Too Tired for Sex

Dear DH, I’m a 47-year-old man who was diagnosed with type 2 diabetes in 2008. For two years, I haven’t been interested in sex. I have a demanding retail job and two teenage children. I can still perform, but I am usually so tired that I fall asleep after dinner. I don’t miss sex much, but my wife does, and I don’t want to lose her. By the way, my A1C usually runs around 6.8%.

Worn Out in Wyoming

Dear WOW,

Although family issues may contribute to your loss of sexual energy, it sounds as if you don’t have energy for much of anything. This is not unusual: Excessive tiredness or fatigue is one of the most common symptoms of diabetes. Let’s look at some of the causes and treatments.

● Elevated sugars can tire you out because sugary blood is thicker and takes more work for your heart to push around. High sugars can also make you sleepy, which may contribute to your after-dinner fadeout. Your A1C of 6.8% meets ADA guidelines, but you would feel more lively if you could get it closer to 6%.

● Inflammation is extremely common in diabetes and may be a major source of complications. Inflammatory chemicals called cytokines put you to sleep in order to rest your body so it can heal. That’s why the flu makes you so sleepy.

● Infections use up your body’s energy to fight germs. They also increase inflammation. The most common infections in diabetes affect the gums and feet.

● A major factor in your case might be low testosterone levels. Over 50 percent of men with diabetes have low “T,” twice as many as in the general population. Low T will leave you tired, sad, and uninterested in sex.

● Depression also causes fatigue and weakens your sex drive. Your life sounds hard right now, what with your teenagers and marriage problems, so you might want to be evaluated for depression.

● If you are waking from sleep apnea, frequent bathroom trips, or tension, of course you will be tired during the day.

So what can you do about all these possible causes? You can work with your doctor or diabetes educator to find out more about what is going on. First of all, can you get your sugars down? You might need to exercise more or cut down on carbohydrates. Moderate exercise is always good for boosting energy. You also might want to talk with your doctor about changing or increasing your medications.

If you’re not receiving regular dental care, you should consider having your teeth professionally cleaned to reduce inflammation. Floss, brush, and use antiseptic mouth rinse every night, or even twice a day. This can make a huge difference in your fatigue and glucose control. A recent Chinese study found that men who floss regularly have fewer sexual problems.

Get your testosterone level checked and, if it’s low, consider supplementing it. Testosterone can be replaced with injections or with gels that you rub on your skin.

According to urology professor Abraham Morgentaler, “T therapy increases muscle mass and lowers body fat, and both of these changes are helpful with blood sugar control.” They will also give you more energy and probably increase your sex drive. Some users have reported that raising T levels gave them a whole new outlook on life. “I feel alive again” and “I feel like a man again” are typical comments.

If you are not sleeping well or if you wake up tired even though your sugars are OK, you should be tested for sleep apnea (SA). Actually, your wife may already know (from listening) if you have SA. But it might be worth spending a night in a sleep lab. If you are waking because you have to urinate, there are medicines and self-management approaches that can help.

Making Time for Love

WOW, you have two teens, a stressful job, and diabetes. It’s not reasonable to expect to jump from all of that directly into sex. You have to make time for it and for your relationship. Sex expert Michelle Gannon, MD, says, “Take time to release stress so sex does not become one more chore at the end of the day … If your career or housework or child care continue to take precedence over your sex life, no wonder you are too exhausted for sex.”

You will have to make pleasure time with your wife a priority. Dr. Gannon says that if you wait until the end of the evening, after everything else is done, you will probably fall asleep instead. If you’re wound up by worries and work, you won’t be able to relax enough to enjoy loving. Try doing some romantic activities like showering or bathing together, taking a nice walk, or putting on some music and dancing. Once you get going, don’t stop to check your e-mail or wash the dishes. Keep the flow going.

Remember that sex does not have to be confined to the evening. Take note of your most energetic times and plan to have sex at those times. For many people, early morning works well.

Finally, some people lose interest in sex because they just don’t like it that much. It could be that your sex life has become repetitive and not much fun. You might rekindle interest by trying some different positions or activities, using toys, or watching videos for ideas. Use your imagination.

You might also want to explore all your relationship issues with your wife and your whole family. Family counseling might help. As with all aspects of marriage, communication is the key to a better sex life. It’s also a key to living well with diabetes.

Bottom line: Fatigue is common in diabetes. It can cripple your sex life, which in turn can cripple your marriage. But fatigue is manageable, and sex with diabetes can still be great. Work with your doctor for better glucose control. Try some of these ideas and make your relationship a priority. You’ll like the results.



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