World Diabetes Day is here again this year!
Today, November 14th, is World Diabetes Day (WDD). It marks the birthday of insulin discoverer Frederick Banting and was established by the International Diabetes Federation and WHO.
Every year on this day, events and symposiums about diabetes are held around the world. I think it’s excellent that it creates an opportunity to think about diabetes.
But when all we hear is stuff like “Type 1 diabetes isn’t caused by lifestyle choices like Type 2 diabetes” or “To prevent Type 2 diabetes, walk more and avoid overeating,” it makes it seem like “People with Type 2 diabetes are just lazy slobs who don’t exercise and overeat.” Doesn’t that just make discrimination and prejudice against Type 2 diabetes worse…!?
People from so-called diabetic families often develop Type 2 diabetes around the same age as their parents, even without particularly unhealthy lifestyles… They’re already going through enough—please stop blaming them even more.
↑↑↑There are several rules to follow when using the “Blue Circle,” so if you’re thinking “I want to use it too,” please read this (official) page carefully.
The illustration above is from my book, “Low-Carb CIAO!” Only two characters in it have diabetes, but the others are supportive allies.
Volume 1 is now on sale! If you’re interested, please check it out! A paperback version is also available.
Do doctors truly wish to “eradicate diabetes”?
It may sound harsh to say this, but do diabetes specialists truly wish from the bottom of their hearts for diabetes to disappear as a disease? I ask purely out of curiosity.
For some time now, I’ve seen numerous posts on X (formerly Twitter) from individuals identifying themselves as “Japanese doctors treating diabetes patients (mostly private practitioners)” containing statements like the following. Some have since been deleted.
“Diabetes patients, especially those on insulin, are incredibly profitable—the cost per patient skyrockets.”
“The local diabetes clinic is raking it in. I wish I’d gotten my specialist certification (in diabetes) too.”
“How to maximize profits.”
Private practitioners are business owners who employ staff, so there’s nothing inherently wrong with them making money. It is a business, after all.
But when doctors openly discuss things like “Money is the most important thing!” in front of patients, it doesn’t exactly leave us feeling good, does it?
Moreover, if “the treatment that makes doctors the most money” and “the treatment that’s best for the patient” were to align, it would be a win-win situation. But the problem is that reality doesn’t always work that way.
What would you do if, while being told “I’m recommending the best method for you,” you were actually being advised to choose “the treatment that’s second most effective but the most profitable”? You have the right to choose the best method for yourself, not just what’s most profitable for the doctor! If you leave it entirely up to the doctor and don’t educate yourself, you’ll end up just accepting whatever they say without understanding.
Incidentally, the doctor who wrote that “diabetes patients, especially those on insulin, are incredibly profitable because the cost per patient skyrockets” also wrote that “restricting carbohydrates is not good.”
In a way, it makes sense, doesn’t it? Because there’s a possibility that fewer patients would need insulin injections (= less income).
About my diabetes
I come from a family with diabetes; both my father and younger brother developed it at a young age. Working at a sports club, I thought, “I’m careful, so I’ll be fine.” But I developed gestational diabetes at ages 26 and 28, and at 37, I was diagnosed with diabetes and its complications.
Below are my test results from age 37, when I caught the flu from my family, became bedridden, and then developed diabetic ketoacidosis requiring emergency hospitalization.
My blood sugar was a staggering 475 mg/dL, even though it was fasting! My HbA1c was 15.0%, meaning my average blood sugar was around 384 mg/dL. That’s ultra-sumo-level bad!
I’ve heard there are cases where excessive soft drink consumption can cause HbA1c to exceed 10% in a short period, yet the diabetes itself isn’t severe. However, that wasn’t the case for me, as I already had diabetes complications.
During my 16-day hospitalization, the focus was mainly on tests for diabetic complications and diabetes education classes. I was absolutely overwhelmed with anxiety, constantly wondering, “What on earth is going to happen to me now?”
My young attending physician at the time (29 years old) initially tried to prescribe me the traditional diabetic diet plus a large number of medications. However, when I requested, “I want to try a low-carb diet,” he hesitated for a moment but then said, “Alright, let’s give it a try.” Since the results were good, I was allowed to continue with it.
Regarding my eye complications, there were initially massive amounts of hemorrhage marks and edema deep within my eyes, but they improved significantly after a year. It’s only relatively recently that they completely disappeared and became clear.
Since I already had insulin secretion deficiency 11 years ago, no matter how hard I try, I won’t reach a state equivalent to being cured. However, I continue with carbohydrate restriction with the goal of preventing the progression of diabetic complications.
