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“It Feels Like Home When You Eat Rice and Beans”: Perspectives of Urban Latinos Living With Diabetes. Diabetes Spectrum. 21(2):120-127. Spring 2008.

This article reports on a qualitative study that explored psychosocial issues that affect diabetes self-management for Hispanic/Latino men and women of primarily Caribbean ancestry. The study included 37 adults with diabetes in Bronx, NY, who were recruited to seven focus groups. The focus groups were conducted in Spanish and English, audiotaped, transcribed, and subjected to qualitative analysis. The authors report on the themes that emerged from these groups: the effect of diabetes on sexual health problems, perceptions about the link between depression and diabetes, intergenerational issues and their impact on participants’ beliefs about diabetes, and perceptions of discrimination and discontinuity in health care. The article includes numerous direct quotes from the focus group participants. The authors conclude that perspectives among Hispanic/Latino populations about living with diabetes are diverse, and more research is needed. 2 tables. 38 references.

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Gender-Specific Issues. IN: Beaser, R.S., ed. Joslin’s Diabetes Deskbook: A Guide For Primary Care Providers. 2nd ed. Boston, MA: Joslin Diabetes Center. 2007. pp 541-572.

This chapter on gender-specific issues is from a book that gives primary care providers a comprehensive overview of diabetes care. The authors remind readers that the impact of diabetes on gender-related issues, including sexual and reproductive function, can be significant and the need to address these concerns is an important part of the care they seek. The first section of the chapter considers women’s health issues, including menstrual cycle concerns such as hypothalamic amenorrhea (HA), oligomenorrhea, and fluctuations in glucose levels across the cycle; fertility and contraception, notably birth control pills; hormone replacement therapy (HRT) and concerns about osteoporosis; endometrial cancer; and sexual dysfunction in women. The remainder of the chapter focuses on male sexual dysfunction, including normal aging changes; normal penile physiology; the pathophysiology of erectile dysfunction (ED) and medications that affect erectile function; diagnostic strategies, including patient history, psychological considerations, the physical examination, laboratory measurements, nocturnal penile tumescence and rigidity monitoring, vascular evaluation, and neurologic evaluation; treatment options, including determining which symptoms can be corrected, sex therapy, hormone treatments, medical therapies, oral medication, local pharmacologic therapy, and nonpharmacologic therapy; the evaluation of ejaculatory dysfunction; and when to refer a diabetes patient with ED to a specialist. 4 tables. 5 references.

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Genitourinary Complications. IN: Veves, A.; Malik, R.A., eds. Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. pp 453-472.

This chapter on genitourinary complications is from a textbook on diabetic neuropathy. The authors note that disturbances in bladder emptying or storage are often asymptomatic to the patient, particularly in the beginning of this diabetes complication. However, sexual dysfunctions are readily perceived by the patient. Topics covered include the physiology of micturition, the pathophysiology and clinical symptomatology of the diabetic bladder, a diagnostic approach and treatment options for micturition disturbances, the epidemiology of erectile dysfunction (ED), the physiology and pathophysiology of erection, treatment strategies for ED, other sexual problems in men with diabetes, and female sexual dysfunction. The authors stress that impairment of bladder storage and emptying as well as sexual dysfunction may have severe organic and psychosocial consequences, so their existence should be systematically screened for in the routine diabetes clinic. 3 figures. 3 tables. 74 references.

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Sex And Diabetes: For Him And for Her. Alexandria, VA: American Diabetes Association. 2007. 211 p.

This book helps readers diagnosed with diabetes, and their partners, understand how diabetes can complicate even the most loving and open relationships. The authors review common physical and emotional complications of diabetes and treatments for both men and women, then provide tips about how to talk with one's health care provider about the sexually related complications of diabetes. The book includes practical information about losing weight, exercising, and keeping physically healthy; ideas and tips for building sexual intimacy through music, movies, romantic foods, and more; information about how to avoid dangerous or money-wasting sexual health scams; and detailed suggestions to help spice up one's romantic life. Nearly all the pages in the book have sidebars noting specific tips, readers' suggestions and experiences, and summaries of the concepts presented in the text. One chapter offers a variety of healthy, diabetes-friendly recipes using ingredients purported to be aphrodisiacs. A final chapter lists resources that may prove helpful for readers seeking additional, reliable information about diabetes and diabetes-related sexual complications. A detailed subject index concludes the volume.

