Director's blog

FY2022 JURAKU Internal Medicine Clinic Homepage “Director’s Diary” Popularity Top 10

武本 重毅


The number of times our clinic articles have been viewed in FY2022 is 33,497 and is increasing.

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Influenza vaccination during steroid therapy



Antidiabetic Drugs of Attention Now: SGLT2 Inhibitor and Imeglimin Hydrochloride



Mitochondria where NMN works Part 7: Rejuvenation with antidiabetic drugs



A patient who was infected with COVID-19 and had aggravated colonic diverticulitis and narrowly escaped death



Erythropoietin discovered in Kumamoto



3. Relationship between gastrointestinal surgery and anemia



The secret of life is to obtain one “Geigetsu” Analects [Iseihen]



About autoimmune diseases, about patient suffering



Cosmetic Safety Issues: Food Allergies?



Mitochondria where NMN works Part 8: A new antidiabetic drug



This time, let’s introduce the 1st to 4th place again.


The first place

Influenza vaccination during steroid therapy


Categories: Diary, Nursing student Q&A, Cure at the pre-disease stage, Q&A from patients


A woman receiving oral steroid treatment came to receive an influenza vaccination. Looking at the contents, the oral dose was gradually reduced, and prednisone 20 mg/day is still being taken.


Steroids are used to treat allergies and connective tissue diseases because they reduce the immune response. It is also given with other anticancer drugs as a treatment for lymphoid tumors. However, steroid therapy should be performed while paying attention to side effects such as susceptibility to infection due to weakened immunity, diabetes, hyperlipidemia, and obesity due to metabolic effects, hypertension, osteoporosis, gastric mucosal disorders, and mental symptoms such as insomnia and depression.


Of course, live vaccines cannot be given during steroid therapy because they have strong side effects, but what about inactivated vaccines? In terms of side effects, there are no particular problems. However, how effective is it as a vaccine? It is thought that steroids suppress the process in which the information delivered by the vaccine is sufficiently transmitted to the cells of the immune system to produce antibodies against the influenza virus. In particular, it can be considered that the vaccine cannot be expected to be effective when the steroid dose is 20 mg/day of prednisone.


On the other hand, it can be said that the immunosuppressed state during oral steroid treatment is in a state of susceptibility to influenza virus infection. Sudden discontinuation of oral steroid treatment may exacerbate symptoms due to rebound, so the dose should be gradually reduced, that is, tapering off. It is difficult to know how many mg of prednisone should be reduced to achieve the normal level of vaccination effect, but according to the literature, it seems that vaccination is recommended at 5 mg/day.



2nd place

Antidiabetic Drugs of Attention Now: SGLT2 Inhibitor and Imeglimin Hydrochloride


Categories: Diary, Medical Topics


Diabetes treatment drugs are now used not only to lower blood sugar levels, but also to prescribe drugs that are expected to have further effects.

Among them, the drugs that I am paying particular attention to are SGLT2 inhibitors such as Suglat and Forxiga, and Twymeeg (Imeglimin hydrochloride).


First, let’s talk about SGLT2 inhibitors.

SGLT is a protein that plays a role in taking nutrients such as glucose and sodium into cells in the body. Among them, only SGLT2 exists exclusively in the proximal renal tubule of the kidney and has the function of reabsorbing glucose excreted in the urine.


In healthy people, it is not excreted as urinary sugar due to its function. It is excreted as urinary sugar in hyperglycemic conditions beyond the limit of SGLT2 reabsorption. And we know that the expression of SGLT2 is increased in diabetes. In other words, it creates a high blood sugar state.


Therefore, when SGLT2 inhibitors are used, glucose reabsorption from the proximal renal tubule is suppressed, which increases urinary sugar and improves hyperglycemia.

The effects of SGLT2 inhibitors do not stop there.

It is said to reduce body weight, lower blood pressure, and improve lipid abnormalities. Furthermore, it is also effective for chronic heart failure and chronic kidney disease, and it is expected that it will be possible to avoid the introduction of hemodialysis.


