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Dr Larisse Badenhorst helps us understand why men who have diabetes may also suffer with diabetic erectile dysfunction.

Understanding erectile dysfunction

Erectile dysfunction (ED) is defined as the inability to get or maintain an erection firm enough for sex.

A lot must work together to get an erection. Men need healthy blood vessels, good blood supply, intact nerves, balanced and adequate hormones (these include oestrogen, testosterone and thyroid hormones), and a desire to be sexually stimulated.

This is a complex interaction of vascular, neurological, hormonal and psychological systems. It is therefore imperative to seek expert help when you are experiencing ED.

Screening, monitoring and appropriately treating diseases that are comorbid with erectile dysfunction is essential. This will enhance life quality and improved motivation in men with existing erectile dysfunction comorbidities or risk factors. 

Diabetic erectile dysfunction

Erectile dysfunction is a common and distressing complication of diabetes. Both Type 1 and type 2 are risk factors for the development of erection problems.

Many unique characteristics distinguish these two, including insulin and cholesterol levels, obesity status and inflammatory agent profiles. The causes in diabetic erectile dysfunction are multifactorial and it is found that it is more severe and more resistant to treatment when compared with non-diabetics. Erectile dysfunction in diabetics develops 10 to 15 years before men without diabetes.

There are many associated factors, namely advancing age, duration of diabetes, poor glycaemic control, high blood pressure, high cholesterol, sedentary lifestyle (which pertains to lack of exercise and increased weight), smoking, presence of other diabetic complications, depression and other psychological diseases, prostate problems and low testosterone levels.

As important as these are in leading to erectile dysfunction, the medication used in treating these conditions are as important. There are a lot of medicines used to treat other conditions that can make erectile dysfunction worse.

It’s vital to screen for these other conditions in erectile dysfunction sufferers. Premature ejaculation and low libido is commonly associated with diabetic erectile dysfunction. It is important to see to these as well if present.

Diminished erection spontaneity, rigidity (firmness) and/or sustaining capability also negatively affect mood, self-esteem, and confidence. These can compromise motivation to be compliant with medications that treat diseases comorbid with erectile dysfunction.

Managing erectile dysfunction

Seeking medical expertise is imperative to treat the cause and comorbid conditions that can lead to ED. The following treatment is important in diabetic erectile dysfunction, but also important to be addressed in non-diabetics.

Optimising glucose levels is vital, especially in young men with diabetes. Lifestyle modifications are important; these include dietary changes, cessation of smoking and weight loss. Managing other comorbidities adequately is also of utmost importance.

As said before, optimising treatment of diabetes and other comorbidities, and reviewing all medication used much be done, as these can play a vital role in worsening erectile dysfunction.

Tablets

Specific treatment for erectile dysfunction is phosphodiesterase type 5 inhibitors (PDE5I). These include tablets like Viagra, Cialis and Ciavor. These tablets work extremely well, but it is important to be prescribed by a medical professional who will make sure there are no contraindications in the use of these, as well as educating you on the side effects and risks.

Injections

Intracavernosal injections (these are injections administered directly into the penis) also work very well and are commonly used if PDE5I don’t work or contraindications to their use exist.

The dosage needed must be monitored by a medical expert because prolonged erections (known as priapism) can result from the use of the injectables and can have long-term effects.

Pumps

Vacuum devices or pumps are also available. They draw blood into the penis to then obtain an erection and a ring is used to then keep the blood within the penis to maintain the erection.

A common problem is that the device is not used correctly and therefore a lot of men think that it doesn’t work.

Platelet rich plasma

A newer treatment available is platelet rich plasma (PRP). This involves using the person’s own blood products to promote healing and rejuvenation in certain areas of the body. It has gained a lot of popularity in sexual medicine but is still seen as experimental in treating things like erectile dysfunction.

Treating possible underlying psychological problems are very important and seen as key in patients with performance problems.

With the pharmaceutical advances and expanded knowledge of the effects of lifestyle on sexual health, there is seldom a reason for a man to suffer bad erections in this day and age. The earlier you treat, the better the outcome for your general health as well as long-term effects.

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The Heart and Stroke Foundation South Africa advises what foods should be eaten to build immunity during this viral era.

