1. 1 © metabolic balance GmbH metabolic balance ® and Diabetes © Dr. Wolf Funfack, MD, Specialist in Internal Medicine/Nutritional Medicine

2. 2 © metabolic balance GmbH Diabetes worldwide

3. 3 © metabolic balance GmbH Diabetes worldwide Update 2012

4. 4 © metabolic balance GmbH Data from the Canadian Diabetes Association Prevalence of diabetes in Ontario adults >35 years (Canadian Journal of Diabetes 2009;33(1):35-45) yearcasespopulationPrevalence rate 1995341.8935 269.1076,49% 2000495.1345 996.2148,26% 2005707.1966 709.33810,54% WHO: Until 2030 an increase of 40% is estimated for Canada!

5. 5 © metabolic balance GmbH BMI and its sequelae From: Nature, special issue - Diabetes, 2001 Type 2 diabetes High blood pressure Gall stones Heart disease

6. 6 © metabolic balance GmbH Risk of developing diabetesWaist circumference in menin women Low risk< 94 cm (37) < 80 cm (31,5 inches) Slightly increased risk> 94 cm> 80 cm Significantly increased risk> 102 cm (40) > 88 cm (34,65 inches) Average waist circumference e.g. in Germany: Women = 89 cm men = 98 cm The risk of diabetes is halved with a weight loss of only 4 kg. Other risk factor: high levels of triglycerides. From: German Health Report Diabetes 2008 Waist measurement as a risk factor

7. 7 © metabolic balance GmbH Age at the time of diagnosisIn years 20 to <3015 to 20 30 to <4010 to 13 Over 652 to 5 Source: Health Report, German Federal Ministry of Health 2006 Women: 83 years Men: 78 years Reduced life expectancy due to diabetes Life expectancy in Germany

8. 8 © metabolic balance GmbH DiseaseRisk of disease for diabetics Circulatory disorders - affecting the heart - affecting the limbs 15 - 20 2 - 6 20 - 35 Stroke2 - 3 Blindness10 - 25 Chronic kidney failure15 - 20 The average risk of disease in the population is 1 Source: Health Report, German Federal Ministry of Health 2006 Increased risk of long term complications due to diabetes

9. 9 © metabolic balance GmbH Stroke:every 12 minutes Heart attack/amputation:every 19 minutes Dialysis dependence:every 60 minutes Blindness caused by diabetes:every 90 minutes Liebl et al DMW 2001;126 : 585-89 CODE-2 Study (Costs of Diabetes in Europe) The costs of diabetes in Europe

10. 10 © metabolic balance GmbH Pancreas High blood sugar Insulin release Glucose uptake from fat and muscle cells Normal blood sugar level Blood sugar regulation

11. 11 © metabolic balance GmbH Pancreas High blood sugar Low blood sugar Glucagon release Insulin release Glucose uptake from fat and muscle cells Glucose release by the liver Normal blood sugar level Blood sugar regulation

12. 12 © metabolic balance GmbH Insulin receptor Insulin Glucose Glucose transporter How does glucose reach the cell?

13. 13 © metabolic balance GmbH Glucose Muscle contraction Muscle contraction has the same effect as insulin! Glucose transporter Muscle contraction and glucose transporters Insulin receptor

14. 14 © metabolic balance GmbH Blood sugar and serum insulin during i.v. glucose tolerance test in 8 test subjects of normal weight and 10 obese subjects Source: from Karam, J.H. et al. 1963 Blood- sugar (mg%) Obese Minutes Normal weight persons Obese Serum- insulin (µE/ml) Minutes Normal weight persons Obese

15. 15 © metabolic balance GmbH Obesity and the metabolic syndrome Normal weightOverweightSlight obesitySevere obesity Age (years)11.711.912.811.3 MBI18.424.533.440.6 Glucose (mg %)87.486.889.689 Insulin (µU/ml)10.314.631.338.6 Triglyceride (mg %)48.483.1104.696.5 HDL-Chol. (mg %)58.546.741.139.9 CRP (mg %)0.010.050.130.33 493 children + adolescents (age 4 - 20) exclusion: medication to treat hypertension, diabetes or lipids (Source: R. Weiss, NEJM, June 3, 2004; 350: 2362-74)

16. 16 © metabolic balance GmbH Insulinresistance and muscles Muscle cells do not store fat anymore and release it to the blood! Fat is transported into the liver!