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Treatment of Erectile Dysfunction in Diabetic Men: Management of Nonresponders to Phosphodiesterase Type 5 Inhibitors. Practical Diabetology. 26(4): 18-21. December 2007.

This article considers the treatment of erectile dysfunction (ED) in men with diabetes, focusing on those patients who do not respond to phosphodiesterase type 5 (PDE-5) inhibitors, including Cialis, Levitra, and Viagra. The authors note that men with diabetes have a lower response rate to these agents than do other men. The article uses a case report of a 53-year-old man who presented to his primary care physician with the chief complaint of ED. He was treated with oral hypoglycemic agents and was able to significantly reduce his serum glucose level; sildenafil (Viagra) given to treat the ED was subsequently unsuccessful so he was referred to a urologist. Increased dosage of sildenafil, some lifestyle changes, and transdermal testosterone gel were prescribed successfully for this patient to achieve adequate erections for sexual intimacy and an improved libido and energy level. The authors go on to discuss the etiology of ED, the use of PDE-5 inhibitors in men with diabetes, a definition of nonresponders, and the suggested management of nonresponders, including ruling out other causes, changing the dosage of the PDE-5, and considering injections or surgery. 18 references.

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Diabetes in Clinical Practice: Questions And Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. 467 p.

This book deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. The book offers 30 chapters, beginning with an introduction to diabetes and followed by topics including the pathophysiology of type 1 and type 2 diabetes, glycemic control, hypoglycemic, diabetic coma, surgery in diabetes, acute illness in diabetes, diabetes and exercise, diabetes and pregnancy, diabetes and the young, diabetes and old age, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, microangiopathy in diabetes, diabetic foot, skin disorders in diabetes, sexual function in diabetes, musculoskeletal system and diabetes, infections in diabetes, hypertension and diabetes, lipids and diabetes, diabetes and driving, diabetes and travel, nutrition, oral medications, insulin, new therapies, and the prevention of diabetes. Each chapter presents three to six case studies, which are individually discussed, and relevant questions are posed and answered. Each chapter concludes with a list of references for further reading. Some chapters are illustrated with black-and-white photographs. A detailed subject index concludes the text.

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Diabetes in the Bedroom. Diabetes Forecast. 59(9): 54-57. September 2006.

This article helps readers with Type 1 diabetes learn how to enjoy a healthy and satisfying sex life by considering any diabetes-related concerns before heading into the bedroom. Written in a question and answer format, the article discusses the impact of sexual activity on blood glucose levels, how to know when to snack before or after sexual activity, how to manage an insulin pump (and its tubing) during sex, birth control issues, the carbohydrate content of bodily fluids, diabetes as a cause of erectile dysfunction and ejaculation problems, diabetes as a cause of female sexual problems (including susceptibility to yeast infections and lack of lubrication), and the impact of diabetes on one’s libido. The author cautions that depression can also play a role in lack of interest in sexual activities and there is a common link between diabetes and depression. One side bar offers suggestions for readers who want to keep their own sexuality alive: control blood glucose levels, exercise, have hormone levels check, check other medications, take plenty of time, and communicate with one’s partner. Readers are also encourage to talk with their health care provider about any sexual concerns they may have.

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Diabetic Neuropathies. IN: Mensing, C., ed. Art and Science of Diabetes Self-Management Education. Chicago, IL: American Association of Diabetes Educators. pp. 550-572.

Diabetic neuropathy (DN) is not a single entity, but rather a number of different syndromes, each with a range of clinical and subclinical manifestations. This chapter on diabetic neuropathies is from a comprehensive text that serves as a resource for all health professionals, community professionals, and individuals who provide education to individuals with diabetes. Topics covered include diagnostic strategies, neuropathic pain, subclinical neuropathies, generalized symmetrical polyneuropathy, autonomic neuropathy, gastrointestinal disorders related to autonomic neuropathy, sexual dysfunction, bladder dysfunction, sweating disturbances, focal and multifocal neuropathies, treatment of diabetic neuropathies based on pathogenetic mechanisms, and controversies in neuropathy management. A thorough history and detailed physical examination, together with the aid of simple clinical tests, are essential for the diagnosis. Small-fiber neuropathy may lead to foot ulceration and subsequent gangrene and amputation. Large-fiber neuropathy produces numbness, ataxia, and impairment of quality of life and may lead to falls and fractures. Recent studies on new agents that target the pathophysiological mechanisms have led to a better understanding of the pathogenesis of diabetic neuropathy as well as the pain mechanisms for the different types of pain syndromes. The chapter includes a list of key points, a summary of teaching strategies, case studies, suggested Internet resources, a glossary of key terms, and a list of references. 6 tables. 90 references.

