Can Impotence Caused By Diabetes Be Reversed

StaminaStar

So my pancreas went on a permanent coffee break, my blood sugar spiked, and my erections filed a formal grievance with HR. For those of you in the “T2D + ED” club, is impotence actually reversible here, or are we just learning to MacGyver the plumbing with pumps, pills, and pep talks?

I’m trying to separate internet folklore from reality. If you’ve been there, what actually moved the needle (pun absolutely intended)? Curious about the difference between “fixable” and “manage-it-forever” when diabetes is the root cause.

Specific things I’d love real-world intel on:

Glycemic control: If you dropped A1c (how low, how long), did function rebound? Are we talking weeks, months, or “see you next fiscal year” timelines?
Wiring vs. plumbing: If the issue is neuropathy versus microvascular damage, what has actually bounced back for you? Any tests (NPT, penile Doppler, biothesiometry) that predicted who improves?
Meds that helped or hurt: Experiences with PDE5 inhibitors in diabetics (higher doses needed, different response)? Did GLP-1s or SGLT2s accidentally improve things via weight loss and cardio benefits, or did dehydration/other side effects make things worse?
Lifestyle levers: Did resistance training, HIIT, sleep apnea treatment, or going on the “two-drink max” plan make a noticeable difference? Placebo or legit?
Pelvic floor: Anyone try pelvic floor PT specifically for diabetic ED? Worth it or just pricey squats?
Testosterone: For those with borderline-low T (very common in T2D), did TRT actually change game day, or just the pre-game hype? Combo with PDE5s better?
Shockwave therapy: Miracle or marketing? Especially in diabetics, any durable gains from Li-ESWT? Protocols that weren’t pure wallet cardio?
Supplements: L-citrulline, Pycnogenol, ginseng, etc.-anything that wasn’t just expensive salad?
Signs of true recovery: Return of morning wood, better nocturnal tumescence, less “lag” between arousal and response? Anyone notice same-day performance correlating with CGM time-in-range, or is that wishful biohacking?
Specialists: Did coordinating endo + urologist + cardiology actually uncover hidden issues (e.g., ED as early warning for vascular disease)? Worth the circus?
When is an implant the “sane” option: If neuropathy/vascular damage is far along, did anyone go straight to an implant and think, “Should’ve done this sooner,” especially with diabetes-related infection risk considered?

Bonus points if you can share your before/after snapshot: age range, A1c before/after, meds, timeline, and which single change delivered the biggest “aha.” I’ll be over here telling my circulatory system I’d like to speak to its manager.

vanguardvigor

FWIW, here’s what actually moved the needle for me and what my uro/endo kept stressing:

A1c and time-in-range: I didn’t see much until I got A1c under ₇.2 and time-in-range >70% for a few months. Vascular “snap” felt better in weeks; nerve-type issues took 6-12 months and didn’t fully normalize. On “high” days (>220), erections were noticeably worse that same night.
Testing that predicted improvement: NPT helped confirm I still had nocturnal erections (good sign). Penile Doppler showing decent arterial inflow but venous leak pointed me to pelvic floor + daily tadalafil. Biothesiometry was noisy for me and didn’t change the plan.
PDE5s in T2D: Needed higher/more consistent dosing (tadalafil 5 mg daily + on-demand booster). Big wins came from taking it truly on an empty stomach and giving it multiple tries. Adding a vacuum device before sex bridged bad nights.
GLP-1/SGLT2: GLP-1 (semaglutide) helped via weight loss and BP; libido/erections improved after ₁₀-15% weight loss. SGLT2 was neutral-positive but I had to push fluids to avoid feeling “flat.”
Sleep + training: Treating sleep apnea (CPAP) and doing 2-3x/wk resistance training were surprisingly legit-better morning wood and faster arousal response in ₆-8 weeks. Cutting alcohol to 0-1 drink on “game days” mattered more than I wanted to admit.
Pelvic floor: Not magic, but 8-12 weeks with a PT who does men’s health tightened up the “venous leak” feel. Worth it if you can find someone who uses biofeedback, not just generic Kegels.
Testosterone: Borderline-low T + symptoms-TRT helped energy/libido; erections noticeably better only when combined with PDE5s. Needed two separate morning labs before starting.
Li-ESWT: Modest bump for me, not a miracle. Diabetics seem to respond less. If you try it, look for a real urology protocol (e.g., 6-12 sessions, 2k shocks, focused device), not a spa upsell.
Implant: Everyone I met who went that route said “should’ve done it sooner.” Surgeons pushed for A1c under ₈-8.5 to cut infection risk. Pick a high-volume implanter and it’s a night-and-day quality-of-life upgrade.

Curious if anyone else noticed same-day performance dipping when CGM lives in the 200s, and whether daily tadalafil + GLP-1 gave you more reliable mornings?

positivesteps

Couple of angles that don’t get enough airtime, rapid‑fire style:

Glycemic variability > A1c headline: flatten the post‑meal spikes and you’ll often see same‑day performance perks. A 10-15 min pre/post‑meal walk is silly effective.
Med audit is huge: swapping thiazide diuretic to ACE/ARB, metoprolol to nebivolol (NO‑friendly), and SSRI to bupropion moved the needle more than I wanted to admit. Finasteride… proceed with caution. And nitrates + PDE5s = nope.
PDE5 “non‑responders”: take on a truly empty stomach, try at least 6-8 times, and don’t be shy about dose under supervision. If still meh, intracavernosal injections (Trimix) are brutally reliable even in diabetics-use meticulous sterile technique.
Pelvic floor isn’t just Kegels: a lot of us are hypertonic. Down‑training + diaphragm breathing + biofeedback beat “more squeezing.” Helped my “venous leak” feel more than weights ever did.
Timing hacks: mornings win (higher T, better NO). Skip heavy dinners and booze on game day. CPAP users often notice a legit bump after a few weeks.
Lifestyle one‑offs: Mediterranean-ish diet, beet/spinach nitrate bump (cheap, low risk), and if you cycle, get a noseless saddle-perineal numbness trashes the wiring.
Cardio workup was worth it: ED led to a coronary risk check and BP tune‑up; fixing endothelial health helped the bedroom, too.
Implants: if you’re there, pick a high‑volume surgeon, antibiotic‑coated device, and keep A1c <8ish. Regret rates are low; “should’ve done it sooner” is common.

TL;DR: tame the spikes, audit the meds, get the mechanics right, and if all else fails, injections or an implant turn “project management” back into “fun.”

peakperformer

Yeah, the CGM spikes over 200 definitely tanked my same-day performance-noticed it within hours, like a direct hit to rigidity. Daily tadalafil (5mg) paired with semaglutide stabilized things for me after 3 months; mornings got way more consistent once weight dropped 12%. Anyone else find L-arginine (3g daily) amps up the PDE5 response without sides?