17. 17 © metabolic balance GmbH Fat is stored in the liver cells! They do not react on insulin anymore, so the release of glucose is not blocked! Fat from the liver is transported into the  and  -cells of the pancreas. Insulinresistance and the liver

18. 18 © metabolic balance GmbH Insulinresistant  -Cells produce more Glucagon! Insulinresistant  -Cells produce more Insulin! Insulinresistance and the pancreas

19. 19 © metabolic balance GmbH Insulinresistant cells of the brain cause stressreactions! In situations of stress the liver releases Glucose! Insulinresistance and the brain

20. 20 © metabolic balance GmbH In Insulinresistance The kidney increases the Glucose levels by: 1.Gluconeogenesis 2.Increased Glucose Reabsorption Gluoneogenesis in the kidney can Increase by 300%!! Insulinresistance and the kidneys

21. 21 © metabolic balance GmbH Fructose leads to faster fat storage Fructose‏Glucose Insulin dependent Metabolism Not insulin dependent Fatty liver disease! No storage Storage form

22. 22 © metabolic balance GmbH 62,5 % of participatns reduced their weight by more than 5% and maintained it at least for one year. 50 % of participants need to reduce their weight by more than 5% and need to maintain it for more than one year. metabolic balance ® International recommendations for long-term success of an efficient weigh management program Reduction in Body Weight

23. 23 © metabolic balance GmbH Jolly, Kate et al. BMJ, 2011, 343; d6.500 “Comparison of range of commercial or primary care led weight reduction programmes. randomised controlled trial” 62,5% metabolic balance ® 50% Comparison of weight reduction programs

24. 24 © metabolic balance GmbH 53 % of diabetics could stop their insulin even after 1 year. Results of the evaluation study insulin requirements) Before End Before the study 8,3% of the participants were treated with insulin End of the study 3,9% were still on insulin

25. 25 © metabolic balance GmbH Mr G. L. a 47 year old teacher, with Type 2 diabetes, hypertension and impaired lipometabolism Medication: Depot insulin:morning 32 I.U., evening 16 I.U. short-acting insulin:3x a day before meals depending on blood sugar values between12 and 18 I.U. daily insulin dose 70 - 90 I.U. Hypertension:80 mg Metoprolol, 10 mg Amlodipin, 16 mg Valsartan, Other drugs:40 mg Simvastatin, 100 mg aspirin Omeprazol 20 mg if required for stomach ache. Case history

26. 26 © metabolic balance GmbH After 2 weeks: Weight loss 8.4 kg, depot insulin:only 1 x 12 I.U. before meals; short-acting insulin:between 8 and 12 I.U. other medication: 20 mg Metoprolol, 8 mg Valsartan, Amlodipin and Simvastatin were discontinued. It was no longer necessary to take Omeprazol at this stage. Case history

27. 27 © metabolic balance GmbH In the 4th week: Weight loss has plateaued, frequent low sugar and hunger pangs during the day. He has been exercising more in the last week, e.g. Nordic walking and 1 day in the gym. Fasting blood sugar was higher in the morning than in the evening even if he did not eat anything in the night. Case history After this, depot insulin was discontinued

28. 28 © metabolic balance GmbH Comparison of values at the start and end Initial weight:127.0 kgBMI: 40,1 Height: 1.78 m Final weight:86.4 kgBMI: 27.3 All medications were discontinued Case history

29. 29 © metabolic balance GmbH BPHRChol.LDLHDLTrigl.HBA1cLDL/HDL 02.04.2008166/11088/min278183392647.64.7 25.08.2008125/8072/min167119531346.22.2 Case history

30. 30 © metabolic balance GmbH Source: http://www.evolvehealth.nl/mental-coaching/ metabolicbalance® Get Dr. Funfack's eBook at Amazon.Com “metabolic balance® – Nutrition basics: Introduction to the success program” metabolicbalance® Get Dr. Funfack's Book through our Offices „metabolic balance® – Your Personalized Nutrition Roadmap“ www.metabolic- balance.com 3.Contact one of our Coaches via www.metabolic- balance.com Canada: 4.Contact our Canadian Office Canada: 1-289-291-3959 Take the next Step

31. 31 © metabolic balance GmbH Many thanks for your attention!