Diabetes-Carmarthenshire

Erectile dysfunction

Gastroparesis

Noctunal diarrhoea

 

Erectile dysfunction

• Erectile dysfunction is much more common in patients with diabetes than in the general population, and can be present in upto 75% of men with diabetes. It can be due to vascular problems, neuropathy, medication, or problems with psychological adjustment to the condition. Often, it is a combination of different factors.

• Given the high prevelance of erectile dysfunction, it is imperative to discuss this with men with diabetes. Written information can be useful to provide general information, but given the sensitivity of the subject, it is important to ask specifically about the issue in diabetic clinics, as the patient may otherwise not volunteer the information. A routine question on erectile dysfunction should therefore be included in the diabetic annual review clinic.

• If erectile dysfunction is present, a full history is the cornerstone of assessment. This can help to identify the contribution of psychological factors versus physical, and the patient's (and partner's) expectations and objectives of treatment. A full medication history, history of surgical procedures, trauma or radiotherapy, alcohol consumption and smoking should also be obtained.

• Certain factors suggest a psychogenic component in the cause of the erectile dysfunction. Sudden onset; good quality or "better" spontaneous, self-stimulated or waking erections; problems or changes in the relationship; major life events, or psychological problems, all suggest that there may be at least some psychological part in the erectile dysfunction. In these circumstances, patients are best referred at initial presentation to the male health clinic, as psychosexual counselling may be of benefit.

• Any obvious modifiable cause of erectile dysfunction (e.g. medication, high alcohol intake) should be tackled if at all possible before initiation of medical treatment.

• Referral to the male health clinic should be made by referral letter, to include personal details, brief description of problem, current medication and past medical history where known.

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All referrals should be made to 'The Male Health Clinic'
Department of Urology
West Wales General Hospital
Carmarthen
SA31 2AF

Patients are seen strictly by appointment only.

Clinics are available at:
Elizabeth Williams Clinic, Llanelli, held monthly Friday Mornings
Pond Street Clinic, Carmarthen , held fortnightly Tuesday Mornings
Withybush Hospital , Haverfordwest, held monthly Wednesday Mornings

CONTACT NUMBERS
Local: Derek Harrison 01267 227654
National: The Impotence Association 020 8767 7791

 

Gastroparesis

• Defective gastric emptying sometimes occurs in diabetes. Symptoms include a feeling of fullness during or straight after eating, nausea and vomiting

• investigation using radiological or radioisotope methods may help in diagnosis

• investigation of cardiovascular autonomic neuropathy may help diagnosis

• Cisapride and domperidone are worth a trial

 

Diabetic nocturnal diarrhoea

• Those affected mostly have long standing and usually poorly controlled type 1 diabetes

• Diagnosis is usually by exclusion of other causes such as chronic pancreatitis or coeliac disease

• Management involves regular codeine phosphate, loperamide or diphenoxylate

• Broad spectrum antibiotics such as erythromycin / tetracycline may be useful to treat any accompanying bacterial overgrowth