Diabetes and reproductive health

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What is diabetes?

Diabetes is a problem with the body’s ability to regulate sugar levels in the blood, due to low levels or low action of insulin. People with diabetes have hyperglycaemia (higher-than-normal blood sugar levels).

How common is diabetes?

The most common types of diabetes are Type I and Type II diabetes mellitus.

One in 18 Australian males (5.5%) has diabetes1. Rates of Type I and Type II diabetes are higher in Australian men than women2.

Type II diabetes affects about 1 in 24 Australians, and around 1 in 167 Australians have Type I diabetes1.

The prevalence of diabetes among Aboriginal and Torres Strait Islander people is almost three times higher than in other Australians2. People living in rural and remote parts of Australia have higher rates of diabetes than people living in major cities, and low socioeconomic areas have higher rates than high socioeconomic areas.

The proportion of people in Australia with Type I diabetes is fairly stable, but the rate of Type II diabetes has increased from 3.3% in 2001 to 5.5%1.

Your risk of Type II diabetes increases as you age.

Symptoms of diabetes

Symptoms of Type I and Type II diabetes include:

  • Increased thirst
  • Passing lots of urine
  • Feeling tired, lethargic
  • Blurred vision
  • Weight loss (in severe cases)
  • Increased appetite
  • Increase in infections (especially of the skin; e.g. thrush)
  • Delayed wound healing

People with Type I diabetes may have unexplained weight loss, whereas people with Type II diabetes can have a gradual increase in weight.

At least one in 10 men with erectile dysfunction probably have undiagnosed diabetes.

Causes of diabetes

In people with Type I diabetes, the cells in the pancreas that make insulin are progressively destroyed by the body’s own immune system. The cause of Type I diabetes is not known, but a genetic contribution is involved. Having a mum or dad, or a sister or brother with Type I diabetes, makes you 15 times more likely to get Type I diabetes than if you don’t: however, there is no family history for more than 85% of children who develop the disease3.

In people with Type II diabetes, insulin doesn’t work properly. The combination of ‘insulin resistance’ (i.e. insulin not working properly), and a decrease in insulin over time, often occurs because of a lack of exercise, poor diet and obesity.

Some of the risk factors for type II diabetes are beyond your control, such as family history, ethnicity, sex, age and social conditions. Risk factors for Type II diabetes that you may be able to do something about, include4:

  • A diet with low amounts of fibre, fruit and vegetables, or high amounts of sugars
  • Weight gain
  • Low levels of physical activity
  • Long periods of sitting in front of a screen
  • Smoking
  • Not enough sleep
  • Low mood, stress and depression
  • Exposure to road traffic
  • Low socioeconomic status

There are factors associated with diabetes that are specific to men:

  • Around 10% of men with erectile dysfunction have undiagnosed diabetes5
  • The lower your testosterone level, the higher your likelihood of developing diabetes6

Treatment for diabetes

Not everyone’s diabetes is the same, so treatment needs to be tailored to suit each person with the disease. Some people’s diabetes can be managed with diet and exercise, whereas others will need medication for the rest of their lives7.

Your doctor will help you come up with a plan to help you manage your diabetes8, which should include:

  • Working out your goals for your health
  • Regular appointments with health professionals needed to help you reach your goals
  • Development of a diet and exercise plan
  • A plan to help make sure you take the medications you need and are monitoring your blood glucose level well

Health effects of diabetes

Diabetes affects most cells, tissues and organs in the body, so there are many bad effects on your health if your diabetes is not well managed.

Disease processes that are caused or accelerated by diabetes include5:

  • Development of plaques and inflammation in the walls of large blood vessels, which can lead to a stroke or heart attack
  • Disease of blood vessels in the arms and legs, which can lead to ulcers and gangrene that require amputation.
  • Damage to small blood vessels, that contributes to damage to nerves
  • Progressive nerve damage that results in numbness, pain and weakness
  • Kidney disease that can result in complete kidney failure and the need for a kidney transplant
  • Damage to the retina in the eye that can cause blindness
  • Abnormal immune system function that probably contributes to periodontal (gum) disease and foot infections

Men with diabetes have a higher risk of erectile dysfunction than men with normal blood glucose control. About two out of three men with Type II diabetes, and one in three men with Type I diabetes, develop erectile dysfunction9.

Testosterone levels tend to be lower in men with diabetes than in those without10, which can affect energy levels, sex drive and mood.

What to do about diabetes

If you have any symptoms of diabetes, you should make an appointment to see your doctor. It’s best not to wait and see if the symptoms go away on their own because the sooner you get control of your diabetes the better.

Taking care of yourself by eating a healthy diet and being active is not only an effective way to avoid diabetes, but it is an important part of treatment.

Sticking to your diabetes management plan and keeping your appointments with your healthcare providers will help prevent the progression of your diabetes and your risk of it causing other health problems.

What questions should I ask my doctor about diabetes?

  • Is there anything about my health that places me at risk of diabetes?
  • What health problems should I be aware of and how will I know if they start to develop?
  • Is there someone I can talk to about my diet?
  • What exercises do you recommend, to help control my diabetes?
References

[1] https://www.abs.gov.au/statistics/health/health-conditions-and-risks/diabetes/latest-release [25 August 2021]

[2] https://www.aihw.gov.au/reports/diabetes/diabetes/data

[3] Couper et al., 2018. ISPAD Clinical Practice Consensus Guidelines 2018: Stages of type 1 diabetes in children and adolescents. Pediatric Diabetes

[4] Kolb & Martin, 2017. Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes. BMC Medicine

[5] McMahon, 2019. Current diagnosis and management of erectile dysfunction. Medical Journal of Australia

[6] Gyawali et al., 2018. The role of sex hormone-binding globulin (SHBG), testosterone, and other sex steroids, on the development of type 2 diabetes in a cohort of community-dwelling middle-aged to elderly men. Acta Diabetologica

[7] Kaul et al., 2013. Introduction to Diabetes Mellitus, in: Autophagy: Biology and Diseases. Autophagy: Biology and Diseases

[8] Diabetic care plans for health professionals. https://healthtimes.com.au/hub/diabetes/23/guidance/healthinsights/diabetic-care-plan-for-health-professionals/2690/ [accessed 25 August 2021]

[9] Kouidrat et al., 2017. High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies. Diabetic Medicine

[10] Gianatti & Grossmann, 2020. Testosterone deficiency in men with Type 2 diabetes: pathophysiology and treatment. Diabetic Medicine 37, 174–186.. doi:10.1111/dme.13977

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