NEW YORK (Reuters Health) – Men with type 2 diabetes or the metabolic syndrome, or both, are prone to have low testosterone levels. If so, testosterone replacement therapy with a gel applied to the skin may improve their response to insulin and their sexual function, according to the results of a new clinical trial.

Testosterone levels fall if testicular function is subnormal, a condition termed hypogonadism. “Consideration should be given to screening type 2 diabetic and metabolic syndrome patients for hypogonadism,” Dr. T. Hugh Jones told the Endocrine Society’s annual meeting in San Francisco this week. Jones, of Barnsley Hospital and the University of Sheffield in the UK, and colleagues tested the effect of a testosterone gel (Tostran) on insulin resistance and symptoms of hypogonadism in 221 men with low testosterone levels.

One average, the men were 60 years age with a body mass index of 32, in the obese range. Eighty percent had metabolic syndrome, 64 percent had type 2 diabetes, and 44 percent had both. They were randomly allocated to use the testosterone gel daily or a matching placebo gel.

The study showed a statistically significant improvement in insulin sensitivity in testosterone-treated men at 6 and 12 months, Jones reported.

Testosterone therapy also led to a significant improvement in the score on a standard assessment of erectile function after 6 and 12 months.

Adverse events were similar in the two groups. Skin-related problems were the most commonly reported adverse events, experienced by 19 (17 percent) placebo-treated and 27 (25 percent) testosterone-treated men.

“These data tell us that replacement therapy for low testosterone in hypogonadal males not only improves sexual function but, more importantly, can also have an impact on insulin sensitivity,” Jones said. “Long-term improvements in insulin resistance may help to improve cardiovascular and other diabetes complications and improve quality of life in this at-risk population.”

“Awareness of the problems caused by low testosterone is becoming more widespread and its connection to health issues like diabetes continues to become increasingly apparent,” he added. “As the incidence of hypogonadism continues to grow along with the aging population, we need to … implement a more rigorous screening program, particularly in men with type 2 diabetes.”

The study was sponsored by ProStrakan, with US headquarters in Bedminster, New Jersey, makers of Tostran (also marketed as Fortigel, Tostrex and Itnogen).

Just as with other types of neuropathy, diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves.

Signs and Symptoms

Signs and symptoms of gastroparesis (delayed gastric emptying) are:

• heartburn
• nausea
• vomiting of undigested food
• an early feeling of fullness when eating
• weight loss
• abdominal bloating
• erratic blood glucose (sugar) levels
• lack of appetite
• gastroesophageal reflux
• spasms of the stomach wall

These symptoms may be mild or severe, depending on the person.

Complications of Gastroparesis

Gastroparesis can make diabetes worse by making it more difficult to manage blood glucose. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise.

If food stays too long in the stomach, it can cause problems like bacterial overgrowth because the food has fermented. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine.

Diagnosis

The diagnosis of gastroparesis is confirmed through one or more of the following tests.

Barium X-ray

After fasting for 12 hours, you will drink a thick liquid containing barium, which covers the inside of the stomach, making it show up on the X-ray. Normally, the stomach will be empty of all food after 12 hours of fasting. If the X-ray shows food in the stomach, gastroparesis is likely. If the X-ray shows an empty stomach, but the doctor still suspects that you have delayed emptying, you may need to repeat the test another day. On any one day, a person with gastroparesis may digest a meal normally, giving a falsely normal test result. If you have diabetes, your doctor may have special instructions about fasting.

Barium Beefsteak Meal

You will eat a meal that contains barium, which allows the doctor to watch your stomach as it digests the meal. The amount of time it takes for the barium meal to be digested and leave the stomach gives the doctor an idea of how well the stomach is working. This test can help find emptying problems that do not show up on the liquid barium X-ray. In fact, people who have diabetes-related gastroparesis often digest fluid normally, so the barium beefsteak meal can be more useful.

Radioisotope Gastric-Emptying Scan

You will eat food that contains a radioisotope, a slightly radioactive substance that will show up on the scan. The dose of radiation from the radioisotope is small and not dangerous. After eating, you will lie under a machine that detects the radioisotope and shows an image of the food in the stomach and how quickly it leaves the stomach. Gastroparesis is diagnosed if more than half of the food remains in the stomach after two hours.

Gastric Manometry

This test measures electrical and muscular activity in the stomach. The doctor passes a thin tube down the throat into the stomach. The tube contains a wire that takes measurements of the stomach’s electrical and muscular activity as it digests liquids and solid food. The measurements show how the stomach is working and whether there is any delay in digestion.

Blood tests

The doctor may also order laboratory tests to check blood counts and to measure chemical and electrolyte levels.

To rule out causes of gastroparesis other than diabetes, the doctor may do an upper endoscopy or an ultrasound.

