1. Diabetes and the Pancreas The New Epidemic William J. Hennen, PhD Chief Scientific Officer Brent Vaughan, MS RD R&D Scientist 1

2. Diabetes Mellitus Singapore Year % population with diabetes 19751.5 19844.7 19928.6 19989.6 The New Epidemic 2

3. Diabetes Mellitus Malaysia Year % population with diabetes 19600.6 19822.1 19957.7 19968.3 20049.0 The New Epidemic 2

4. Diabetes Mellitus Number of people with diabetes is on the rise. The New Epidemic 3

5. Ethic differences In Malaysia and Singapore, diabetes is most common in Indians ( 16 % ), followed by Malays ( 4.7 % ) and then Chinese ( limited data ).

6. Latest update!! World Health Organization survey on worldwide Diabetic population in 1997 is 135 million and estimated that by 2025 to be 300 million.

7. Latest update!! Population of diabetics in Singapore is 300,000.

8. Latest update!! 1 in 3 people in their 60’s will get diabetes. Accounts for 1 in 10 deaths in Singapore.

9. Cost $$$$ Costs depends on how serious the disease is. A diabetic person spends $ 1,600/yr on unsubsidized specialist outpatient care in public hospital. He spends $ 650/yr for subsidized outpatient care at a polyclinic. If his kidney fails, he will have to pay $ 12,400 / year for dialysis and diabetic treatment.

10. Latest update!! Surveys have shown that for every two known diabetics, there is at least one who never knew of having the disease Type 2 diabetes is no longer seen as a disease of the middle age or old age. Children as young as 10 years suffering from ( Type1 & Type 2 ) are uncommon now

11. Diabetes Mellitus Far reaching effects –Non-traumatic amputations (60% or 56,000) –Blindness ( 53 %) –Kidney disease (40% of all new cases) –200%-400% increased risk of cardiovascular disease The New Epidemic 4

12. Blood Glucose Stress General health Activity Consumption of food Factors 5

13. Diabetes Mellitus Children and adolescents (age <40) Frequent drinking, eating, urination Autoimmune Requires insulin Type I (5-10%) 6

14. Diabetes Mellitus Late onset, usually age >40 Insulin resistance and/or decreased insulin production Requires insulin in late stages Possible genetic link Immune component Type II (90-95%) 7

15. Diabetes Mellitus Vision (cataracts and glaucoma) Kidneys (loss of kidney function) Nerves (loss of sensation in hands and feet) Heart/Circulation (increased risk of heart attack and stroke, poor circulation) –Leading cause of death among diabetics. Secondary Conditions 8

16. Diabetes and Supplements Transfer Factor Fenugreek Bitter melon Gymnema Indian kino Korean ginseng Alpha Lipoic Acid Chromium Vanadium 9

17. Diabetes and Supplements Reduced blood sugar in mice. (Biotherapy. 1996;9(1-3):149-57) Type I diabetes has a dominant autoimmune component. (J Clin Invest. 2004 Feb;113(3):451-63.) –May be initiated through viral infections. (J Immunol. 2004 Mar 1;172(5):3173-80.) Increased immune activation and low- grade inflammation in type II diabetes. (Diabetes Care. 2004 Mar;27(3):813-23.) –Autoimmune mechanism possible. (Minerva Endocrinol. 2003 Dec;28(4):297-312.) Transfer Factor - Immunity 10

18. Diabetes and Supplements Stimulates ß-cell activity. (Am J Physiol 1999 Oct;277(4 pt 1):E617-23.;Diabetes 1998 Feb;47(2):206-10.) Synergistic effect with vanadium: lowering dose and improving safety. (Indian J Exp Biol 1999 Feb;37(2):193-5.;Indian J Exp Biol 1999 Feb;37(2):196-9.) Lowers plasma glucose. (East Mediterr Health J 2000 Jan;6(1):83-8.;Eur J Clin Nutr 1988 Jan;42(1):51-4.) Fenugreek (Trigonella foenum-graecum) 11