Next, I would like to talk about Twymeeg (Imeglimin hydrochloride).

It is a new class of oral hypoglycemic agents with a different structure and two mechanisms of hypoglycemic action from existing drugs. It is presumed that these actions are related to various actions mediated by mitochondria, and there seems to be some skepticism among diabetes specialists.


In fact, this mechanism is part of the rejuvenation activated by the action of NMN (nicotinamide mononucleotide), which I am interested in taking (sold at JURAKU Internal Medicine Clinic).


It is known that when NMN is taken orally, it changes to NAD+ in the body and activates sirtuin proteins to improve changes associated with aging in humans. Among these are the improvement of insulin secretion from the pancreas, the improvement of glucose metabolism in the liver, and the improvement of insulin action by increasing muscle mass and reducing fat.


In other words, it is a drug that works on rejuvenation (aging treatment) via mitochondria to prevent and treat the onset of diabetes associated with aging.

(Mechanism of action quoted from Twymeeg pamphlet and pharmaceutical company website)


At JURAKU Internal Medicine Clinic, we would like to contribute to your healthy life expectancy through treatments that lead to anti-aging.



3rd place

Mitochondria where NMN works Part 7: Rejuvenation with antidiabetic drugs


Categories: Diaries, Medical topics, Clinic management


Metformin, one of the antidiabetic drugs, has an effect similar to calorie restriction.

It works to limit mitochondrial metabolic reactions.


 Mitochondria, also known as the “power plants of the cell,” are responsible for converting glucose and other substances into energy, but Metformin has the effect of slowing this process.

Then AMPK (AMP-activated protein kinase) is activated.

AMPK is an enzyme that restores mitochondrial function when energy levels are low.


Metformin also increases the activity of SIRT1.

It has also been shown to have the effect of suppressing the metabolism of cancer cells and increasing the number of mitochondria.

It seems that the cells try to produce more mitochondria to compensate for the lack of mitochondrial function.


Thus, treatment of diabetes with Metformin may lead to healthy longevity.


And recently, anti-diabetic drugs have become available that are expected to contribute to healthier longevity.

Next time, I will introduce Twymeeg, which has been prescribed to multiple patients at our clinic and is highly rated.



4th place

A patient who was infected with COVID-19 and had aggravated colonic diverticulitis and narrowly escaped death


Categories: Diary, Medical Topics


Actually, I am an outpatient doctor at a hospital in the city from morning to evening on Saturdays.

It is a hospital known to those in the know as Shimada Hospital.

I became friends with the current chairman, and because our fathers were also friends, I started helping out three years ago.

Now, I see 25 to 30 patients a day, and before I knew it, I was a family doctor for about 250 people.


It is not uncommon for us to share various dramatic experiences in such a situation.

Let me introduce you to one of them.


As mentioned in the hospital director’s diary from the other day, the 8th wave of the new coronavirus infection is raging, and not only the number of infected people is increasing, but also the number of deaths is increasing, which is a big problem in Japan.


A man who visited the outpatient clinic last week was going to the hospital for treatment of a lifestyle-related disease, and I had been preaching the necessity of improving his eating habits and exercise therapy with a sour mouth.

In other words, there were several factors that aggravated COVID-19 infection.


He came into my clinic the other day with a refreshing look on his face (I felt that he had changed the moment I saw him).

Then I learned that he almost gave up his life, but luckily my friends operated on him and saved his life.


At the end of last year, he was infected with the new coronavirus (COVID-19) and started recuperating at home.

Two days later, an ambulance was called due to severe abdominal pain.

However, due to the medical situation as it is now, it seems that he continued to run for two hours in an ambulance just because he was infected with COVID-19.


And it was Kumamoto Central Hospital that finally reached out.

He underwent emergency surgery, had his colostomy installed, and was able to return to society safely.

It was a friend of mine who undertook the operation.

It seems that my friend came to the hospital room to see his face every day after the operation.

Hearing that, I myself was filled with gratitude for the encounters I had so far.


He is now seriously working on diet and exercise to close the colostomy.



武本 重毅