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Erectile Dysfunction. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 363-376.

This chapter on erectile dysfunction (ED) is from a comprehensive text on obesity and diabetes. ED is defined as the consistent or recurrent inability to attain or maintain a penile erection sufficient for sexual intercourse. ED is a common sexual dysfunction, especially among men with diabetes. Diabetes mellitus, hypertension, hyperlipidemia, and coronary artery disease are known to increase the likelihood of having ED. The author discusses a definition and epidemiology of ED, its pathophysiology, the diagnostic evaluation, treatment options, and the costs of various treatments. Vascular impairment in diabetes will lead to ED from large-vessel disease, but more important, from problems with intrapenile blood flow. Diagnostic components should include the patient's history, a physical examination, and diagnostic testing, including tests that measure nocturnal penile activity and patient symptom surveys. Treatment options include optimizing glycemic control, oral medications, injectable therapy, transurethral therapy, vacuum assistance devices, constriction rings, and penile implants. 1 figure. 5 tables. 35 references.

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Sexual Dysfunction and Diabetes. Today's Dietitian. 8(9): 25-26. September 2006.

This article helps dietitians understand the impact of diabetes on sexual function. The author notes that sexual dysfunction potentially affects a rather large number of people, yet, due to its private and subacute nature, it is a problem that may often be overlooked or ignored by patients and providers alike. Research suggests that men with diabetes commonly struggle with erectile dysfunction (ED) but generally experience no impact on levels of sexual desire. Women may have decreased sexual desire and can also experience difficulties with arousal, vaginal lubrication, and painful intercourse. The author reviews these problems and the role of diabetes complications (such as neuropathy) in their development. The author notes that while most dietitians probably will not be directly addressing issues of sexuality with their clients, recognition of the impact that diabetes has on various aspects of the client’s life is an important part of providing quality, holistic health care. References are available through references@gvpub.com.

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Sexual Function And Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 251-260.

This chapter on sexual function and diabetes is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include the repercussions of diabetes mellitus (DM) in sexual life, including erectile dysfunction and its management, and ejaculation disturbances; the role of vascular disease risk factors; sexual problems in women with diabetes; and the use of oral contraceptive pills in women with diabetes, including the risk of complications such as thrombophlebitis and pulmonary embolism. The chapter presents three detailed case studies, with relevant questions posed and answered. Readers are walked through the diagnostic and patient care management process for the case studies presented. 6 references.

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Sexual Wellness. Diabetes Self-Management. 23(2): 19-22. March April 2006.

This article explores sexual dysfunction and sexual wellness, focusing on people with diabetes. The author cautions that up to 50 percent of people with diabetes will experience some sort of sexual dysfunction at some point. In addition, other diabetes-related health issues can influence one’s sexual disease and can be a threat to intimacy within a relationship. The article covers specific problems, including desire disorders (decreased libido), hormonal changes, arousal disorders (including erectile dysfunction), orgasm disorders, and pain disorders. The author outlines the complications of diabetes that may have an impact on sexuality, including high blood glucose levels, impaired circulation, and neuropathy; encourages readers to try preventive and proactive strategies to any sexual concerns; and advises readers to consult their diabetes or other health care provider for assistance. The article concludes with a section reminding readers of the importance of healthy and open communication between sexual partners, particularly as they deal with any sexual concerns that may arise. 3 references.

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Care of Children and Adolescents With Type 1 Diabetes: A Statement of the American Diabetes Association. Diabetes Care. 28(1): 186-212. January 2005.