While many people are stocking up on immune boosters, vitamin C tablets and green juices, we’ve put together a few ideas on the type of nourishment our bodies need as we fall into winter. More importantly, as we find ourselves caught up in this viral era, here are 10 top foods to build immunity, without compromising your diabetes.

1. Citrus fruits

All citrus fruits, such as oranges, grapefruits and lemons are high in vitamin C, which acts as an antioxidant. Antioxidants help fight free radicals; a type of unstable molecule known to damage the immune system. Vitamin C also increases the production of white blood cells which are key to fighting infections.

Keep seedless oranges in a fruit bowl (up to four days with peels intact) for easy grab-and-go snacks.

When it comes to fruits, try to limit your intake to two fruits per day and where possible a fruit should be consumed with the skin on for that extra fibre.

2. Spinach

Spinach is rich in vitamin C. It’s also packed with numerous antioxidants and beta carotene, which increases the infection-fighting ability of your immune system. Spinach is healthiest when it’s cooked as little as possible so that it retains its nutrients.

3. Yoghurt

Yoghurt is a fermented food that naturally contains lots of probiotic cultures. These cultures help to increase the good bacteria in your gut – the place where more than 70% of your immune cells live.

4. Oily fish

Salmon, tuna, sardines and other oily fish are a rich source of omega-3 fatty acids. Omega-3 fatty acids suppress inflammation and keep immunity in check.

Fatty fish also contain vitamin D which helps regulate the immune system and is thought to boost the body’s natural defences against diseases.

Vitamin B6 found in fatty fish is vital to supporting biochemical reactions in the immune system.

Make sardines in tomato sauce on toasted low-GI bread with a few slices of avo – creamy and delicious, or if you prefer add anchovies for a salty kick.

5. Mushrooms

Mushrooms contain antioxidants that provide anti-inflammatory and immunity protection. Cooking mushrooms lowers their anti-inflammatory compounds so it is best to eat them raw or lightly cooked.

6. Almonds

Almonds are packed with vitamin E, which is a powerful antioxidant. Maintaining ample levels of vitamin E is crucial for maintaining a healthy immune system.

Almonds are also a source of zinc; zinc is an essential mineral involved in the production of certain immune cells.

For a dose of protein and healthy fats, add a spoonful of almond butter to oatmeal.

7. Green tea

Green tea has high levels of epigallocatechin gallate (EGCG) which is a powerful antioxidant that enhances your immune function.

8. Ginger

Ginger is another ingredient many turn to after getting sick. It helps to decrease inflammation, which can reduce a sore throat and other inflammatory illnesses.

9. Garlic

Early civilisations recognised garlic’s value in fighting infections. It’s immune-boosting properties come from a heavy concentration of sulphur-containing compounds, such as allicin.

10. Turmeric

Research shows that high concentrations of curcumin, which gives turmeric its distinctive colour, help to prevent inflammation.

Use a pinch of turmeric in scrambled egg. If you or your family are new to turmeric, this is a great place to start because the colour is familiar and the flavour subtle.

Make tea by simmering turmeric with coconut milk to make an earthy and comforting beverage aka the popular Golden Milk.

This winter, plan your meals and snacks to include these top 10 powerful immune boosters.

Podiatrist, Dennis Rehbock, shares winter foot care advice for people living with diabetes.

While winter in South Africa may not be extremely cold and snowy like other places in the world, it can be unpleasant and pose some dangers to the feet of a person living with diabetes.

Foot care is of great importance to a diabetic patient and should be practiced every day. But, in winter it’s even more important if the patient is high risk, such as poor circulation, Raynaud’s disease (a condition in which some areas of the body feel numb and cool in certain circumstances), peripheral neuropathy (weakness, numbness and pain from nerve damage, usually in the hands and feet), or any foot ulceration.

Winter foot care tips

• Check your feet every day. Do this yourself if you can or get a family member or helper to do it. This will enable you to see any problems before they happen.
• Inspect for any lesions, discolouration, swelling, dryness, corns, cracked heels, peeling skin (especially in between toes), pain and numbness. Anything new or unusual should be seen to as soon as possible.

Even in this COVID-19 lockdown period you may and should go to your podiatrist or diabetic doctor for any problem or foot problem that you are having.

