Introduction.
The goal of diabetes treatment is not only to "lower blood glucose levels.
More important is to prevent complications such as atherosclerosis and neuropathy.
This requires multifaceted control of blood sugar, blood pressure, lipids, and weight.
This article will focus on the three pillars of diabetes treatment (diet, exercise, and pharmacotherapy) and will explain the treatment flow and our approach in an easy-to-understand manner.
1. basis of treatment - creating a "life without raising blood sugar
The mainstays of diabetes treatment are diet and exercise.
When these do not improve or when the risk of complications is high, drug therapy is used in combination.
medical diet
The key to the diet is to "balance the carbohydrate intake without overdoing it.
- Staple food: Moderate white rice and bread, go to cereal rice or brown rice
- Main dish: meat, fish, and soybeans in good balance (reduce fat)
- Side dish: vegetables, mushrooms, and seaweed for fiber
- Fruits: limited to 80-100 kcal/day due to high fructose content
- Beverages: avoid sweetened juices and canned coffee
To slow the absorption of carbohydrates, **"Eat vegetables first "** order is also effective.
therapeutic exercise
Exercise not only lowers blood glucose but also improves the effectiveness of insulin.
- Aerobic exercise: walking, jogging, bicycling, etc. 30 minutes per day
- Strength training: Squats, push-ups, etc. 2-3 times a week
It is effective not only in controlling blood sugar, but also in improving fatty liver (MASLD), hypertension and dyslipidemia.
Ikejiri-Ohashi Sera Clinic has introduced a physician-led exercise therapy program and medical diet,
We support "design that even those who are not good at exercising can continue to do so."
2. drug therapy - to assist in blood sugar control
If diet and exercise are insufficient to improve the condition, medications are used in combination.
There are many different types of medications and they are used according to the mechanism that raises blood sugar.
(1) Biguanides (metformin)
- Reduces gluconeogenesis in the liver and increases insulin sensitivity
- Side effects: gastrointestinal symptoms, rarely lactic acidosis
- Recommended as first-line drug in Japanese (JDS 2024)
(2) SGLT2 inhibitors
- Lowers blood sugar by excreting sugar in the urine.
- Weight loss and blood pressure reduction effects, useful in cases of obesity and hypertension
- Beware of dehydration and urinary tract infection.
(3) DPP-4 inhibitors
- Prevents the breakdown of incretin (GLP-1) and suppresses postprandial blood glucose
- Widely used in Japan with low risk of hypoglycemia
(4) GLP-1 receptor agonist (injection/oral)
- Slows gastric emptying and suppresses appetite
- Effective for weight loss and obese diabetes
- In recent years, weekly injections and oral types have also appeared.
(5) SU drugs and fast-acting insulin secretagogues
- Promotes insulin secretion from the pancreas
- Lower postprandial hyperglycemia, but watch out for hypoglycemia risk
(6) Insulin therapy
- Used when the pancreas is exhausted and insulin secretion is insufficient
- Control in combination with blood glucose self-monitoring
3. the goal of treatment - "protect blood vessels" not just numbers
The fear of diabetes is not in the blood sugar itself, but in the complications.
The goal of treatment is not to "lower HbA1c" but to protect blood vessels, nerves, and organs.
A typical complication is shimeji:
- Shi: Neuropathy (numbness, pain)
- Eye: Retinopathy (loss of vision)
- J: Nephropathy (reduced renal function)
Furthermore, "enoki":
- Eh: gangrene
- of: Stroke
- (2) Angina pectoris, myocardial infarction
In other words, diabetes treatment is "treatment to protect blood vessels throughout the body.
4. treatment system of Ikejiri-Ohashi Sera Clinic
We provide medical care by diabetes specialists and cross-sectional treatment of lifestyle-related diseases.