In caring for children with diabetes, professionals need to understand the importance of involving adults in the child's diabetes management. The education about how to care for a child or adolescent with diabetes must be provided to the entire family unit, emphasizing age and developmentally appropriate self-care and integrating same into the child's diabetes management. This American Diabetes Association Statement provides a single resource on current standards of care pertaining specifically to children and adolescents with type 1 diabetes. It is not meant to be an exhaustive compendium on all aspects of the management of pediatric diabetes. However, relevant references are provided and current works in progress are indicated as such. The information provided is based on evidence from published studies whenever possible and, when not, supported by expert opinion or consensus. The Statement discusses and provides recommendations in the areas of diagnosis, initial care, diabetes education, identification (medical tags), appropriate self-management by age, glycemic control, insulin management of diabetes, blood glucose monitoring, nutrition, medical nutrition therapy (MNT), exercise, assessment of child and family risk factors at diagnosis, psychosocial issues, acute complications, immunization, chronic complications, associated autoimmune conditions, adjustment and psychiatric disorders, adolescence, adherence to self-management, and special situations, including sick day management, and diabetes care at school and day care. A final section considers risk behaviors, including use of tobacco and recreational drugs and unprotected sexual intercourse. 4 tables. 237 references.

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Conversation About Your Sex Life: Is It Time to Talk?. Diabetes Vital. 1(3): 4. Fall 2005.

Sexual dysfunction is a common occurrence in diabetes, yet is not often talked about when discussing complications of the disease. This brief article describes how poorly controlled diabetes, blood glucose fluctuations, and medication side effects can affect sexual function and libido (desire). The author provides five simple tips to remember when talking with one's partner about sexual dysfunction. These are: choose the right moment, be open and honest, share responsibility, stay connected, and prepare together for any visits to health care providers to get help with sexual dysfunction. The author encourages readers to communicate openly with their partners as well as with their health care providers in addressing any concerns about sexual dysfunction.

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Evaluation And Prevention of Diabetic Neuropathy. American Family Physician. 71(11): 2123-2128. June 1, 2005.

This article reviews the evaluation and prevention of diabetic neuropathy, a nerve disorder associated with both type 1 and type 2 diabetes mellitus. The primary types of diabetic neuropathy are sensorimotor and autonomic. Patients may present with only one type of diabetic neuropathy or may develop combinations of neuropathies, for example, distal symmetric polyneuropathy and autonomic neuropathy. The authors discuss the classification of diabetic neuropathy, sensorimotor neuropathy, focal neuropathy, distal symmetric polyneuropathy, diabetic amyotrophy, diabetic autonomic neuropathy, cardiovascular autonomic neuropathy, vasomotor neuropathy, sudomotor neuropathy, gastrointestinal autonomic neuropathy, diabetic bladder dysfunction, erectile dysfunction, female sexual dysfunction, glycemic control, foot care. The authors conclude that strict glycemic control and good daily foot care are the keys to preventing the complications arising from diabetic neuropathy. 1 figure. 3 tables. 27 references.

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Urinary Incontinence and Diabetes in Postmenopausal Women. Diabetes Care. 28(7): 1730-1738. July 2005.

This article reports on a study that evaluated diabetes characteristics and other risk factors for urinary incontinence among community-dwelling post-menopausal women. The cross-sectional analysis included 1,017 postmenopausal women (218 with diabetes) aged 55 to 75 years, enrolled from a health maintenance organization. Overall, 60 percent of the women had any incontinence in the prior month and 8 percent had severe incontinence. Parity (the number of pregnancies a woman has had) and post void residual bladder volume were not associated with incontinence). Oral estrogen and vaginal estrogen use were positively associated with a report of any incontinence but not severe incontinence. A history of urinary tract infection (UTI) and measures of general health were associated with both outcomes. Women with diabetes reported disproportionately more severe incontinence, difficulty controlling urination, mixed (stress and urge) incontinence, use of pads, inability to completely empty the bladder, being unaware of leakage, and discomfort with urination. Multiple regression analyses showed that diabetes duration, treatment type, peripheral neuropathy, and retinopathy (eye disease) were significantly associated with severe incontinence; However additional adjustment for body mass index (BMI) diminished the strength of the relationship. 3 tables. 35 references.

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Urologic Complications of Diabetes. Diabetes Care. 28(1): 177-185. January 2005.

