If you have diabetes and erection problems, you are far from alone. The US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says more than half of men with diabetes will get erectile dysfunction (ED), and that men with diabetes may develop it 10 to 15 years earlier than men without diabetes1. The good news is that ED tablets work for many men with diabetes, and looking after your diabetes can help too.
Why diabetes affects erections
An erection depends on healthy blood vessels, healthy nerves and the right hormone balance. Over time, high blood sugar can damage the blood vessels and nerves involved1. Changes in hormones and emotional health that come with diabetes can play a part too1.
You are more likely to have problems if1:
- your blood sugar is not well controlled
- you already have nerve damage (neuropathy)
- your blood pressure or cholesterol is high and not treated
- you are overweight or not physically active
- you smoke or drink a lot of alcohol
- you take certain other medicines
ED can also be a sign of undiagnosed diabetes. Changes in sexual function may be one of the first signs1, so if you have new erection problems, a blood sugar test is worth having.
Can better diabetes control help?
It can help, although it will not fix every case. NIDDK says good diabetes management may help prevent and treat ED caused by nerve damage and circulation problems1. European urology guidelines say conditions such as diabetes and high blood pressure should be well controlled as the first step of any ED treatment, and that lifestyle changes such as exercise (especially aerobic exercise), weight loss and treating heart risk factors may improve sexual function2.
In practice, that means working with your diabetes team on blood sugar, blood pressure and cholesterol, stopping smoking, cutting down on alcohol and moving more3. These steps protect your heart, kidneys and eyes as well. Our guides to metformin, SGLT2 inhibitors and GLP-1 medicines explain the main diabetes treatments.
ED tablets for men with diabetes
ED tablets (PDE5 inhibitors) are the usual first treatment, and they have been tested specifically in men with diabetes. Sildenafil (Viagra) and tadalafil (Cialis) were each studied in a trial of men whose ED was linked to diabetes, and both labels report that the medicine was effective in this group45.
- Give them a fair trial. Take the tablet the right way, with enough time and arousal, on several occasions before deciding it does not work. Our guide Viagra not working? covers the common reasons tablets seem to fail.
- Which one? There is no proven difference in how well the different ED tablets work2. The choice comes down to timing, side effects and your other medicines. See sildenafil vs tadalafil.
- Heart check first. Diabetes raises the risk of heart disease, and ED itself can be an early warning sign of narrowed arteries6. Our guide to ED pills and your heart explains what to check.
Diabetes medicines and ED tablets
Diabetes medicines are not among the medicines that ED tablets must never be taken with. The absolute “no” combinations on the labels are nitrates (such as GTN for angina) and riociguat45. In studies, sildenafil had no significant interaction with tolbutamide, an older diabetes tablet4.
Many men with diabetes also take blood pressure medicines. Most are fine with ED tablets, but alpha-blockers need a lower starting dose4. Always give your prescriber a full list of everything you take.
One more point: diabetes is one of the risk factors for a rare eye problem called NAION, which has been reported in men taking ED tablets. If you ever lose vision suddenly, stop the tablet and get help straight away4.
Low testosterone
Low testosterone is one of the hormone causes of ED3. European guidelines recommend an early-morning testosterone test as part of checking men with ED2. If yours is low, testosterone treatment can be given alongside an ED tablet, and in men with low testosterone who do not respond to tablets it may improve the response27.
Other sexual changes with diabetes
- Retrograde ejaculation. Rarely, diabetes affects the nerves so that semen goes backwards into the bladder instead of out of the penis. It is passed out safely in urine1.
- A curved penis (Peyronie’s disease) is more common in men with diabetes1.
- Low mood and stress can make ED worse, and counselling, with your partner if you like, can help7.
If tablets are not enough
Men with diabetes have the same other options as anyone else: injections or a urethral pellet of alprostadil, a vacuum pump, and a penile implant if other treatments fail27. European guidelines note that diabetes is a risk factor for infection after implant surgery, so good blood sugar control matters before an operation2.
Our ED medicines and diabetes medicines pages list what we supply.
ED tablets we supply include Viagra 100 mg, Cialis 20 mg and, for daily use, Cialis 5 mg, as well as generic versions. All need a prescription.
Frequently asked questions
Can diabetics take Viagra?
Yes, most men with diabetes can. Sildenafil was tested in a trial of men whose ED was linked to diabetes. Check with your prescriber first, especially if you have heart disease or take nitrates.
Is ED from diabetes reversible?
It can improve for some men with better blood sugar, blood pressure and cholesterol control, exercise, weight loss and stopping smoking. Damage that has built up over years may not fully reverse, which is why ED tablets and other treatments are often needed as well.
Which ED pill is best for diabetics?
No single tablet has been shown to work better than the others. Sildenafil and tadalafil both have trials in men with diabetes. The right choice depends on timing, side effects and your other medicines.
Can erectile dysfunction be a sign of diabetes?
Yes. Changes in sexual function can be an early sign of diabetes, so a blood sugar test is worth having if you develop erection problems.
Do diabetes medicines cause ED?
Diabetes medicines are not on the NIDDK list of medicines that commonly cause ED, but blood pressure medicines and water tablets are. The diabetes itself is a more likely cause. Do not stop any medicine on your own; ask your doctor.
Sources & references
- National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes, Sexual, & Bladder Problems.
- European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Management of erectile dysfunction.
- National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and Causes of Erectile Dysfunction. Last reviewed October 2024.
- US National Library of Medicine, DailyMed. Viagra (sildenafil) prescribing information.
- US National Library of Medicine, DailyMed. Cialis (tadalafil) prescribing information.
- British Heart Foundation. Erectile dysfunction, Viagra and your heart. Updated 29 May 2026.
- National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Erectile Dysfunction. Last reviewed October 2024.
Related reading
- ED or low testosterone?
- What is erectile dysfunction?
- ED medication side effects compared
- Sildenafil medicines
- Tadalafil medicines
- Vardenafil medicines
This content is for informational purposes only and is not medical advice. If you have diabetes, talk to your diabetes team or doctor before starting any ED medicine. Used as prescribed by a licensed medical professional.
Mahesh Gupta is a licensed clinical pharmacist with 15 years of experience. He holds a B.Pharm and M.Pharm from LN Mithila University. At OnlineMeds, he reviews medicine and health content to help ensure it is accurate, evidence-based, and easy to understand.