glucose results
• Have high cholesterol
• Have high blood pressure
• Have low testosterone
• Are overweight or obese
• Are 40 or older
• Smoke cigarettes
• Do not exercise

Breaking the Erectile Dysfunction-Type 2 Diabetes Link

Having diabetes doesn't mean you have to live with erectile dysfunction. The right diabetes treatment can help. Follow these guidelines:

• Get your diabetes under control. According to Dr. Nehra, the most important number you need to stay on top of is your A1C, which is a blood test that lets you know how well your blood sugar has been controlled for the past few months. Lifestyle changes can help and so can medications. Diabetes medications do not add to your risk for erectile dysfunction, says Nehra.
• Maintain a healthy lifestyle. Eating a well-balanced, nutritious diet and getting enough exercise will help both your diabetes and your erectile dysfunction.
• If you smoke, quit.
• Maintain a healthy weight. If you're overweight or obese, losing even a small percent of your body weight will help control diabetes. Obese men might also benefit from gastric bypass surgery, which has been shown to relieve both erectile dysfunction and diabetes in some patients.
• Seek treatment for erectile dysfunction. There are many ways to treat erectile dysfunction, including pills, injections, vacuum pumps, and surgery. Talk to your urologist about what you can do for erectile dysfunction even while you are working to control your diabetes.
• Get heart disease risk factors under control. Work with your doctor to lower blood pressure and high cholesterol, both of which can contribute to erectile dysfunction.

The connection between impotence and diabetes is undeniable, but that doesn't mean you have to accept this outcome. Taking steps to control your diabetes and reduce erectile dysfunction will improve your quality of life.

 

What are some of the most common health concerns among aging type 2 diabetics, and how can they be managed?

Type 2 diabetes can lead to serious health complications, and older people with the disease are especially vulnerable. The American Diabetes Association (ADA) estimates roughly 27 percent of people 65 years of age and older have diabetes, and studies have shown that the highest rates of diabetes-related heart attacks, kidney failure, and amputations are among older adults.

According to a 2012 report published by the ADA and the American Geriatrics Society, "diabetes in older adults is linked to higher mortality, reduced functional status, and increased risk of institutionalization." But many complications can be delayed or even prevented with treatment and lifestyle changes. Here are some of the most common health concerns among aging type 2 diabetics.

Limited Mobility

Everyone knows physical activity is key to overall health, especially for people with diabetes. Exercise helps regulate weight, improve cardiovascular health, and strengthen bones and muscle. A recent study in New Zealand suggests that short bursts of exercise before  main meals may help control blood sugar levels. But aging can often limit mobility and physical activity, even for people accustomed to exercising.

Sam Penceal, 69, was diagnosed with diabetes almost 15 years ago. A former college basketball player, he was able to quickly jumpstart his fitness routine to help manage the disease. Though he still exercises three to five times a week, Penceal admits he now needs more time for his body to rest.

"I realize that I have to give my body more time to recoup," said Penceal, who sits on the executive committee of the ADA's Step Out Walk NYC and is captain of his Step Out Walk team. "If I exercise heavily two days in a row, it's important I give my body a day of rest."

If a person does not have a history of consistent exercise, precautions should be taken before beginning a new regimen.

"Because the risk of heart disease is higher in diabetic patients, I recommend those in the aging population talk with their physicians or even go through an exercise stress test to make sure their heart is okay for physical activity," said Betul Hatipoglu, MD, an endocrinologist at Cleveland Clinic.

Diabetics are at a greater risk for joint and bone disorders, which can impact their ability to exercise. Dr. Hatipoglu recommends working with your doctor to come up with an individualized exercise plan, which should include walking and light weight training to help with balance.

Falls and Fractures

The risk of falls and fractures is a normal part of aging, but mobility problems associated with diabetes raise the risk even higher.

Hypoglycemia, or low blood glucose, can cause symptoms including shakiness, weakness, and lack of coordination. Hyperglycemia, or high blood sugar, can cause dehydration, leg cramps, and imbalance.

Hatipoglu stresses the importance of a safe home environment complete with non-slip rugs, bed rails, and grab-bars in the shower and bathroom.

Vision and Hearing

People living with diabetes have a much higher risk of eye complications, including glaucoma and cataracts, and the risk increases with age. Retinopathy, a disorder of the retina, is also common.

There are treatment options available, but the condition needs to be caught as early as possible. "It's very important for elderly diabetics to have regular checkups with their ophthalmologist, especially if they are driving or working," Hatipoglu said.

Hearing loss is twice as common in people with diabetes as it is in those who don't have the disease. The reason for the increased risk is unclear, though it may be that diabetes damages nerves and blood vessels of the inner ear. If you suspect hearing loss, talk to your doctor.

Mental Health

"The lifestyle modification that comes with type 2 diabetes has definite psychological effects," said Xavier Jimenez, MD, a psychiatrist at the Cleveland Clinic. The stress of diabetes management can take its toll on a patient's mental and emotional well-being. Studies show that people with diabetes have a much greater risk of depression, which can compromise their self-care and commitment to a healthy lifestyle.

Even patients who have been dealing with diabetes for a long time can become demoralized. "It's basically people saying they're sick and tired of being sick and tired," said Dr. Jimenez. "It's a little less severe than depression, but should still be addressed."

Diabetics may feel isolated from family and friends. Penceal emphasizes the importance of having a stable support system to help with the day-to-day challenges. "Find a group of people who are going through the same things you are," he said. "It can be difficult when your family doesn't have to go through the same diet and lifestyle changes you do. Join a support group to discuss those challenges."

Diabetes, especially type 2, may increase a person's risk for Alzheimer's disease or vascular dementia. Evidence suggests diabetes may lead to mild cognitive and memory problems that impact a patient's ability to manage their condition.

