The most important way of treating diabetes

1. What is diabetes?

　Organs and cells in the human body need nutrients to work actively. Three major nutrients are carbohydrates (sugar), protein and lipids. Vitamins and Minerals are necessary, but these are naturally supplemented by taking three major nutrients properly. For the proper utilization of these three major nutrients, Insulin is necessary.
　Diabetic patients are lacking Insulin (absolutely or relatively) and consequently they become hard to utilize nutrients efficiently.

2. Carbohydrates and lipid as well is the source of the energy

　Energy source such as Oil (gas) is necessary to drive motorcar. Energy source for human is glucose. If insulin is lacking, glucose cannot produce energy well by a sort of imperfect combustion and every part of the body such as organs and cells does not work well.
　Blood sugar level (concentration of the glucose in the blood plasma) becomes high in diabetic patients. When the amount of the nutrients was relatively high compared with their body and activities and/or his insulin level, residual sugar that could not be used or stored in the tissues accumulate in the blood.
　If a patient cannot excrete insulin well and cannot utilize energy from glucose well, he or she utilizes lipids as their energy source. Mild lacking of insulin does not induce serious problem, but severe lacking of insulin lead to a lot of degradation of lipid subsequently acidic waste of the metabolic products in the body. It is not good for human body.

3. Protein and Lipid is the source of the firm architecture of the body.

　For the car to move safely, firm body and the electric system and the tubing of the fuel supply have to be firm enough. Like that, not only the human skeleton but also every part of the body including blood vessels, nerve, bone, muscles and every cell that form those organs have to be firm enough. The sources of this firm architecture of the body are proteins and lipids.

4. The most important thing for the treatment of diabetes

　The most important thing for the treatment of diabetes is not to lower blood glucose.
　The most important thing is "To make cells, organs, body efficiently utilize not only sugar but also every nutrients including protein and lipids to work well"
　This is the main reason why taking well-balanced nutrients and sufficient insulin is necessary.
　After overeating, excess nutrients cannot be utilized. Excess glucose elevates blood glucose level and is converted to fats, which make the body fatty. If you become very fatty, activity of the insulin may become weak even if the amount of insulin were sufficient. This may lead one difficult to utilize glucose, protein and lipids and then fall into a vicious cycle.
　Not only above, if you are short of necessary nutrients, organs and cells cannot work well and blood vessels and nerves may become fragile.
　Make sure that taking well-balanced necessary nutrients is paramount.

5. Subjective symptom of diabetes

　As the blood sugar level become high enough, typical symptoms in the list become apparent.
1.Eat a lot
2.Thirsty and drink water (juice)
3.Very big volume of urine
　In addition, nerve may not work well and this make one irritable and may become easy to agitate, may have symptoms like dementia

6. Organs are gradually worsening even without apparent symptoms

　No symptoms may apparent in the mild diabetes even if control is not so good. But although you are not aware of the symptom, organ such as eye, kidney, nerve and/or middle to large blood vessels are getting worse unconsciously.
　If you treat diabetes improperly or unless you treat it for a long while, you may easily have those complications as follows:

　To prevent these complications above, you have to control your diabetes as well as possible now.

7. Is it good that blood glucose level is as lower as possible?

　No. There seem many patients who think the better as the blood sugar level is lower. But it is wrong. We have to explain here about it.
　Don't you think the better as the blood glucose level is the lower? You may hear about hypoglycemia. But there may be many patients who think that the better as the glucose level is lower.
　As cells work by glucose as the energy source, too low glucose level will lead to make to excrete adrenalin to elevate glucose level with those symptoms well known as hypoglycemia. Adrenalin constricts blood vessels in the body, so organs will be lack of blood and enough oxygen. This leads eye and/or kidney easy to get complication including eye hemorrhage.
　One hypoglycemic episode is as risky as several times of hyperglycemia. You should be cautious not to induce hypoglycemia as possible as you can.
　If you don't have clear and typical hypoglycemic symptoms such as cold sweating and/or pounding heart but if you merely feel nauseated or poor appetite or only feel sick, these symptoms may be induced by relatively hypoglycemic state, even if blood sugar level were not so low (i.e. 100mg/dl or so). Unless you take food your blood sugar may fall more and you may fall into the vicious cycle.
　If your blood sugar level might have been staying very high for significantly long period and if your blood sugar level decreased very rapidly, your retinopathy may worsen more rapid. You should be cautious about it.

8. Poor meal is also no good!!

　Don’t you believe that poor meal is better because of the risk of elevating blood sugar or atherosclerosis? If you think so it is wrong way of thinking.
　Overeating is of course no good but poor meal is also no good.
　Never forget protein and lipids are the very important source to make firm parts of your body.