Feature 1: Comprehensive inspection system
- Evaluation of complications by fundus examination, ABI, carotid echocardiography, and Holter ECG
- Simultaneous check for MASLD (fatty liver), hypertension, and dyslipidemia
Feature 2: Exercise and nutritional guidance
- Introduce physician-supervised medical diet/exercise regimen
- Emphasis on "realistic treatment" that can be continued in daily life
Feature 3: Continuing Support
- Routine HbA1c and blood glucose monitoring
- Review of therapeutics and management of side effects
5. key points for successful treatment
- Early detection and treatment
In the early stages, it can be controlled by lifestyle modification alone. - Continuation of periodic inspections
HbA1c, urine albumin, fundus examination, etc. at least once a year. - Visualization" of complications
Examine the condition of the blood vessels to get a feel for the purpose of treatment.
summary
- The three pillars of diabetes treatment are diet, exercise, and medication.
- The goal is not to "lower blood sugar" but to "protect blood vessels and organs.
- At Ikejiri-Ohashi Sera Clinic, we have established a cross-sectional treatment system with diabetes specialists,
We provide total support for examination, lifestyle, and drug treatment.
References
- The Japan Diabetes Society. Diabetes Care Guide 2024-2025.
- American Diabetes Association. Standards of Care in Diabetes 2024.
- Davies MJ, et al. Management of hyperglycemia in type 2 diabetes, 2023. Diabetologia.
- The Japan Diabetes Society. Complication Prevention Guidelines 2023.
Diabetes Series - Related Article List
1. Know the basics of diabetes
- What is Diabetes - Why does blood sugar rise? Causes and Mechanisms Explained
Introduces the root causes of diabetes, including "insulin resistance," "heredity," and "lifestyle," which are all related to the development of diabetes, in an easy-to-understand manner. - Early Symptoms of Diabetes - Don't Miss the Early Detection Signs
Early signs that are difficult to recognize, such as thirst, polyuria, and weight loss, are carefully explained. - Diagnostic criteria for diabetes - Difference between HbA1c, blood glucose and OGTT and latest criteria
It summarizes the numerical values used for diagnosis and the key points of the recently revised diagnostic criteria. - Diabetes Testing - Comprehensive evaluation of blood, urine, and even complications
Introduction to the comprehensive examination system available at the Ikejiri-Ohashi Sera Clinic, including fundus examination, ABI, and carotid artery echocardiography.
2. Treatment and lifestyle modification
- Diabetes Treatment - Protecting Blood Sugar and Blood Vessels with Diet, Exercise, and Medication
Explains treatment strategies to "prevent complications" rather than "lower the numbers. - Diabetes Diet - Control Blood Sugar Effortlessly with Locavore
A practical diet that emphasizes how to eat, not what not to eat. - Diabetes and Exercise - Muscle is Medicine! The Science of Aerobic x Muscle Training
The benefits of exercise to directly lower blood sugar and how to create an easy to follow exercise routine. - Drug Therapy for Diabetes Mellitus - Latest Treatment Policies and Multi-Drug Approaches
The characteristics of DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 agonists are compared, and the latest treatment trends are presented.
3. To prevent complications
- Complications of diabetes - Complication measures to remember with "shimeji" and "enoki" mushrooms
The six major complications of neuropathy, retinopathy, nephropathy, gangrene, stroke, and cardiac disease are explained together. - Neuropathy due to diabetes - Mechanisms and countermeasures for numbness and pain in hands and feet
Early signs of peripheral neuropathy and ways to improve life that should be done early. - Diabetes and Renal Dysfunction - Importance of Urine Albumin Testing and Habits to Protect
Practical approaches to reduce the burden on the kidneys and prevent dialysis. - Diabetes and Eye Disease - Causes of Blurred Vision and Early Detection of Retinopathy
Explains how fundus camera examinations work and the risks of neglect.
4. Prevention and early intervention
- Prevention of Diabetes - Reduce blood sugar waves and make your body less prone to diabetes.
Introduces diet, exercise, and sleep regimens to "get in shape before it happens," rather than "fix it after it happens. - Characteristics and constitution of people prone to diabetes - Self-check that you can do now
Early intervention is recommended by sorting out the risk of developing the disease, including heredity, fatty liver, and lack of exercise.
5. Our features and support system
- Lifestyle-related disease treatment at Ikejiri-Ohashi Sera Clinic - Cross-cutting management of diabetes, MASLD, hypertension and dyslipidemia
Includes a comprehensive evaluation system including physician supervised exercise therapy, locavore diet support, fundus, ABI, and carotid artery echocardiography.