Why is the risk of blood vessel diseases increased so much in diabetes?

There are several reasons why the risk of vascular diseases, such as heart attack, stroke, and diseases of the vessels in the limbs (peripheral vascular disease), is increased in both types of diabetes. The weight gain and lack of exercise common in people with type 2 diabetes lead to other conditions such as abnormal cholesterol levels and high blood pressure, which are potent causes of vascular disease. If all of these risk factors are not treated effectively, the probability of vascular disease remains high. High blood sugar over months and years leads to a chemical reaction of the sugar in the blood vessels, damaging them structurally. Perhaps most importantly, we now know that diabetes and obesity can be described as irritants to the body tissues, meaning that the body becomes generally inflamed. We know that this is so because we can measure high levels of compounds that indicate inflammation in the blood of many people with diabetes. It turns out that this inflammation, when maintained over time, extends to the lining of the blood vessels, which attracts inflammatory cells out of the bloodstream. Cholesterol also takes on an inflamed form, enters the lining of the blood vessels, and attracts still more inflammatory cells from the bloodstream, setting the stage for serious damage.

Peripheral vascular disease

Diseases of the vessels in the limbs.

Inflammation

Swelling, pain, tenderness, and disturbed function in an area of the body, usually as a result of injury.

Other contributors to vascular disease include the fact that high blood pressure results from nephropathy, which further damages blood vessels. This further damages the kidney and blood pressure rises still further, setting up a vicious cycle. Even short periods of high glucose, such as may occur after meals in people with diabetes and even prediabetes, can cause problems with the function of blood vessels, making them more sticky, inflamed, and less able to relax. Whether these repeated briefer periods of high blood sugar combine over time to cause permanent vascular damage is not known. However, it is known that the risk of vascular disease is already high in people with prediabetes.

Can my diabetes affect my sex life? If so, how and what can I do about it?

Diabetes can have a profound effect upon a persons sexual drive, functioning, and satisfaction. This is especially apparent in men, although there is some evidence that some women with diabetes can also experience adverse effects on their sexual responses. The reason for the significant effects on male sexual function arises from the complexity of the penile erection mechanism. This requires satisfactory nerve, blood vessel, and hormone function to be achieved and sustained. Diabetic nerve damage (see Question 32) can be of two main types. One form is damage to the system that serves conscious movement and sensation and the other is damage to the system that serves unconscious or automatic responses, such as bowel contraction and the heart beat. The erectile mechanism is served by the latter, while the sensation of pleasure in sexual performance is served by the former. Since the nerves to the genital area are relatively lengthy, they are prone to the damage described in Question 32. Normal erectile function also depends on a healthy blood supply to the penis, as erection entails engorgement of the organ with blood. If the blood supply is compromised, the quality of the erection will be poor. As discussed in Question 35, vascular damage is commonly associated with diabetes and frequently affects the health of the vessels supplying the genitals. Finally, normal levels of the male hormone testosterone are necessary not only for sexual interest (libido), but also for perception of pleasurable sensations from sexual arousal. Low testosterone levels, already common in middle-aged and older men, are even more common in men with diabetes. Indeed, there is suggestive evidence that low testosterone levels may contribute to worsening of diabetes, thus creating a vicious cycle that further depresses hormone levels. In light of the three strikes of diabetic nerve damage, vascular damage, and diminished levels of male hormone, it is not surprising that poor sexual performance and diminished satisfaction are a frequent finding in men with diabetes. Indeed, more than half of all men with type 2 diabetes of five or more years' duration will complain of one or more symptoms of sexual dysfunction. Sometimes this is worsened by medications commonly used by people with diabetes, such as certain blood pressure-lowering drugs.

 
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