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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17665
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have had diabetes type for 7 years now. I have been having

Resolved Question:

I have had diabetes type for 7 years now. I have been having erections problems as i am unable to sustain one for sexual intercourse. My blood sugar has been stable for the last 4 months but i must admit it was not very well controlled in the last 2 years. Can you help me?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
Thank you for using JustAnswer. I will be glad to discuss this with you.
However, when you ask whether we can help you, it is important to clarify what help you are seeking.
Over the internet, we can discuss and provide information regarding the situation that you are having, including possible causes and treatments.
However, if you are seeking prescriptions for treatment of that condition, we are unable to do so.
If it would be helpful to you to provide this service, I would be glad to do so.
Please let me know.

Customer: replied 2 years ago.

Hi Dr Love,


 


Thanks for getting back so quickily.


 


My husband & I are just looking for possible causes and treatments before we decide on what to do next.


 


My husband is 45 years old with Type 2 Diabetes since 2007.


 


He is currently on medication and taking Diamicron 60mg 2 tablets per day & Galvus Met 850 mg Twice per day.


 


For the last four years my husband has had a low libido & sometimes unable to sustain an erection.


 


We have never done anything about it until now.


 


Kindly advise.

Expert:  Dr. D. Love replied 2 years ago.
I will be glad to assist you.
It will help if you could first provide some further information:
What has his blood sugar been running over the past 4 months when it has been more stable?
What was his most recent HgbA1c?

Customer: replied 2 years ago.

Sugar readings have been between 4.5 to 6.9.


 


My last HgbA 1c was done in january and was 9.7 but i was on glucophage XR 1mg daily.

Expert:  Dr. D. Love replied 2 years ago.
Thank you for the additional information.

There are several issues to consider in this situation.

Diabetes is one of the most common causes of erectile dysfunction (ED) in men. This is because diabetes can adversely affect both the blood vessels and the nerves that serve the penis, which is the underlying mechanism of ED for the vast majority of men.

Therefore, the first issue is to get good control of the diabetes. The recent sugar readings are good and hopefully the next HgbA1c will reflect this. If the HgbA1c is still elevated, then it may help to increase the metformin to 1000 mg twice daily, and at that dose, I prefer to use the extended release form of the medicine.

Unfortunately, some of the adverse effect on blood vessels and nerve is not reversible with better control of the blood sugar, and if so, the usual next step would be to directly treat the ED with a medicine directly for the ED, such a Viagra or Cialis. These medicines inhibit a particular enzyme (phosphodiesterase type 5, or PDE5), that improves blood flow to cause an erection. These medicines have been shown to work for ED from a wide variety of causes, so the usual approach is to try one of these medicines first.

Another issue to consider in a man with ED and poor libido would be to check the level of testosterone. Statistically, it is more likely that this problem is due to the diabetes, but a poor libido should also raise the question of a low testosterone. Diabetes does not typically directly affect the libido, although any cause of ED can cause a secondary effect on libido.

If the PDE5 inhibitor does not help and the testosterone level is not low, then it may be helpful to consider a more detailed evaluation, such as an ultrasound assessment of blood flow to the penis, or other treatments, such as a vacuum pump or medicines applied directly to the penis, such as alprostadil by injection or suppository. However, the PDE5 inhibitors are so effective, these other options are not needed anywhere near as often as was once true.

If you have any further questions or need clarification, please let me know.

Customer: replied 2 years ago.

Attachment: 2014-04-26_091423_agha_khan0001.pdf

Thank you for your response.


Kindly evaluate my results that had been requested for by my doctor and see if all is well or maybe be able to have an indication as to what the problem maybe

Attachment: 2014-04-26_091633_agha_khan0001.pdf

.


 


Regards

Expert:  Dr. D. Love replied 2 years ago.
Your doctor has already checked your testosterone level and it was fine, so that is not a factor in the ED and decreased libido.

The other labs are mostly OK. The good cholesterol (HDL) is low, so is considered a risk factor, but the bad cholesterol (LDL) is also low, which is an excellent level and largely offsets the low good cholesterol. None of this is at a level that would be contributing to your symptoms.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17665
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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