"If a patient keeps coming back with uncontrolled high blood sugar, instead of blaming them, we should sit back and ask ourselves, 'Could this be a sign of depression or dementia?' " said Hatipoglu.

Bladder and Bowel Dysfunction

Diabetic neuropathies are disorders that damage nerves all over the body. When the autonomic nervous system ? which controls the bladder, stomach, and intestines ? is affected, patients may experience problems with bladder and bowel function. Symptoms can include constipation, diarrhea, urinary tract infections, and incontinence.

"When you have urinary incontinence, you are at a much higher risk for infection and as a result hyperglycemia, which can cause more urinary leakage," said Hatipoglu. "It's a vicious cycle."

Hatipoglu urges patients to not be embarrassed. Report any changes in digestion and urination to your healthcare provider because early treatment is so important.

Drug Interactions

Older adults with diabetes may be taking several medications to manage multiple conditions, raising the risk for adverse interactions and side effects. Patients can become confused about dosages and what drugs are taken when.

The doctor should review all medications a patient is taking, even over-the counter drugs, at every visit. Hatipoglu suggests caregivers can help as well by writing down clear, easy-to-follow instructions.

"Writing down which medications to take and when in big letters is very helpful," she said. "You have to get creative and simplify things so they can follow the instructions."

Prevent diabetic nephropathy, one of most serious complications of type 2 diabetes, with regular monitoring of your blood and urine.

Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy. This condition develops when the network of tiny blood vessels in your kidneys are damaged to the point that they can no longer filter out waste properly. If kidney problems are left untreated, you may eventually need dialysis (a treatment to filter out waste products from the blood) or even a kidney transplant.

Symptoms of Diabetes-Related Kidney Disease

Typically, you won't notice symptoms of kidney disease until it has advanced, so it's important to have your kidney function checked every year.

If you experience any of the following symptoms, tell your doctor as it may indicate kidney trouble:

• Swelling in your ankles and legs
• Leg cramps
• A need to go to the bathroom more often at night
• A reduction in your need for insulin
• Nausea and vomiting
• Weakness and paleness
• Itching

The best way to prevent kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood-glucose levels and your blood pressure under control.

Exercise is crucial for managing type 2 diabetes but can affect blood sugar levels, so be sure to consult with your doctor before you get started.

There are so many ways to get exercise, from walking and hiking to swimming, biking, tennis, or even ballroom dancing. The Centers for Disease Control and Prevention recommends engaging in at least 30 minutes of moderate-intensity activity five days a week.

Whatever you decide to do, it's important to consult with your doctor before you begin. Exercise is a great way to lose weight and maintain a healthy heart. But it also impacts your blood-glucose levels because it increases your energy demands, so you need to monitor how your body will respond.

Get in the Pool

Your community or club pool can be a great place to start your exercise routine. Swimming is excellent aerobic exercise because it gets both your upper and lower body moving. And if you're overweight, it can feel great to spend time in a pool, where buoyancy makes it easier to move. Some ideas:

• Dive in with a group. Try water aerobics, swimming laps with friends, or even a little water volleyball.
• Use a kickboard for extra lift in the water, especially if you are a less-than-confident lap swimmer.
• Work on increasing your time spent swimming. Each time you visit the pool, swim a bit more, resting as needed. To steadily improve your aerobic fitness, swim three times a week.

However you decide to fit swimming into your life, be sure to test your blood-glucose levels before and after you exercise and adjust the intensity of your routine if it is getting too high. And never swim alone.

Climb Back on Your Bike

Biking can provide many health benefits, but be sure that your equipment and your course are safe ones. As with any form of exercise, monitor your blood glucose before and after, and be sure to carry a form of quick-acting glucose to eat if you need it during your ride ? such as sugar or glucose tablets, fruit juice, or hard candy. Ask your doctor or certified diabetes educator (CDE) for suggestions about the best form of emergency glucose to have on hand. A few considerations:

• Inspect your bike to make sure it's in good condition before you set off. Check the brakes and the chain, and be sure the tires are correctly inflated.
• Always wear a helmet.
• Be sure to stay hydrated. Bring plenty of water with you on your bike ride, and remember to drink it.
• Wear a medical-alert bracelet or necklace that will inform others of your health condition should there be an emergency.

(Feeling ambitious? Become a "Red Rider" by signing up for the ADA's Tour de Cure, an annual fundraiser with some 80 events in 43 states.)

Exercise and Your Blood Sugar

Studies show that the positive effects of exercise on blood sugar drops 72 hours after you've finished your activity, so instead of trying to get in your exercise once a week ? on a weekend, for example ? you should spread out your activities throughout the week. Studies also show that people who want to receive health benefits from aerobic exercise should work out for 30 minutes a day at least five days a week. But you don't have to work out in 30-minute blocks; three brisk 10-minute walks spaced out through the day will also do the trick.

So what's happening when you exercise? Your body uses the glucose in your blood to provide energy to your cells. As a result, your levels can go down as you exercise. You don't want it to go dangerously low, though, so you may need to pause and have a snack during or immediately after your activity. This is something you'll learn with experience.

Whether it's walking, riding a bike, exercising at home, going to a gym, or taking part in a class, physical activity affects your blood glucose: So it's important ? especially in the beginning ? to test your level before and after exercising. It's also a good idea to have a snack handy in case your blood glucose falls too low. For every 35 minutes of exercise you engage in, plan to consume 15 grams of carbohydrates to avoid low blood-glucose episodes.

You can keep track of your workouts (and see your improvement over time) by using the activity tracking tool on Everyday Health's Calorie Counter tool.

Next step: Dining Out Guide