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Endocrine Disorders

Diabetes

What causes diabetes?

Type 1 diabetes occurs when the body’s immune system attacks the beta-cells of the pancreas where insulin is produced. Insulin is the hormone that controls blood sugar levels, keeping them in the healthy range. In type 1 diabetes, the pancreas is unable to make enough insulin. Daily medication (insulin) is therefore needed to control blood sugar levels.

Type 2 diabetes is a progressive condition. It occurs over time, as the body becomes resistant to the effects of insulin and the pancreas initially over-produces insulin, but with time gradually becomes unable to produce enough insulin to keep blood sugar levels in the normal range, Together, this results in high blood sugar levels. Depending on the severity, type 2 diabetes can be managed with diet and exercise, and medication.

Type 3 (Gestational diabetes) is high blood sugar that develops during pregnancy and usually disappears after giving birth. It can be managed with a healthy lifestyle (diet and exercise). Sometimes medication is also needed.

Type 4 Diabetes (secondary diabetes) is when pancreatic diseases such as pancreatitis (inflammation in the pancreas), cancer, cystic fibrosis, etc. affect pancreatic function overall causing insulin deficiency.

Diabetes and female fertility

Women with diabetes often experience lower rates of fertility than women who do not. There are multiple factors associated with diabetes that can make it difficult for women to achieve a pregnancy: obesity, being underweight, having diabetic complications, having Polycystic Ovarian Syndrome, or having an autoimmune disease. The following conditions are associated with diabetes in women and generally lead to reduced fertility rates:

  • PCOS- A common hormonal condition that can affect fertility by leading to irregular or absent periods. PCOS is largely associated with type 2 diabetes and obesity.
  • Irregular or absent periods – Many women with diabetes experience irregular periods, which can arrive in cycles of 35 days or more. Some also experience absent periods, when a woman previously had a normal cycle but stopped getting a period for 6 months or longer.
  • Premature menopause – Women with Type 1 diabetes are more likely to experience premature menopause, meaning their periods stop before they turn 40.
  • Endometrial cancer (uterine cancer) – More common in women with type 2 diabetes and PCOS, this disease can lead to infertility if not treated early on.
  • Women with poorly controlled diabetes also face high risks of miscarriage as well as congenital abnormalities (birth defects) in the newborn which can vary from minor to life-threatening.

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Diabetes and male fertility

Diabetes can impact male fertility in many ways, such as:

  • Erectile dysfunction – Diabetes can cause reduced penile blood flow leading to difficulty in maintaining an erection, making it difficult for them to conceive without assistance.
  • Ejaculatory dysfunction – The nerve damage caused by diabetes that can cause erectile dysfunction, can lead to a failure of the mechanism that propels sperm forward. This causes either retrograde ejaculation or a complete lack of ejaculation.
  • Semen abnormalities – Men with diabetes are more likely to experience decreased sperm count, poor motility, abnormal sperm shape, and a decrease in sperm DNA integrity.

Whether you are a man or woman with diabetes, if you are trying to conceive, it is crucial to speak with your doctor to ensure you get your diabetes under control prior to trying to conceive. When diabetes is well managed, you have a lower risk of fertility issues than when it is not under control.

Treating diabetes

Diabetes can be treated with lifestyle changes, better weight management, and medications including insulin. It is vital to have diabetes very well controlled before attempting conception.

Higher doses of supplements such as folate are also important to reduce birth defects.

Want to find out more?

If you have been diagnosed with or suspect you may have diabetes, and that it may be affecting your ability to fall pregnant, you can arrange a nurse chat or book an appointment with Flinders Fertility Endocrinologist Associate Professor Dr Vasant Shenoy.

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