For men, type 2 diabetes often masks itself behind everyday complaints- less energy at the gym, creeping weight gain, a fading libido - and such like subtle symptoms.
Dr Rilwan Adan, Head of Lions Diabetes and Care Centre, says erectile dysfunction (ED) is a common but often overlooked complication of diabetes in men.
"Erectile dysfunction in people living with diabetes is usually linked to nerve damage as a result of high sugars, poor circulation and also low testosterone," she explains.
"Usually, up to one in three men with type 2 diabetes may have low testosterone. And the symptoms are mainly low libido (reduced sex drive), fatigue, low moods, difficulty concentrating, increased body fat and reduced muscle mass."
Is diabetes-induced ED always permanent? "Not always. Erectile dysfunction in people with diabetes is often caused by damage to the nerves and blood vessels due to persistently high blood sugar levels. In the early stages, before severe damage sets in, ED can often be reversed with proper diabetes management. This includes keeping blood sugars in check, adopting a healthy lifestyle, and sometimes using medications.”
However, if diabetes is left uncontrolled for a long time, the nerve damage may be severe. In such cases, while some improvement is possible, full recovery of erectile function may not always be achievable. Each case is different, and early intervention gives the best chance for reversal.
Beyond reproductive issues, poorly controlled diabetes can impact sperm quality, motility, and even cause changes to DNA; known as epigenetic changes (DNA methylation).
Men are also at increased risk of cardiovascular diseases at a much younger age than women.
"Younger age meaning 20s?" I ask.
"No. I mean, usually these complications you expect in men aged 65 and above. So, you can get it in the early 40s, 50s or even late 30s," she clarifies.
However, while the pathophysiology of diabetes is similar in men and women, the outcomes can vary. "The difference is because of their poor health-seeking behaviours; men go to the hospital when something is really wrong, hence delayed symptom reporting."
She adds that type 2 diabetes can be hard to detect early. "It can be silent, and you can go even months without experiencing any symptoms other than fatigue, a common one that people tend to complain about."
Diabetes, particularly type 2, is more than just high blood sugar. In men, it can have wide-ranging effects on muscle health, energy, hormones, and mental wellbeing.
Dr Adan explains, "Sugar is your body's fuel; you need it in your muscles to generate energy for strength training or even just walking. But in type 2 diabetes, sugar isn't getting into the muscles where it's needed. It stays in the blood."
This happens due to insulin resistance, where the body's cells no longer respond properly to the hormone. When you eat, starches break down into glucose, which enters the bloodstream.
Insulin is supposed to shuttle that glucose into the muscles and brain for energy. "But if insulin isn't working, the sugar just floats in the bloodstream," she says. "And if it's not being used, it gets stored as fat."
This is why many men begin to gain weight around the midsection, especially in middle age. "We call it central adiposity, fat around the abdomen. It's one of the earliest physical signs of insulin resistance," says Dr Adan. This type of fat, especially when stored in the liver and around organs, is linked to a higher risk of diabetes and heart disease.
The skin may show early warning signs too. "Sometimes in the folds around the neck or armpits, there’s a darkening of the skin called acanthosis nigricans," she adds, another clue pointing to insulin resistance.
Muscle health takes a direct hit. If glucose isn't getting into muscle cells, energy is lacking. "If your leg muscles can't access glucose, even walking becomes sluggish, let alone strength training," Dr Adan shares. This leads to loss of strength, reduced muscle mass, and overall fatigue.
And it doesn't stop there. Men with diabetes often have low testosterone, also known as hypogonadism, which compounds the problem.
"Testosterone plays a role in maintaining muscle. Without it, men lose lean body mass and gain fat, especially around the belly."
These physical effects are worsened by poor lifestyle habits. Smoking, excessive alcohol, unhealthy eating, high stress, and poor medical follow-up all make diabetes harder to manage. Mental health also plays a critical role.
"A third of patients with type 2 diabetes experience diabetes-related emotional distress, and men are less likely to seek help," Dr Adan cautions.
Her advice? "Men need to take charge of their health, eat better, move more, check in regularly with their doctor, and look after their mental wellbeing. Diabetes is manageable, but it needs commitment."
