Q: I have type II diabetes since 15 years. I am 54 years old and weigh 98 kgs. My BP is 90/130 mm Hg and cholesterol 167 mg/dl. I am taking insulin 32-28 units Penfill HM 50 before food in the morning and at night, Diaonil, Glyciphage, Optineuron, Diacobal, Aquazide and Cardace. My blood sugar levels are fasting 94 mg/dl and PP 147 mg/dl. I do not do any exercises. I am feeling tired, suffering from pheripheral neuropathy with tingling, burning sensation, numbness and swelling in the feet in a sitting posture and while travelling. It leads to restlessness and sleep disorders. I feel weakness in the legs and nerves supplying blood to the feet. I have a small sized penis. I have no issue. I do not feel attracted to my wife due to my sexual disorder and guilt. I am also suffering from erectile dysfunction and premature ejaculation. The moment I insert my penis, it is not stiff enough for intercourse. Please advise with proper medications to overcome my problems. I am following strict diet control for controlling sugar levels.

A:Your diagnosis is Type 2 DM with neuropathy with erectile dysfunction. Despite a good glucose control you have got this complication and reason is long standing DM. For your erectile dysfunction you can try Viagra under your physicians supervision and see the effect. In case no improvement contact a urologist who can suggest you other alternatives like injection in the penis before intercourse. The weakness is also due to nerve involvement. I suggest you to undergo a complete assessment from a neurologist including nerve conduction studies so that a decision can be taken for further treatment as now we have few newer medications for neuropathy as well.