Is it best to live with diabetes “in moderation”?
Eleven years ago, I was hospitalized for 16 days after discovering I had “diabetes and diabetic complications that had gone unnoticed for years and become severe.”
At first, I was super nervous and freaked out, worrying things like, “Oh no! What do I do?! My fasting blood sugar is around 120 today! Is it okay if I don’t take extra insulin??”
But now, 11 years later, I don’t get that worked up anymore. It’s more like, “Ah, it’s pre-menstrual, so it’s over 130. Well, whatever! Can’t be helped” .
My previous doctor said, “It’s okay if your blood sugar occasionally goes up to around 250 mg/dL—it won’t kill you.”
When I heard that, I thought, “Huh? 250!? I can’t believe it!!” But now, when I eat out, it sometimes goes over 200, and I think, “Well, I’ll just walk it off…”
I don’t think my doctor meant “don’t worry too much about your blood sugar.” I think what he meant was, “It’ll occasionally spike temporarily when you eat out, so worrying about every little spike would be exhausting.”
Since I’m managing things more loosely than before, my HbA1c doesn’t quite reach the ideal range. But I don’t get hypoglycemia, so my diabetes complications are looking good. My eyes, especially, are almost as healthy as a non-diabetic person’s. But complacency is the enemy!
Patients who cannot tell others they have diabetes
I don’t hide the fact that I have diabetes from those around me at all. I don’t think having diabetes is something to be ashamed of.
However, many people find it difficult to talk about having diabetes. Young women especially dislike being thought of as “the kind of person who gets type 2 diabetes because they’re overweight” or “probably ate too many sweets, right?”
I don’t think you necessarily have to be open about having diabetes with everyone. However, I do think it’s better to tell people if you take insulin injections, regardless of the type, and are at risk of hypoglycemia. If you faint without warning, those around you won’t understand why and will be at a loss.
A doctor’s comment made me think: “Diabetes develops due to various causes. It’s not a disease caused by poor lifestyle habits, but rather a disease that requires careful attention to lifestyle habits.” That made sense.
When people read “Type 2 diabetes develops due to a combination of genetic predisposition and lifestyle factors like overeating and lack of exercise,” they often think, “So it’s genetic, but I developed it because I was lazy!” I’ve even seen people say, “My parents have diabetes, but I don’t because I’m careful.”
But you know, we can’t really say whether those people avoid developing it because they’re truly “making an effort.” While a predisposition to diabetes can be inherited, it’s not 100% guaranteed. Among siblings, it’s possible that about half happen to not inherit that predisposition. Please don’t say that everything can be prevented through effort alone—that those who couldn’t prevent it simply didn’t try hard enough.
I know people who eat quite a lot yet never develop diabetes, and others where you wonder, “Why you?” Calling it a “lifestyle disease” is misleading.
And even if those around you have misconceptions about diabetes, I think it’s often due to ignorance rather than malice.
But even if it’s just ignorance, it’s still troubling to face unfair treatment at work because of diabetes. I’m a manga artist, and I’ve been told, “You shouldn’t push yourself too hard because you’re sick.” It made me feel utterly disheartened, thinking, ‘Are they thinking, “We shouldn’t commission this person for a serialization because they might suddenly die in the middle of it?”’
Just because we’re both diabetic doesn’t mean we understand each other
Healthy individuals without diabetes may sometimes fail to understand diabetes due to their lack of knowledge.
While that is problematic in itself, it doesn’t necessarily mean that people with diabetes always understand each other. Some patients who are also qualified healthcare professionals can become overly confident, thinking, “I understand this better than anyone!” and adopting an attitude like, “My version of the ‘right answer’ is the only one that matters! I reject all others!”
Once, a Type 1 diabetic woman working at a hospital said, “Type 2 people are different from me—their sloppy lifestyle habits are the cause. I won’t budge on this. Everyone who comes to our hospital is like that.” It made me so sad I ended up distancing myself.
Even among type 2 diabetes patients, you sometimes hear things like, “I’m lucky I don’t have to restrict carbs since my case is mild! People with severe diabetes are so pitiful!” I’ve been told that myself.
Some people insist on pushing their own theories, like “You have to limit fats too if you’re restricting carbs!” or “Protein is bad for your kidneys!” But since you hear this kind of thing fairly often, maybe you don’t necessarily need to seek out interactions with people who have the exact same condition.
Then there are those selling information products (?) claiming things like, “No need to go to the hospital! Just take this course and your blood sugar will be normal!” It’s unclear whether the “testimonials” shared there are genuine.
