General Health

Sexual and urological complications in diabetes patients

Introduction

Diabetes is a chronic insidious health condition wherein there is high blood sugar due to malfunctioning of the pancreatic hormone insulin. Insulin is responsible for utilising the glucose consumed from food and transportation into the cells from the bloodstream.

Inefficient production or utilisation of this hormone results in failure of glucose transport from the bloodstream to the target cells with the final outcome being, elevated levels of blood glucose exceeding 100 mg/dL fasting and 140 mg/dL two hours after a meal in adults.

Types of diabetes

The type of diabetes can be divided on the basis of the absolute or relative absence of insulin in the beta cells of the pancreas.

  • Type 1 diabetes or insulin-dependent diabetes is the condition where there is zero to minimal production of insulin. This could be due to autoimmune destruction or viral infection of the insulin-producing cells. Life-threatening diabetic ketoacidosis with blood glucose levels exceeding 600 mg/dL and diabetic coma have been reported in this condition. It mostly affects young individuals before the age of 20. Treatment involves strict hyperglycemia controls with the injection of external insulin to maintain functional blood glucose levels.
  • Type 2 diabetes or Diabetes Mellitus where there is some production of the insulin hormone, but faulty utilisation of the same leads to elevated glucose in the bloodstream. This is more common in adults and has been strongly linked to obesity. It is milder than type 1 diabetes, however, uncontrolled hyperglycemia can cause significant mortality and morbidity. Treatment includes oral hypoglycemic drugs like sulfonylureas and DPP4 inhibitors along with exercise and diet changes.
  • Diabetes insipidus is a rare disorder due to malfunction of the Antidiuretic hormone, vasopressin that regulates fluid balance in the body. Symptoms include excess thirst followed by excess urination or diuresis which in turn lead to electrolyte imbalance. Treatment includes desmopressin that replaces the vasopressin that is lacking. Thiazide diuretics are another class of drugs prescribed to lower the amount of urine production. Additionally, monitoring the levels of sodium consumption can provide some symptomatic relief.

Current diabetes scenario in India

According to the International Diabetes Federation in 2017, there are an estimated 72.9 million adults in India living with diabetes. The prevalence is higher in the urban population when compared to rural India which can be attributed to the increasingly sedentary lifestyle and western diets with more processed food products consumed in the cities. Additionally, Asian descent predisposes to the development of abdominal obesity which releases a protein called Retinol Binding Protein-4 (RBP4) that has been linked to insulin resistance.

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Burden of disease

High blood sugar has been known to affect a multitude of organ systems. However, this article will narrow down on the impact of diabetes on the urological and sexual functions of the individual.

Chronic hyperglycemia causes increased flux through the polyol pathway, which leads to an overconsumption of the ROS (Reactive Oxygen Species) scavenging molecule NADPH, thereby exacerbating the oxidative stress in blood vessels and nerves.

Urinary tract problems are common among people with type 2 Diabetes Mellitus; so much so that frequent urination and nocturia are some of the key diagnostic features of this condition. Diabetic Autonomic Neuropathy (DAN) has been known to play a pivotal role in the development of these symptoms. Increased oxidative stress, reduction of neurotrophic growth factors and nerve hypoxia in concerte lead to this.

A constellation of symptoms recorded includes urinary incontinence with leaking out of urine due to weakness of the urethral sphincters and overactive bladder that gives the sensation of needing to void every time the urinary bladder fills up with miniscule quantities of urine as a result of spasm of the detrusor muscles. Moreover, high blood sugar also attracts bacteria leading to recurrent urinary tract infections which often present with a triad of fever, burning micturition and urinary hesitancy in both males and females. These factors cause significant embarrassment and psychological stress in diabetic patients and lower the overall quality of life.

Sexual dysfunctions have been reported more frequently in diabetic patients. Erectile dysfunction (inability to maintain an erection during sexual intercourse) is 3.5 times more common in men with diabetes when compared to men without the condition. The pathophysiology behind erectile dysfunction can be understood by diabetic neuropathy and impairment in the relaxation of the cavernosal muscles around the penis that facilitates erection. Additionally, some new studies have shown that men with diabetes tend to have lower concentrations of the testosterone hormone that could lead to low libido and indirectly, ED. However, more light needs to be shed on this.

Sexual difficulties faced by women due to diabetes are more psychophysiological in origin. The presence of overlapping symptoms includes arousal disorder, dyspareunia (painful sexual intercourse) and genito-pelvic pain disorder. Female sexual dysfunction has been associated with both type1 and type2 diabetes and is more common in the post-menopausal age group. Therefore, importance should be placed on counselling these women and educating them about their condition along with appropriate medications.

Author

Ananya Roy

Ananya Roy is currently an intern at Smt. NHL Municipal Medical College Ahmedabad, India. With an inclination towards writing in between her ward shifts. She believes that voicing concerns over issues keeps her in touch with reality, meanwhile feeding her creative conscience. Loves animals, dogs, in particular, strong advocate for women’s rights and takes a staunch interest in lending voice to the voiceless and oppressed. Roy dreams of opening a shelter home for strays in India and embarking on rescue missions to save dogs from the slaughterhouses of Taiwan, Bali, and Cambodia.

 

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