New research to be presented at the Annual Meeting of The European Association for the Study of Diabetes (EASD) in Milan, Italy (Sept 28 – Oct 2) shows, with the use of continuous glucose monitoring (CGM) devices, sexual intercourse is safe for people living with type 1 diabetes. The study is by Dr Dominica Orłowska, Medical University of Warsaw, Warsaw, Poland, and colleagues.
Sexual intercourse (SI) – as an activity that can consume high levels of energy across various time periods - may be perceived as a risk factor for hypoglycemia (dangerously low blood sugar) by individuals with diabetes, and hypoglycemia-related fear can adversely affect intimacy and quality of life.
The authors explain that when they started asking their patients directly about fear of hypoglycemia during sex, they explained that it does happen. There is also some published evidence: in a survey of 53 young adults with type 1 diabetes, approximately one third reported fear of hypoglycemia during sexual intercourse (Pinhas-Hamiel et al., Diabetes Metab Res Rev 2017;33:e2837). But importantly, all of the existing evidence comes from questionnaires and interviews. Blood sugar has never before been measured objectively in this context.
On the one hand, sex is physical exertion like any other, and can lower glucose in the same way. But in practice it is different, and our patients tell us so. Exercise can be planned for - you can reduce your insulin dose, eat beforehand, set an activity mode on your pump. Yet sexual activity is usually spontaneous, and it typically happens in the evening or at night, which is already the window of greatest risk for severe and unrecognized hypoglycemia. And above all, nobody talks about it: patients will discuss exercise with their diabetologist and receive concrete advice, but almost no one asks about sex, so the fear is never addressed. Yet sex life is central to quality of life, and fear of hypoglycemia can lead people to avoid intimacy."
Dr Dominica Orłowska, Medical University of Warsaw, Warsaw, Poland
In this research, the authors aimed to assess whether sex is associated with an increased risk of hypoglycemia in adults with T1D based on CGM data.
The study assessed 12 adults with T1D (7 women, 5 men; median age 36 years, range 21-64; mean BMI 24 kg/m²) using CGM (FreeStyle Libre 2 or Guardian 4) who were enrolled in a prospective observational study. Participants were treated with multiple daily injections of insulin (n=6) or insulin pump therapy (n=6; including 2 using automated insulin delivery systems). None of the five male participants reported erectile dysfunction.
Over a 3-month period, participants marked SI events in their CGM application. CGM data collected from 2 hours before to 6 hours after each SI event were analysed. Subgroup analyses assessed the effects of SI timing (daytime 06:00-20:00 vs. Nighttime 20:00-06:00), BMI (under 25 versus 25 and over), diabetes duration, and insulin delivery mode.
A total of 110 SI events were recorded. All participants using insulin pump therapy reported removing their devices during SI. No clinically significant hypoglycemia was observed. Blood sugar changes were unrelated to insulin therapy mode or diabetes duration.
In 64 events (58%), mean post-SI glucose decreased by 27% (180 to 132mg/dL; statistically significant); in the remaining 46 events (42%), glucose increased by 34% (122 to 164 mg/dL; statistically significant). Both patterns – increasing and decreasing blood glucose - were observed in SI events in every participant.
Higher pre-SI glucose was associated with greater post-SI reduction when decreasing and with a smaller rise when increasing . Nighttime SI (66 events) was associated with a statistically significant reduction in glucose levels (165 to 147 mg/dL), whereas daytime SI (n=44) had no effect (144 to 143 mg/dL). There were no differences between mean glucose recorded for 2 and 6 hours after SI.
Participants in the higher BMI group (25 and over) showed a greater post-SI glucose decrease (−10.7%; 150 to 134 mg/dL, statistically significant) than those with BMI under 25 (−5.6%; 159 to 150 mg/dL; not statistically significant).
The authors conclude: "Sexual intercourse in adults with T1D does not appear to increase the risk of clinically significant hypoglycemia, even at night. Blood sugar responses are bidirectional and seem to be influenced by pre-SI glucose level, BMI, and time of day. These findings may support clinical counselling and help reduce hypoglycemia fear-related avoidance of sexual activity in people living with T1D."
They add a cautionary note about people with T1D not using CGM, explaining: "In an ideal world, every person with type 1 diabetes should be using CGM. Those who do not may have no idea whether they are experiencing hypoglycemia during sex – or, in fact, any setting."
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