A few years back, someone posted an article saying something like, “Even with diabetes, thanks to this supplement, I can eat tons of bread and my blood sugar stays normal!” When I looked into it, I found they were selling a different supplement under a different name on a subdomain of the same blog. That’s basically what I mean.
What should you do if you’ve been diagnosed with diabetes?
For those diagnosed with diabetes, I believe it’s crucial not to interrupt treatment under any circumstances. Quite a few people stop treatment for reasons like “medical costs are too high” or “I don’t get along with my doctor.”
But while it might be manageable for those with very mild cases, stopping treatment can be dangerous for others (myself included). You really should keep going to your appointments.
Issues like medical costs or compatibility with your doctor can sometimes be resolved by changing hospitals. I’ve heard some people lose trust in healthcare after encountering a doctor with a harsh personality, but there are good doctors out there! Definitely.
For many years, I was seen by an understanding, experienced primary care physician (the head of the internal medicine department). However, this spring, I switched to a younger doctor in their twenties. This change happened because my previous doctor became even busier and significantly reduced their outpatient schedule.
Honestly, compared to my previous doctor, the younger one still feels quite by-the-book. But that’s just how it is. If you think of your visits as just getting blood and urine tests done, you can brush off whatever else they say.
And I think it’s best to keep track of your blood sugar levels as much as possible. If you can, try using the Freestyle Libre. Nowadays, you don’t even need the Libre device itself—just install the app on your smartphone.
If you can figure out what foods and how much cause high blood sugar (and sometimes delayed low blood sugar as a rebound effect), what you need to do will naturally become clear.
Moderate exercise is important, but first, check with your doctor: “Is it okay for me to exercise?” Depending on your complication status, there might be restrictions on exercise.
And many sports instructors, including my past self, don’t know much about diabetes. I worked part-time at a sports club before being diagnosed with severe diabetes 11 years ago. When my supervisor saw my resting heart rate was 120 (actually a symptom of diabetic neuropathy, now gone), he just said, “Ah, we get people like that sometimes.”
Both high blood sugar and low blood sugar are bad for diabetes. It’s long been known empirically that hypoglycemia worsens diabetic retinopathy, and the mechanism behind this is now becoming clearer.
Furthermore, even without high or low blood sugar, excessive insulin secretion or high insulin injections (hyperinsulinemia) increase the risk of atherosclerosis and cancer.
By living in a way that avoids high blood sugar, low blood sugar, and high insulin levels as much as possible, it might even be possible to halt the progression of diabetic complications.
Even with Type 1 diabetes, eating a lot and gaining weight leads to high insulin levels, so please don’t think this is solely a problem for Type 2 diabetes. Type 1 individuals who are already obese should be especially careful.
What can I, just a diabetic, do?
Someone once asked me, “Don’t you get tired of thinking about diabetes all the time?” They also said, “Why bother sharing all this troublesome info when you could just leave it to the doctors?”
Unfortunately, in my case, I can’t forget I have diabetes for even a single day… just like someone with severe food allergies can’t forget they have it. And honestly, it’s not that hard for me. I’m used to it now!
Since I have to remember and do it anyway, I decided to enjoy it as much as possible. Getting diabetes is actually why I aimed to become a manga artist at 42, debuted at 44, and managed to publish manga books.
As for sharing information, while I do want people to read my books (my new volume released today—please buy it! Kindle Unlimited subscribers can read the entire 154 pages for free! written in Japanese), I also do it because I hate the thought of others with the same condition going blind or developing kidney failure.
If you think “I don’t care about anyone else,” it’s easier to stay silent. But wouldn’t it be better if we all got healthier together?
Unfortunately, the current standard treatment for diabetes in Japan is not yet perfected. If what doctors say were completely accurate, why do people develop diabetic complications despite diligently following treatment? I’ve even read about a diabetes specialist whose own retinopathy from type 2 diabetes worsened, forcing him to seek help from an ophthalmologist!
Slowly but surely, more medical institutions are incorporating carbohydrate restriction as a new treatment option.
While the American Diabetes Association has gradually embraced carbohydrate restriction, Japan is about a decade behind. If the guidelines change, most doctors will likely accept it, but waiting for that change could mean some people lose their vision or kidney function.
That said, choosing any treatment method is a personal freedom. Many doctors following the Japanese Diabetes Society and guidelines will undoubtedly give the safe advice to “eat a balanced diet and get moderate exercise,” but your choice is your freedom.