9. Long term continuing treatment is at most important

　If you do not feel any symptom now, the effect of today's treatment will be apparent after 5 or 10 years. Whichever the today's treatment good or bad, the effect will be apparent reflecting it after very long period later.
　So even if you don't feel any symptom now, please continue patiently taking well-balanced meal, suitable exercise and insulin supplement if necessary.
　If you patiently continue to treat your diabetes properly, you will be able to live as long as others without diabetes. If your diabetes is mild, well-balanced nutrients may prolong your life more than that of average people.

10. Let's learn the important nutrients and well-balanced healthy meal

　What is the important nutrients and well-balanced healthy meal?
　Let's listen to the explanation of dietician and make your own plan: amount of food making some menu.
　Suitable menu for diabetics is good (ideal) for people without diabetes.
　Even if you are a non-diabetic, food suitable for diabetics will make you healthy and prevent diabetes and/or high blood pressure.
　Please read and study the good diet food.

Synopsis: evaluations of drugs for diabetes.

Sulfonylureas (SU): You'd better avoid most of them

　Tolbutamide is one of the SUs. By using it for a long time, patients who died from myocardial infarction increased and total mortality tend to increase.
　These were confirmed by the UGDP (University Group of Diabetes Program) of US in which some very large and long term controlled clinical trials were carried out. UKPDS (United Kingdom Prospective Diabetes Study) carried out similar clinical trial, but no clear evidence by which one should reconsider the results of UGDP.
　As for Japanese type 2 diabetes that are rarely severely fatty, continuing to control blood sugar very strictly make lower the complication of eye (retinopathy) and/or kidney (nephropathy). This was the excellent (as the global standards) randomized controlled study that has been done very rarely in Japan.
　Thus, even if your diabetes is type 2 and even if you take the calculated energy and elements of nutrients properly, even if you exercise properly, but your blood sugar might increase, we recommend you should take insulin, although a very small amount at first.
　All of the SUs are not totally safe. Among them, acetohexamide and clorpropamide have very strong blood-glucose lowering effects and may affect very strongly in some patients and in the elderly with severe hypoglycemia complicating with severe sequelae. Do not use them.

Which SUs are relatively less toxic?

　Relatively less toxic sulfonylureas are glibenclamide and gliclazide. But if your body cannot excrete insulin well, insulin supplement affect your body more tenderly. It is as if you wear glasses if necessary. Please know adverse effects and the risks before you take glucose-lowering pills.

You'd better avoid new drugs until definite evidence of long-term efficacy and safety might be proved

　Glimepiride (Amaryl) is a new drug belonging to the SUs. It's long-term efficacy and safety is not proved yet. So you'd better avoid until it might proved.
　Acarbose and Voglibose, alpha-glucosidase inhibitors that delay the final step of decomposition of starch and sugar. This is a chemical and it is absorbed and may cause severe toxicity such as liver damage. It's long term efficacy and safety have never been proved by a long term large scale randomized controlled trial even though 6 to 7 years have past wince it's introduction to clinical practice. So you'd better avoid these products until final evidence might be available.

Biguanides should also be avoided

　One of the biguanide, phenformine was studied in the UGDP. It elevated the mortality rate and induced lactic acidosis more and the clinical study were stopped before the end of the study. Metformine and buformin are approved in Japan, we recommend don’t use these.
　Metformine is approved to use in foreign countries, and it was shown that it worked well for those very fatty diabetics in UKPDS. But in the same study it was also shown that it worked badly when given to the patients who were not well controlled by only SUs. So this drug is not fully proven to be useful for long-term treatment of diabetics.

Never use followings:

　Pioglitazone is approved for those whose insulin does not work well although they can excrete insulin well (resistant to insulin, most of them are very fatty) and their blood sugar level increase. It is also approved in the United States but we (NPOJIP) investigated very precisely and concluded it is highly probable that long-term use of it could induce bad effects. Never use it (for more information see p32 and p36).
　Eparrestat, an aldose reductase inhibitor protects to make sorbitol that may affect tissue such as nerve badly in diabetic patients. According to this theory, it may be effective. But evidence of efficacy has never shown so far. This is used only in Japan in the world. Never use it (for more information see p31 and p34).

Overall (long term) efficacy and bad effect is not well known

　Nateglinide is one of the new drugs. It has somewhat different chemical structure compared with sulfonylureas. But the mechanism of action is almost the same as sulfonylureas. This means that it may have some effects including unknown bad effects other than glucose lowering effect. Thus long-term safety is more obscure than sulfonylureas. You'd better not to use it until more definite evidence might be available.

Insulin is the best in principle

　 For those who lack insulin by themselves whose glucose level might increase even though they take proper amount of meal compatible with their build and activities, very good drug "INSULIN" is available.
　For diabetics, proper exercise and taking proper amount of nutrients calculated for their build and activities, enjoy eating, relaxing, make your body weight near standard and maintaining are very important. There is no way superior to these.

If your blood glucose might elevate, you should take insulin as a drug (injection).

　Even though there are some glucose lowering drugs (pills) other than insulin that were classified as "limited use", but they are merely supplementary. They have been no clear evidence that indicate long-term use prolong life and prevent complications so far.

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