Looking ahead at a disease that keeps spreading

From the time I finished medical school and began working as a resident, I knew I wanted to be an internist. Part of the appeal, I think, was the sheer breadth of the field: internal medicine lets you treat a wide range of conditions. But that same breadth makes it hard to settle on a single specialty.

What caught my attention was diabetes and the other lifestyle-related diseases. Even then, the number of people with diabetes was climbing. Yet while most had heard of the disease, few really grasped how dangerous its complications can be or how to prevent them. A checkup might flag someone as high-risk, but in the early stages there are almost no symptoms, so it’s easy to shrug it off: “I’m probably fine.”

Given all that, there was no doubt in my mind that over the next ten or twenty years the number of patients would only grow. So I made up my mind. I would specialize in diabetes and become a doctor who could help patients for decades to come.

I spent many years in the Department of Diabetes and Endocrinology at Mie University Hospital, where I also devoted myself to teaching the next generation. Since opening my own private practice in 2016, I’ve worked to provide care deeply rooted in the local community. Today the clinic is equipped to handle a wide range of needs: lifestyle-related diseases such as diabetes, hypertension, and high cholesterol; endocrine disorders like thyroid disease; and everyday concerns from colds to hay fever.

A diagnosis doesn't have to shrink your life

Many people assume a diabetes diagnosis means never eating what you love again. I don't see it that way. Diet and exercise matter, of course, but that hardly means eating a restricted diet every single day of the year without exception.

Say you take a few days' trip with family or friends. You visit the famous sights and take a long soak in a hot spring. Naturally, you'll want to try the local specialties too. Denying yourself at a moment like that, thinking "No, I have to watch what I eat," only piles on stress.

Life is a long stretch of the ordinary, broken now and then by the extraordinary. On an out-of-the-ordinary occasion like a trip, it's fine to set the usual limits aside and enjoy yourself. When the trip ends and ordinary life resumes, you simply go back to your routine. A few special days are easily absorbed; blood sugar can be managed perfectly well over the span of a week or a month. What matters isn't rigidly obeying the rules. It's building a way of living that keeps the rules while staying sustainable for the long haul.

At the clinic, we run a diabetes class, and we do not simply drill the patients on everything they can't do. If anything, it's a place to show people how much they still can do, even with diabetes.

We'll cook dishes specially made for people with diabetes and have everyone taste them. Most come in assuming the food will be bland and forgettable, then take a bite and find it surprisingly good. "Wait, something this delicious is really okay?" I hear that all the time.
Life is full of pleasures: food, movies, travel, books, music. So many things make life richer. Even in the middle of a busy schedule, I make time to play guitar with friends, a hobby I've kept since I was young.

Diabetes is no reason to give any of that up. You can make peace with the illness and still enjoy a great deal. Rather than letting treatment take over your life, I try to help patients find ways to enjoy themselves. That is the perspective I bring to their care.

The work ahead: spreading the word, and childhood obesity

The number of patients keeps rising, but diabetes specialists are still hard to find. Nationwide there are only about 6,700 of us, and some areas have almost none. So alongside my daily practice, I put real effort into getting the word out through lectures, interviews, and every kind of media. If people understand the disease and catch the warning signs early, I'm convinced a great many patients can be saved.

This work is aimed at young doctors too. I want to convey what makes diabetes care rewarding and, in the process, draw more specialists into the field. With that in mind, for the past fifteen years or so I've taught medical students and residents at Mie University Hospital. There's no telling how many will go into the field, but it's work I intend to keep doing.

However, the rise in childhood obesity has also been on my mind these past few years.
Diabetes has a reputation as a middle-aged person's disease, but that's no longer true. Kids stop at a convenience store on the way home for candy and ice cream, then play video games indoors. They move less, and the number of overweight children is unmistakably growing. I also serve as the school physician for a middle school, and doing the annual checkups, I can feel how many more students now trend toward obesity.

When these children grow up, their odds of developing a lifestyle-related disease are high. That is exactly why I think it matters to start thinking about healthy habits in childhood.

For a long, healthy, and full life

While I have the chance, here is what I want to say to as many people as possible: if a checkup at work or through your local government flags something abnormal, please don't ignore it. These diseases have a genetic component, so if diabetes or high blood pressure runs in your family, that's all the more reason to act with urgency. Lifestyle-related diseases rarely announce themselves, so finding an abnormality on a test is, in a way, a stroke of luck. Let it be a sign to take stock of your life and make a change for the better.

By the time symptoms appear, the disease has usually advanced a long way. That is what makes these conditions so dangerous. Notice the signs early, and once you do, act quickly. That, I believe, is what it takes to live a long and healthy life. For the sake of enjoying your own life to the fullest, that's the one thing I hope you'll never forget.