The SA Journal Diabetes & Vascular Disease Vol 13 No 1 (July 2016)

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48 VOLUME 13 NUMBER 1 • JULY 2016
PATIENT INFORMATION LEAFLET SA JOURNAL OF DIABETES & VASCULAR DISEASE
(ED). The chance of having ED increases with longer duration of dia-
betes, but eventually up to around seven out of 10 men with diabe-
tes will be unable to get or keep an erection.2,3 For many men, ED is
devastating, leading to depression, reduced self-esteem and strained
relationships.4
Nevertheless, paradoxically, ED itself might be a blessing in disguise.
Although that sounds counter-intuitive, ED is an early warning sign that
a heart attack could be imminent, affording time to do something about
it before it’s too late. In fact, men with ED are almost 15 times more
likely than those without to suffer a heart attack, and ED has been
identified as the most significant predictor of that in comparison to any
other conventional cardiovascular risk factor.2
‘I should have told my doctor, but I was too shy to bring it up’, says
Sam. ‘Looking back, that was silly, because it could have prevented
what came next.’
ED, diminished interest in sex and depressed mood are also symp-
toms of low testosterone level, which occurs twice as commonly in men
with diabetes than in those without.5 And diabetes itself also predis-
poses to depression.6 ‘The problem is’, explains Sam, ‘that all of these
symptoms overlap, so you don’t really connect them to one cause. I put
most of them down to me just putting on weight.’
And that’s where it starts. In fact, overweight and obesity, together
with physical inactivity are the strongest risk factors for type 2 diabetes,
and the majority of people with type 2 diabetes are overweight.6,7 It’s a
big problem in our country. Approximately 40% of South African men
are overweight and fewer than one out of four participates in sufficient
exercise! In fact, less than half participate in any physical activity at
all!8,9
‘Men have to be told that diabetes is preventable!’ exclaims Sam
passionately. ‘It’s not that difficult to make healthier food choices and
do a bit of exercise! And get a regular check-up. My doctor told me
that if my diabetes had been detected a bit earlier and I had been more
conscientious with my treatment, I could have prevented some of the
problems that I am facing now.’
DIABETES AND LIFESTYLE
Dr Stevens agrees. ‘Remaining balanced is key. Making time for exercise
and creating a culture of healthy eating is not only important for ourselves
but serves to set an example and ensure the health of our families. Men
who have risk factors for diabetes, such as being overweight or having a
family history of the condition should consider being screened for it.’
Once diabetes has been diagnosed, careful control of blood glucose
levels can help prevent or delay the complications. When control is
achieved early on, the benefits remain for many years, despite it be-
coming more difficult to maintain control of glucose levels.10 For many
men, this merely requires a change in diet, some exercise and sometimes
medication. However, because diabetes is a progressive disease, over
time, insulin may also be required.11
Insulin is the most effective treatment to control blood glucose levels.12
Despite what many people believe, insulin does not need to be compli-
cated to use and often only needs to be taken once a day.11 A small price
to pay for protecting your future health and lifestyle!
BE PROACTIVE ABOUT YOUR HEALTH AND TREATMENT
‘The earlier treatment can be initiated, the better the chances of avoiding
diabetes complications’, explains Dr Stevens. ‘Regular follow up is also
key. The name of the game in diabetes management is prevention. By
regular screening for complications and intensifying therapy as needed,
complications can be minimised.’
You are a man. Some health needs are specific to men. Men are prone
to developing a ‘boep’, which in turn can lead to higher risk of diabetes,
cardiovascular disease and low testosterone level. Each one of these
presents its own challenges to a healthy future, but all are manageable if
they are addressed proactively or, when they do occur, early and before
complications start. And the key to a healthy future is awareness of that.
But men don’t talk about their health, do they? That’s not what being a
man is all about. Or is it?
Be a man. Speak up. Talk to your doctor about your health before it’s
too late.
References
1. International Diabetes Federation. IDF Diabetes Atlas, 7th edn. Brussels, Belgium:
International Diabetes Federation, 2015.
Accessed 11 May 2016.
2. Ma R, Tong P. Erectile dysfunction in men with diabetes – an early warning for
heart disease. Diabetes Voice 2008; 53(3): 25–27.
3. Giuliano FA, Leriche A, Jaudinot EO, et al. Prevalence of erectile dysfunction
among 7689 patients with diabetes or hypertension, or both. Urology 2004; 64:
1196–1201.
4. Seftel AD, et al. Improvements in confidence, sexual relationship and satisfaction
measures: results of a randomized trial of tadalafil 5 mg taken once daily. Int J
Impot Res 2009; 21: 240–248.
5. American Diabetes Association (ADA). Men and diabetes. .
org/living-with-diabetes/treatment-and-care/men/. Accessed 4 June 2016.
6. World Health Organisation (WHO). Global Report on Diabetes. Geneva,
Switzerland: WHO; 2016.
7. Niswender K. Diabetes and obesity: therapeutic targeting and risk reduction – a
complex interplay. Diab Obesity Metab 2010; 12: 267–287.
8. Ng M, Fleming T, Robinson M, for the GBD 2013 Obesity Collaboration. Global,
regional and national prevalence of overweight and obesity in children and
adults 1980–2013: A systematic analysis. Lancet 2014; 384(9945): 766–781.
doi:10.1016/S0140-6736(14)60460-8.9.
9. South African Department of Health. South African Demographic and health
Survey; 2003.
pdf. Accessed 4 June 2016.
10. Holman RR, Paul SK, Bethel MA, et al . 10-year follow-up of intensive glucose
control in type 2 diabetes. N Engl J Med 2008; 359: 1577–1589.
11. Chan JL, Abrahamson MJ. Pharmacological management of type 2 diabetes
mellitus: rationale for rational use of insulin. Mayo Clinic Proc 2003; 78: 459–
467.
12. Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycaemia
in type 2 diabetes: A consensus algorithm for the initiation and adjustment of
therapy. A consensus statement of the American Diabetes Association and the
European Association for the study of Diabetes. Diabetes Care 2009; 32(1):
1–11.