The role of internist in diabetic impotence.Guidlines
Impotence needing non invasive vacuum apparatus or surgery is out of our scope and should be referred to andrology doctor
Assesment.of diabetic impotence ;
1. -Assess renal fiunctions,CKD causes impotence
2. -Thyroid disease may be associated with type 1 DM.Measure S.T3,T4,TSH
3. -S.testosterone levels is low in obese type2 DM. Increased visceral fat leads to raised secretion of proinflammatory cytokines, leptin, estradiol and insulin. These substances may inhibit the activity of the hypothalamic–pituitary gonadal axis at multiple levels, thus lowering the concentrations of testosterone .
Testosterone deficiency, which is also called “male hypogonadism,” contributes to reduced response of insulin to glucose, increased insulin resistance and eventually the onset of Type 2 diabetes. In vivo, insulin is capable of stimulating testosterone production . Low testosterone precedes elevated fasting insulin, glucose, and hemoglobin A1c (HbA1C) values and may even predict the onset of diabetes
4. -High S.prolactin may occur in DM(due to associated myxdema,prolactinoma,drugs,stress). prolactin interferes with FSH and LH secretions.
5. Vacular impotence needs US on penile A.
6. -Biochemical profile HBA1c,Lipids,Creatinine,Liver functions .
TT.
1. -Low
S.free testosterone;testosterone undecanoate amp.Nebido 1gm/monthly IM. Long-term treatment with testosterone therapy in men with hypogonadism and type 2 diabetes improves their glycemic control as well as their insulin sensitivity, according to a new study.,
2. -Before sexual act;sildenafil 25.50,100mg or tadalafil ceiles 20mg-tadanerfi thin oral film sublingual or ananavil with fast onset of action.
Ceiles 5mg daily can improve erectile dysfunction.Ceiles the safest drug for erectile dysfunction for diabetes.Cialis does not alter blood sugar levels in people with diabetes
3. -High S.prolactin cabergoline Dostinex 0.5mg/week
4. -In associated myxdema;Eltroxin
5. -Control of S.glucose,lipids,BP.-Stop smoking-Excersise,weight reduction
6. -tt.of depression.the antidepressant Trazadone Trittico helps erection and as a side effect causes priapism
7. vitamin B6 which lowers prolactin levels by increasing the neurotransmitter dopamine
8. Other lines of tt is out of our scope
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