Risks and Complications of Type 2 Diabetes in Men

Type 2 diabetes (T2D) is a complex chronic condition that develops when the body loses its ability to use and produce the hormone insulin properly. As a result, the body does not regulate blood sugar efficiently. Chronically high blood sugar levels are toxic to blood vessels and organs, such as the eyes, kidneys, and heart.

Your specific symptoms will depend on the affected organ. For example, eye damage may lead to blurry or double vision, and kidney damage may lead to more frequent urination.

Research shows that men are more likely than women to develop type 2 diabetes, underscoring the importance of looking out for early signs unique to men, such as erectile dysfunction and retrograde ejaculation, and taking steps to prevent diabetes in this high-risk population.

This article addresses the risks and complications of type 2 diabetes in men.

Prevalence

According to the Centers for Disease Control and Prevention (CDC), 1 in 10 people—nearly 40 million adults in the United States—are living with type 2 diabetes. There potentially are many people who are unknowingly living with type 2 diabetes or prediabetes.

Type 2 diabetes is most common in men and women older than 45 years old, but diabetes rates are increasing in all populations, including children, teens, and young adults.

Men are at particularly high risk—the prevalence of type 2 diabetes in men is 14.6% compared to 9.1% in women—because they carry more belly fat. Belly fat is a known primary risk factor for type 2 diabetes. It promotes insulin resistance which decreases the efficiency of insulin delivery in the body. Over time, the pancreas produces higher and higher amounts of insulin until it cannot.

Also, men tend to develop type 2 diabetes at a younger age than women. While the exact cause is unknown, the primary reason points to higher amounts of abdominal fat compared to women, although biological, sociocultural, economic, and lifestyle factors play an important role as well.

Of note, obesity is the greatest risk factor for type 2 diabetes.

Below are potential complications of type 2 diabetes in men.

Erectile Dysfunction

Men with type 2 diabetes are more likely to have trouble getting or maintaining an erection, a condition called erectile dysfunction (ED).

Causes

ED is very common in men with type 2 diabetes. In fact, one study reports that over half of men with type 2 diabetes also report having ED.

Chronically high blood sugar levels are toxic to the nerves and blood vessels of the body. Damage to the nerves (autonomic neuropathy) and blood vessels (atherosclerosis) affects muscle and nerve function.

Damage to the autonomic nerves that control the body's automatic responses—such as the nerves of the penis that help give rise to an erection during sexual arousal—along with the narrowing of blood vessels in the penis from atherosclerosis is the leading cause of ED. 

Treatment

Controlling your diabetes with a combination of lifestyle modifications and medications, such as insulin and/or metformin, are key to preventing and treating ED.

Common oral medications in the phosphodiesterase-5 enzyme (PDE-5) inhibitor drug class—such as Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil)—are first-line medications for ED.

They work by relaxing the muscles of the penis and promoting blood flow by blocking PDE-5, an enzyme that restricts blood flow. Managing other medical conditions like high blood pressure and high cholesterol are also likely to help improve your ED symptoms. 

Of note, if oral medications and lifestyle changes do not relieve your ED symptoms, your healthcare provider may recommend other options such as:

• A penile pump
• Intraurethral suppository
• Vacuum pump
• Penile implant

Medical treatment for ED should always be done under the guidance of a healthcare professional. 

Autonomic Nervous System (ANS) Dysfunction

Diabetic autonomic neuropathy (DAN)—the primary and most serious form of ANS dysfunction—occurs when the nerves that control the automatic functions of the body become damaged and stop functioning properly.

Causes

DAN may affect your blood pressure, heart rate, temperature control, and even sweating. 

Organ systems throughout the body that may be affected include:

• Gastrointestinal system: The esophagus, stomach, and large and small intestines are the most commonly affected organs and symptoms may include esophageal enteropathy, gastroparesis, constipation, diarrhea, and fecal incontinence. 
• Genitourinary system: The bladder and penis are the most commonly affected organs and urinary incontinence, erectile dysfunction, and retrograde ejaculation are among the most common symptoms that result. 
• Cardiovascular system: Symptoms of cardiac autonomic neuropathy are subtle and can range from a fall in blood pressure when you stand up (orthostatic hypertension) to a “silent” or asymptomatic heart attack (also known as myocardial infarction). 

Treatment

There is no one-size-fits-all treatment for DAN.

DAN affects the entire body.

Treatment is based on the organ that is most affected by nerve damage, therefore, you may be on a number of medications aimed at treating your diabetes (and any other underlying conditions), and managing your specific symptoms.

Retrograde Ejaculation

Retrograde ejaculation is a common symptom of T2D that is characterized by semen entering the bladder instead of out through the penis during orgasm.

Oftentimes, retrograde ejaculation has no symptoms except for cloudy urination after sex and more rarely, difficulty having a child, which is a sign of infertility.

Decreased or Damaged Sperm

Research has shown that men with diabetes not only have a lower sperm count but also may have a higher likelihood of damaged sperm due to epigenetic changes to sperm DNA and disturbances in glucose metabolism.

Therefore diabetes that is not well managed can have a detrimental effect on male fertility, even in the absence of ED.

Urological Problems

Type 2 diabetes can cause urologic problems in men, including:

• Overactive bladder: Nerve damage can send mixed messages to the bladder, causing it to spasm and leak at unpredictable times. 
• Incontinence: Chronically high glucose levels can damage the nerves of the bladder (neuropathy) leading to a loss of bladder control.
• Urinary tract infections (UTI): These are more common in men living with type 2 diabetes but they are also more severe and carry worse outcomes compared to people who have UTIs without type 2 diabetes.
  

Treatment

If you have type 2 diabetes, managing your blood sugar with a combination of lifestyle modification centered around diet and exercise and medication will be the best way to avoid serious medical complications.

Meeting with a diabetes counselor can help you to formulate a plan that works best for you. This plan may include: 

• Developing a heart-healthy eating plan focused on eating a healthy balance of good carbohydrates and fats and low sodium
• Getting regular exercise
• Testing your blood sugar and keep a record of the results
• Recognizing the signs of high or low blood sugar and what to do about it
• Learning how to provide yourself insulin, if needed
• Taking diabetes medication, such as metformin, and learning the importance of medication compliance
• Attending a diabetes education class
• Checking your feet, skin, and eyes to catch problems early
• Buying diabetes supplies and storing them properly
• Limiting or avoiding stressful situations
• Managing other medical conditions that may exacerbate your diabetes or vice versa. 

In addition to attending regular appointments with a healthcare professional, connecting with support groups and discussing your diabetes journey with family and friends may also provide you with the support and encouragement you need to best adapt to these new lifestyle changes. 

Summary

Men are more likely than women to develop type 2 diabetes, underscoring the importance of looking out for early signs unique to men, such as erectile dysfunction and retrograde ejaculation, and taking steps to prevent diabetes in this high-risk population.

A Word From Verywell 

Type 2 diabetes can impact anyone, no matter your age, weight, or eating habits. Getting routine wellness visits to a trusted healthcare provider is one of the best ways to develop a health plan aimed at lowering your risk of diabetes.