The Nerve Damage of Diabetes
Gastrointestinal Problems continued...
To relieve diarrhea or other bowel problems, antibiotics or clonidine HCl, a drug used to treat high blood pressure, are sometimes prescribed. The antibiotic tetracycline may be prescribed. A wheat-free diet may also bring relief since the gluten in flour sometimes causes diarrhea.
Neurological problems affecting the urinary tract can result in infections or incontinence. The doctor may prescribe an antibiotic to clear up an infection and suggest drinking more fluids to prevent further infections. If incontinence is a problem, patients may be advised to urinate at regular times (every 3 hours, for example) since they may not be able to tell when the bladder is full.
Sitting or standing slowly may help prevent light-headedness, dizziness, or fainting, which are symptoms that may be associated with some forms of autonomic neuropathy. Raising the head of the bed and wearing elastic stockings may also help. Increased salt in the diet and treatment with salt-retaining hormones such as fludrocortisone are other possible approaches. In certain patients, drugs used to treat hypertension can instead raise blood pressure, although predicting which patients will have this paradoxical reaction is difficult.
Muscle weakness or loss of coordination caused by diabetic neuropathy can often be helped by physical therapy.
Urinary and Sexual Problems
Nerve and circulatory problems of diabetes can disrupt normal male sexual function, resulting in impotence. After ruling out a hormonal cause of impotence, the doctor can provide information about methods available to treat impotence caused by neuropathy. Short-term solutions involve using a mechanical vacuum device or injecting a drug called a vasodilator into the penis before sex. Both methods raise blood flow to the penis, making it easier to have and maintain an erection. Surgical procedures, in which an inflatable or semirigid device is implanted in the penis, offer a more permanent solution. For some people, counseling may help relieve the stress caused by neuropathy and thereby help restore sexual function.
In women who feel their sexual life is not satisfactory, the role of diabetic neuropathy is less clear. Illness, vaginal or urinary tract infections, and anxiety about pregnancy complicated by diabetes can interfere with a woman's ability to enjoy intimacy. Infections can be reduced by good blood glucose control. Counseling may also help a woman identify and cope with sexual concerns.