Upper Endoscopy

After giving you a sedative, the doctor passes a long, thin tube called an endoscope through the mouth and gently guides it down the esophagus into the stomach. Through the endoscope, the doctor can look at the lining of the stomach to check for any abnormalities.

Ultrasound

To rule out gallbladder disease or pancreatitis as a source of the problem, you may have an ultrasound test, which uses harmless sound waves to outline and define the shape of the gallbladder and pancreas.

Treatment

The most important treatment goal for diabetes-related gastroparesis is to manage your blood glucose levels as well as possible. Treatments include insulin, oral medications, changes in what and when you eat, and, in severe cases, feeding tubes and intravenous feeding.

Insulin for blood glucose control

If you have gastroparesis, your food is being absorbed more slowly and at unpredictable times. To better manage blood glucose, you may need to

• take insulin more often
• take your insulin after you eat instead of before
• check your blood glucose levels frequently after you eat and administer insulin whenever necessary

Your doctor will give you specific instructions based on your particular needs.

Medication

Several drugs are used to treat gastroparesis. Your doctor may try different drugs or combinations of drugs to find the most effective treatment.

Meal and Food Changes

Changing your eating habits can help control gastroparesis. Your doctor or dietitian will give you specific instructions, but you may be asked to eat six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. Or the doctor or dietitian may suggest that you try several liquid meals a day until your blood glucose levels are stable and the gastroparesis has improved. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

The doctor may also recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion — a problem you do not need if you have gastroparesis — and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars.

Feeding Tube

If other approaches do not work, you may need surgery to insert a feeding tube. The tube, called a jejunostomy tube, is inserted through the skin on your abdomen into the small intestine. The feeding tube allows you to put nutrients directly into the small intestine, bypassing the stomach altogether. You will receive special liquid food to use with the tube. A jejunostomy is particularly useful when gastroparesis prevents the nutrients and medication necessary to regulate blood glucose levels from reaching the bloodstream. By avoiding the source of the problem (the stomach) and putting nutrients and medication directly into the small intestine, you ensure that these products are digested and delivered to your bloodstream quickly. A jejunostomy tube can be temporary and is used only if necessary when gastroparesis is severe.

It is important to note that in most cases treatment does not cure gastroparesis — it is usually a chronic condition. Treatment helps you manage gastroparesis, so that you can be as healthy and comfortable as possible.

If you have ED or some other sexual problem, it’s normal to feel embarrassed or upset. You may blame yourself or your partner. Some men feel guilty and angry. Others feel like there’s no hope. These feelings can make it hard to talk openly with your partner or your doctor. But talking about ED means you’re a step closer to getting help.

In Search of Answers

Today, there are many ways to treat ED and more are on the way. If one thing doesn’t work, something else might.

Here are some options:

· Taking pills to treat ED

· Putting medicine called prostaglandins (prahs-ta-GLAND-ins) into your penis

· Using a vacuum tube and pump that you put over your penis. The pump creates a vacuum in the tube. The vacuum draws blood into the penis. A band is placed around the base of the penis so you keep the erection after you take off the vacuum tube

· Having surgery to put a device in the penis. Surgery can also fix blood vessels so more blood will flow to the penis

Certain medicines, such as some pills for high blood pressure or depression, may cause ED. Pills for stomach ulcers or heartburn also may cause it. Ask your doctor if ED is a side effect of any of your medicines. There may be other pills you can take. Remember, talk with your doctor or diabetes educator before trying any treatment for ED or before stopping any of your medicines.

It’s not easy to accept that you have ED. And it can be even harder to talk about it, especially with your partner. Even if your doctor doesn’t ask about ED, talk about it if you’re having problems. Talking about ED is the only way to learn about treatments and get help.

Family Ties

Diabetes doesn’t affect your ability to become a father. But you and your partner might have questions about starting a family. Talk with your health care team if you have questions or concerns.

Here are some tips:

Not every man with diabetes gets ED
ED is not the end of your sex life
You can get help. There are several treatment options
Talk with your partner and your doctor or diabetes educator to get help

Depression and Anxiety

Diabetes raises your risk for depression. Depression is a medical condition that’s more serious than just feeling a little sad. Depression can lead to ED, and ED can cause men to feel depressed. People with diabetes sometimes feel they have a lot to worry about. They worry about their health, their future, and all the other stresses in their life. For some men, having sexual problems once in a while makes them worry about developing ED all the time. Lots of worry, also called an anxiety disorder, can lead to ED. Talk with your health care team if you have these feelings. Medicine or counseling can help with both depression and anxiety disorder.

Diabetes and Men’s Sexual Health
What you should know about diabetes and men’s sexual health.

Gastroparesis
Learn about this disorder that affects people with both type 1 and type 2 diabetes.