Diabetes is one of the most common endocrine diseases in the population. Moreover, the number of people with diabetes is steadily increasing. Taking into account the improvement of quality of care, and therefore the increased life expectancy of patients with diabetes, problems of prevention of complications and improving the quality of patients with this disease become immensely significant.
Diabetes and Its Manifestation
Diabetes is considered to be a group of diseases with different causes, mechanisms of development, type of inheritance. The unifying link for all of these conditions is increased blood sugar level (hyperglycemia). The increase in the level of blood sugar can occur as a result of lower production of insulin by the pancreas or because of insensitivity of organs and tissues to insulin. In some cases these mechanisms are combined. There are several types of diabetes. Most common are diabetes of 1 and 2 types. Regardless of the type of diabetes, the increase in blood sugar can lead to serious consequences for the organism. Consequences of prolonged elevated level of blood sugar include the damage to the following organs:
- peripheral nervous system;
- cardiovascular system.
One of the most harmful effects of diabetes on the body is erectile dysfunction (or impotence). It goes without saying that impotence has an utterly negative impact on the life of a man. Currently, the erectile dysfunction is known as the inability to have an erection sufficient to be involved in sexual activity. The prevalence of this condition in the population is high: approximately 10% of men suffer from this pathological condition. The main risk factor for the development of erectile dysfunction is age. Moreover, quite frequent are cases of erectile dysfunction from diabetes. According to various research groups, from 20% to 80% of men with diabetes have problems with potency. There are three main variants of this condition:
- ED of organic nature;
- psychogenic ED;
- mixed variant of ED.
According to this classification, erectile dysfunction after diabetes refers to the first type – ED of organic nature. Penile erection is a complex, multicomponent process and is determined by neurovascular interactions. The central and peripheral components of the nervous system are engaged in this process. The basic mechanism of development of penile erection is relaxation of the arteries of the penis (cavernous artery) and cavernous smooth muscle tissue. It results in increased blood flow and the increase in pressure inside the corpora cavernosa. In turn, the filling of the corpora cavernosa with blood and the pressure increase inside it cause compression of the veins under the membranes of the penis, the cessation of venous outflow and—the erection. A leading mediator in the process of relaxation of arteries and the corpora cavernosa is nitric oxide (NO). The development of erectile dysfunction from diabetes is considered a multifactorial process. There are several mechanisms involved in the formation of these complications:
- increased blood pressure;
- psychological problems (depression);
- low testosterone levels (hypogonadism).
Elevated blood sugar level (hyperglycemia) is the leading cause of development of complications of diabetes, including erectile dysfunction. Chronic hyperglycemia leads to the development of micro- and macroangiopathy and neuropathy. Damage to blood vessels of the corpora cavernosa and the nerves engaged in the regulation of erection determines the development of this condition.
Note!Additionally, studies have shown that diabetes causes disturbance of the system of nitric oxide.
The next mechanism involved in the development of ED in diabetes is arterial hypertension. Elevated blood pressure has the ability to pathologically affect the process of filling the corpora cavernosa with blood. On the other hand, some groups of drugs used for the treatment of hypertension and heart failure cause a disturbance of mechanism of erection. The development of ED may be caused by the use of drugs from the group of b-blockers (e.g., anaprilin, obzidan, etc.). The reduction in testosterone level is another pathological mechanism leading to erectile dysfunction. Numerous studies have found that diabetes in men typically leads to a decrease in testosterone level. Moreover, there is a direct correlation between the degree of compensation of diabetes and the level of testosterone. The problem of decrease in testosterone is the most important for patients with diabetes of type 2. Diabetes of type 2 is often one of the components of metabolic syndrome. Metabolic syndrome in addition to diabetes include: abdominal obesity, elevated blood pressure, the increase in lipids in the blood. So there occurs the notoriously common erectile dysfunction from diabetes of type 2.
Remember!In addition to organic damage to blood vessels and nerves, psychogenic component also plays a role in the formation of ED. It is established that diabetes and depressive disorders are related. Besides, as in the case of hypertension, certain drugs for the treatment of depressive disorders can result in erectile dysfunction.
Thus, ED is one of the diseases closely linked with diabetes. There are a large number of factors involved in the development of ED. The main starting point of the formation of impotence and other complications of diabetes is chronic hyperglycemia. Therefore, the main thing in prevention of erectile dysfunction is the achievement and maintenance of compensation of diabetes. Patients with inadequate metabolic control are more exposed to the development of this disease. Also, given the negative role of hypertension and dyslipidemia in the development of erectile dysfunction, it is necessary to carry out regular monitoring and correction of blood pressure and to maintain normal lipid levels. Therefore, the main components for prevention of impotence in diabetes are:
- achieving the compensation of diabetes, including the maintenance of target values of blood sugar level;
- maintaining the normal blood pressure level;
- normalization of weight;
- giving up smoking;
- early detection and treatment of chronic complications of diabetes.