19. Diabetes and Supplements Improved glucose utilization in humans; lowering fasting and meal-time levels. (J Ethnopharmacol 1986 Sep;17(3):277-82.;Bangladesh Med Res Counc Bull 1999 Apr;25(1):11-3.) May have insulin-like or insulin-stimulating action. ( Int J Biochem 1989;21(2):149-55.;J Ethnopharmacol 1985 Jul;13(3):313-21.) May help repair damaged ß cells. (J Ethnopharmacol 2000 Nov;73(1-2):71-9.; Diabetes Res Clin Pract 1998 Jun;40(3):145-51.) Lowers synthesis of glucose. (Biochem J 1993 May 15;292(pt1):267-70.) Bitter Melon (Momordica charantia) 12

20. Diabetes and Supplements Lowered plasma glucose in both type I and type II diabetics. (J Ethnopharmacol 1990 Oct;30(3):295-300.; J Ethnopharmacol 1990 Oct;30(3):281-94.) Increased insulin release. (J Endocrinol 1999 Nov;163(2):207-12.) Decreased glucose absorption. (J Vet Med Sci 1997 Apr;59(4):245-51.) Gymnema (Gymnema sylvestre) 13

21. Diabetes and Supplements Insulin-like properties (Acta Diabetol Lat 1989 Oct-Dec;26(4):291-300.) Lowers plasma glucose. (J Ethnopharmacol 2002 Jan;79(1):95-100.; J Nat Prod 1983 Mar-Apr;46(2):232-4.) Able to reverse experimentally- induced diabetes in animals. (J Nat Prod 1983 Mar-Apr;46(2):232-4.) Indian Kino (Pterocarpus marsupium) 14

22. Diabetes and Supplements Benefits in both short-term and long- term plasma glucose control in humans. (Diabetes Care 1995 Oct;18(10):1373-1375) –Possibly due to increased insulin sensitivity and/or secretion. –Other research suggests effects on glucose receptors and enzymes. (J Pharmacobiodyn 1981 Jun;4(6):410-417; Biol Pharm Bull 1996 Sep;19(9):1238-1240) Korean Ginseng (Panax ginseng) 15

23. Diabetes and Supplements May increase insulin sensitivity. (Diabetes Care 1999 Feb;22(2):280-7.) May prevent or reduce the symptoms of nerve damage. (Diabetes Care 2003 Mar;26(3):770-6.;Bull Exp Biol Med 2000 Oct;130(10):986-90.) –Improves peripheral nerve conduction –Antioxidant properties. Alpha Lipoic Acid 16

24. Diabetes and Supplements Improves diabetic glucose levels w/o affecting individuals with normal or low blood sugar. –Increases insulin receptor numbers and insulin binding at the receptor. (J Am Coll Nutr. 1999 Feb;18(1):6-12.;J Am Coll Nutr. 1998 Dec;17(6):548-55.) –1-2 months of dosing may be necessary Lowers serum insulin and glycosylated hemoglobin levels. (J Fam Pract. 1998 Jan;46(1):83-6.) Chromium 17

25. Diabetes and Supplements Inhibits the glucose from leaving cells. (Mol Cell Biochem 2002 Feb;231(1-2):23-35.;Metabolism 2000 Mar;49(3):400-10.) Targets muscle cells. (Physiol Behav 1993 Aug;54(2):407-9.;Mol Cell Biochem 1992 Feb 12;109(2):157-62.) May also lower insulin requirements in type I diabetics, based on rodent research. (Mol Cell Biochem. 2000 Mar;206(1-2):177-82.) Vanadium 18

26. Diabetes and Supplements Diabetes is one of the fastest growing diseases. –A major contributor to illness and death worldwide. Many supplements can aid the diabetic condition. –Increasing insulin secretion and/or sensitivity –Modifying the absorption of sugar –Altering the cellular movement of glucose. Key Points 19