Diabetes mellitus is associated with an earlier onset and increased severity of urologic diseases, resulting in costly and debilitating urologic complications. Urologic complications, including bladder dysfunction, sexual and erectile dysfunction, as well as symptomatic and asymptomatic urinary tract infections (UTIs), have a profound effect on the quality of life of men and women with diabetes. This review article presents an overview of the current understanding of clinical and basic research on urologic complications of diabetes and recommendations for future directions for research and clinical care. The authors note that research studies that define expected prevalence, incidence, and risk factors, as well as interventions to reduce the risk of developing these complications, are limited. However, intensive glycemic control delays the onset and progression of microvascular complications of diabetes in both type 1 and type 2 diabetes. If microvascular complications also damage the vascular and neurologic innervation of the urethral sphincter, bladder, and corpora cavernosa, then intensive glycemic control may prevent or improve the severity of urologic complications. The authors conclude by reiterating the need for new research initiatives to better understand the disease mechanisms and burden of urologic complications in men and women with diabetes. 118 references.

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Diabetic Neuropathy: Early Clues, Effective Management. Consultant. 44(12): 1549-1556. October 2004.

This article guides physicians in a structured approach to the diagnosis and treatment of diabetic neuropathy (nerve disease associated with diabetes mellitus). The author stresses that the early signs of diabetic neuropathy can be detected during a routine clinical examination and annual surveillance for evidence of neuropathy and intensive diabetes management can reduce the incidence of complications. Physicians should inspect patients' feet for deformities and for sensory loss, which indicate risk of ulceration. Prolonged poor glycemic (blood glucose) control, alcohol abuse, and obesity increase the risk of amputation. Autonomic dysfunction, which can lead to sexual dysfunction and gastropathy (gastrointestinal problems), can be detected by measurement of heart rate and blood pressure. Electromyography and nerve conduction studies can be used to confirm a diagnosis of diabetic neuropathy. Improved metabolic control is the main goal of treatment. Analgesics, neuromodulators, and tricyclic antidepressants are effective for managing pain. 1 figure. 3 tables.

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Erectile Dysfunction Treatments. Diabetes Spectrum. 17(4): 232. 2004.

This patient education fact sheet discusses erectile dysfunction (ED), formerly called impotence. Defined as an inability to achieve or maintain an erection long enough for sexual intercourse, ED is a common problem for men with diabetes. The fact sheet focuses on the treatments available, including ED medications such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis); other drugs used for ED, including alprostadil, which is injected into the penis, and testosterone patches; counseling; vacuum devices; and surgery. Readers are encouraged to learn more about ED and its treatments by meeting with their health care provider.

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Learn the Risks: You Have the Power to Prevent Kidney Disease. Bethesda, MD: National Kidney Disease Education Program. 2004. 4 p.

People with diabetes, high blood pressure, or a family member with kidney failure are more likely to develop kidney disease. This brochure helps African Americans understand the risk factors for kidney disease, a problem that is more prevalent in this community than in white Americans. The brochure outlines the basic physiology of the healthy kidneys, reminds readers that kidney disease often strikes without warning symptoms, and reviews the impact of hypertension and diabetes on the incidence of kidney disease. Diabetes is the most common cause and hypertension is the second leading cause of kidney failure, thus strategies to control these conditions may prevent kidney disease as well. A tear-away card is included that lists questions for readers to ask their health care providers, as well as tips for talking with members of their health care team. Readers are also referred to the National Kidney and Urologic Diseases Information Clearinghouse (www.kidney.niddk.nih.gov) and the National Kidney Disease Education Program (www.nkdep.nih.gov) for more information. The brochure is illustrated with photographs of African Americans.

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Sexual and Urologic Problems of Diabetes. Bethesda, MD: National Diabetes Information Clearinghouse. 2004. 8 p.

This fact sheet provides information about the sexual and urologic problems that can be experienced by people with diabetes. Sexual and urologic complications of diabetes are related to the nerve damage that diabetes can cause. The fact sheet first describes sexual problems in men with diabetes, including erectile dysfunction (ED), and retrograde ejaculation. The next section discusses sexual problems in women with diabetes, which can include decreased vaginal lubrication and decreased or absent sexual response. The fact sheet then discusses urologic problems, including neurogenic bladder and urinary infections. A final section considers whether or not these complications are inevitable and how people with diabetes can lower their risk of sexual and urologic problems, primarily by controlling their diabetes through diet and exercise. Readers are referred to other publications available from the National Kidney and Urologic Diseases Information Clearinghouse. The contact information for four resource organizations is provided, as is a brief description of the goals and activities of the National Diabetes Information Clearinghouse. 1 figure.

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