Intimacy & Diabetes. Janis Roszler

      3. Diabetes and Your Body31

      Have you or your partner suffered from erectile dysfunction for longer than 6 months?

      Are you less confident that you can get and maintain an erection?

      Do you feel that your erections are not hard enough to enter your partner?

      During intercourse, do you often lose your erection?

      Has your interest in sex decreased and now affects your relationship with your partner?

      You have just completed an important pre-test. If you answered “yes” to any of these questions, it is possible that diabetes-re-lated complications have entered your life. Read on to learn how to improve your health and sex life.

      Intimacy Quiz for Males

      32Intimacy & Diabetes

      During the past month, did you experience a decrease in your sexual desire*?

      During the past month, were you less satisfied with your level of sexual arousal† during sexual activity or intercourse?

      During the past month, was it hard for your body to lubri-cate (become “wet”) during sexual activity or intercourse?

      During the past month, did you have a difficult time achiev-ing an orgasm?

      Overall, are you less satisfied with the level of emotional closeness you have with your partner?

      During the past month, did you experience any discomfort or pain during or after sexual activity?

       You have just completed an important pre-test. If you answered “yes” to any of these questions, it is possible that diabetes-related complications have entered your life. Read on to learn how to improve your health and sex life.

      *Sexual desire—wanting to have a sexual experience, feeling receptive to a partner’s sexual initiation, and thinking or fanta-sizing about having sex

      †Sexual arousal—physical and mental aspects of sexual excite-ment. May include feelings of warmth or tingling in the geni-tals, lubrication (wetness), or muscle contractions.)

      Intimacy Quiz for Females

      A – A1C (and other blood glucose measures)

      B – Blood Pressure

      C – Cholesterol (and other lipids)

      The Diabetes A-B-Cs

      3. Diabetes and Your Body33

      Many of the following diabetes-related health issues may be familiar to you. After all, you live with your diabetes every day and may have expe-rienced many of them. Let’s consider them and the effect they can have on your health using the Diabetes A-B-Cs.

      A – Your A1C (and other blood glucose measures).

      Your blood glucose level and how long you maintain it in a range of 70–180 mg/dL (time in range) can be managed well with healthy eat-ing, physical activity, steps that enhance your emotional well-being, and medication. But it is not possible to manage blood glucose levels per-fectly. Your level can climb and fall for many reasons, including hormone swings, stress, illness, and how quickly your body digests certain foods. These swings can leave you too exhausted for sex. Keep an eye on your blood glucose level with routine blood checks (as directed by your team) and an A1C check at least twice a year.

      Below 7% (53 mmol/L) is an appropriate goal for many nonpregnant adults if they can achieve this level without significant hypoglycemia or other problems.

      A more or less stringent glycemic goal may be appropri-ate for you.

      Consult with your health care team about your specific target.

      Goals should be individualized to the patient.

      A1C Goals

      The A1C, which is done at your doctor’s office, provides a picture of your average blood glucose level for the past 2–3 months. But it is only part of the picture and may be less accurate for some individuals. Many people with diabetes wear a continuous glucose monitor (CGM) to obtain even more immediate information about their glucose ups and downs. These additional data can help fill in the gaps. Ask your health care provider about effective ways to collect blood glucose data.

      34Intimacy & Diabetes

      To help keep your blood glucose level in a healthy range, your team may suggest you check your blood at set times throughout the day. Checks you do before meals and at bedtime help your team assess your diabetes care plan. If you check 1–2 hours after the first bite of a meal, you can observe how your food choices affect your blood glucose level. For exam-

      To better understand your A1C value, locate it on the chart below and check out its mg/dL (mmol/L) equivalent, which is the type of result that appears on your glucose meter.

      Determining Average Blood Glucose for the Past Few Months

      A1C level (%)

      Glucose equivalent (mg/dL)

      Glucose equivalent (mmol/L)

      6

      126–135

      7

      7

      154–170

      8.6

      8

      183–205

      10.2

      9

      212–240

      11.8

      10

      240–275

      13.4

      11

      269–310

      14.9

      12

      298–345

      16.5

      How to use this chart: If your A1C level is 9%, your average blood glucose level for the past 2–3 months was approxi-mately 212–240 mg/dL. If it was 11%, your glucose level was approximately 269–310 mg/dL for the last few months. An A1C of <7% puts you at a lower risk for complications. This infor-mation can be combined with other monitoring data to help you and your care team assess the effectiveness of your man-agement strategies. Source: American Diabetes Association. Standards of Medical Care in Diabetes—2019. Diabetes Care 2019;42(Suppl. 1):S1–S193.

      3. Diabetes and Your Body35

      ple, if your blood glucose level after lunch is >180 mg/dL (10 mmol/L), you may need to reduce your carbohydrate portion, adjust your medica-tion, or increase your physical activity level.

      Blood glucose swings can leave you with little energy. When your glu-cose level is in a healthy range, you are more likely to feel better and be more prepared for romance. The following goals are appropriate for most people with diabetes. Your needs may differ. Check your blood glucose level before sex and eat a snack if your level is too low. Engaging with a partner while your glucose level is low can make it harder to concentrate and enjoy intimacy. Review your personal goals with your health care providers.

      Before meals:

      Between 80 and 130 mg/dL (4.4 and 7.2 mmol/L)

      1–2 hours after the first bite of a meal:

      <180 mg/dL (<10 mmol/L)

      Source: American Diabetes Association. Standards of Medical Care in Diabetes—2019. Diabetes Care 2019;42 (Suppl. 1):S1–S193.

      Blood Glucose Goals

      Treat blood glucose lows wisely

      Blood glucose lows feel awful. Symptoms may include the following:

      Headache