1. LOW CARBOHYDRATE, LOW INSULIN, MODERATE PROTEIN, HEALTHY FATS AS THE BASIS FOR BLOOD GLUCOSE NORMAIZATON IN DIABETES RON RAAB B.EC, PRESIDENT, INSULIN FOR LIFE AUSTRALIA

2. Much effort goes into refining insulin doses and types. But little focus seems to be on analysing the effect of that which insulin acts on..... the food we eat....

3. DON’T CONFUSE THE LOW CHO / LOW GI DIET WITH “RADICAL” OR “FAD” DIETS

4. WHY IS THE LOW CHO DIET BETTER? SMALLER QUANTITY OF CHO LESS INSULIN REQUIRED MUCH MORE PREDICTABILITY AND MUCH LESS VARIATION IN BLOOD GLUCOSE LEVELS

5. “HIGH” CHO DIET-one possible pattern RESULTS: MORE ACTUAL AND POTENTIAL VARIATION AND LESS PREDICTABILITY IN BLOOD GLUCOSE LEVELS WORSE OUTCOME TIME INSULIN ACTION (AMOUNT OF GLUCOSE LEAVING THE BLOOD) AMOUNT OF GLUCOSE ENTERING THE BLOOD

6. “HIGH” CHO DIET-another possible pattern RESULTS: MORE ACTUAL AND POTENTIAL VARIATION AND LESS PREDICTABILITY IN BLOOD GLUCOSE LEVELS WORSE OUTCOME TIME INSULIN ACTION (AMOUNT OF GLUCOSE LEAVING THE BLOOD) AMOUNT OF GLUCOSE ENTERING THE BLOOD

7. Usual recommended regime High Carb – High Insulin Usual recommended regime High Carb – High Insulin One of many unpredictable results Time (hours) 5 Food absorption – amount of glucose entering blood Insulin absorption – amount of glucose leaving blood Blood glucose level Result  Large and unpredictable variation in blood glucose levels

8. “LOW” CHO, LOW G.I DIET TIME INSULIN ACTION (AMOUNT OF GLUCOSE LEAVING THE BLOOD) AMOUNT OF GLUCOSE ENTERING THE BLOOD RESULTS: LESS ACTUAL AND POTENTIAL VARIATION AND MORE PREDICTABILITY IN BLOOD GLUCOSE LEVELS BETTER OUTCOME

9. The timing of CHO as it enters the blood as glucose is “ significantly” variable/unpredictable

10. Delayed stomach emptying (gastroparesis)

11. Variability in the timing of insulin absorption

12. Severity of hypos

13. Why did the high CHO diet advice evolve as part of the treatment of diabetes?

14. Example of a “low carb” meal: healthy protein source (eg fish), low-carb vegetables, salads, small amounts of slowly absorbed carb, etc Is low- carb, NOT no-carb... Compared to “high carb” meals such as: large amounts of pasta, bread, rice, fruit, high-carb vegetables, other carbs, etc. R. Raab

15. CONCLUSION

16. THE LOW CHO DIET BETTER BECAUSE SMALLER QUANTITY OF CHO LESS INSULIN REQUIRED MUCH MORE PREDICTABILITY AND MUCH LESS VARIATION IN BLOOD GLUCOSE LEVELS

17. Relationship between HbA1c and average finger blood glucose HbA1c of 9% = 260 mg/dl (14.4 mmol/l) HbA1c of 8% = 220 “ (12.2 “ ) HbA1c of 7% = 180 “ (10.0 “ ) HbA1c of 6% = 140 “ (7.7 “ ) HbA1c of 5% = 100 “ (5.5 “ )

18. One resource for further information www.diabetes-low-carb.org