Keep your feet dry and warm

• Wash your feet daily. Dry them very well, especially in between the toes. Be gentle.
• If necessary, use foot powder on them before you put your socks and shoes on.
• If you have very dry feet then moisturise them daily after your bath or shower.
• Use an urea-based cream that is especially for dry feet. There are many on the market these days.
• Do not cream in between your toes. Rather keep that area dry. 

Socks

• Any socks that are worn should be soft, warm, comfortable and should not have seams in them that could damage your skin. You do get special socks for diabetic feet to protect them.
• The sock material should be a moisture-wicking material to keep the feet dry. Cotton, wool and merino wool is good for this purpose.
• Modern sports and running socks are also made from materials like Drynamix and merino wool (see Falke and Balega socks).
• Some sock materials are infused with silver and copper to help with bacteria.
• Change your socks daily.

CAUTION: If you have cracked wet itchy skin in between your toes, go and see your podiatrist. It may be a fungus (Athlete’s foot) that needs treatment.

Shoes

• In winter, it is best to wear closed shoes that will keep your feet warm and protected. They must keep your feet comfortably warm to help prevent chilblains, ulceration and Reynaud’s.
• The shoes should fit well and not cause any pressure or friction. They must also have good traction to help prevent slipping and falling.
• When you are around at home it is okay to wear thick soft warm sheepskin slippers.

CAUTION: Please do not heat your feet up in front of a fire, or a heater, or in any hot bath or footbath. Electric blankets must be used with extreme care.

Dry skin and hard skin

• If you have dry skin on your feet, moisturise them as mentioned.
• If you have hard skin, like corn, blisters and callouses, refrain from any self-treatment. Do not cut them yourself or use any acid-based creams on them. This is dangerous if you have poor peripheral circulation or peripheral neuropathy.
• Go and see your podiatrist for professional treatment of these lesions.

CAUTION: Do not cut these lesions yourself.

Nail care

• If you can reach your nails and see them well then you may carefully cut your own nails. Cut straight across and file them to make them smooth.
• If you cannot reach or see them well then please do not cut them yourself. Go and see your podiatrist for regular foot care and they will cut your nails.
• Other nail pathologies also need treatment. Damaged nails, ingrown nails, fungal nails can also be treated.

Peripheral nerve changes

• Nerve changes in the feet can occur in patients living with diabetes. If your feet go numb (peripheral neuropathy), it can be a bad thing.
• Nerve changes can affect your ability to balance, to feel pain and foot damage. Your ability to feel heat could also be affected and this may cause foot damage without you knowing.
• Check the temperature of your bath before you get into it.
• Do not sit in front of a heater or fire to warm your feet. You could burn them.
• Keep your blood glucose levels well-controlled. Monitor your diet, exercise regularly, and avoid smoking.
• Have your feet screened once or twice a year for neural and vascular changes.

Circulation

• The peripheral circulation is often affected in people living with diabetes. This can lead to minor vascular lesions in the feet, like chilblains, and to more serious lesions, like ulceration.
• Chilblains are a typical lesion that can occur in very cold weather, especially with sudden changes of temperature. If your circulation is also poor then you are at great risk of getting them.
• The lesions present as red/blueish patches on the skin of the feet and toes. This can also occur on the hands or other exposed areas. The small blood vessels go into a spasm and are usually painful. They are usually self-limiting, but if necessary, they need treating.
• Keeping your feet gently warm, and not smoking is important as smoking is a factor in the cause of chilblains. There are rub-on-creams that may help.
• In more severe cases, oral medication may be necessary to improve the peripheral circulation.
• Exercise also helps improve the peripheral circulation.
• It’s been observed that COVID-19 positive patients may have chilblain-like symptoms on the feet. Painful lesions that look very much like chilblains can appear in these patients, so care must be takes in the diagnosis of the chilblains.

Summary

• Go and see your podiatrist regularly (once or twice a year) or if you have any sudden foot problems in winter.
• Do not treat your own feet. Look after them, observe them daily, but go for professional treatment when necessary.
• Be very careful of using any unusual, untested products on your feet. Rather get professional advice.
• Urea-based foot creams or heel balms are good to use for dry feet.
• If you see any signs of infection or ulceration on your feet, go immediately to your foot care professional.
• Smoking is bad for your peripheral circulation.
• Exercise is good for your peripheral circulation. Get moving and go and walk or run.
  

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