1. Low Carbohydrate, Low Insulin, Moderate Protein, Healthy Fats AS THE BASIS FOR Blood Glucose Normalisation in Diabetes RON RAAB

2. In controlling blood glucose levels there is a lot of focus on insulin and tablets... but little on the effect of the food we eat.... R. Raab

3. “Nutritional management is commonly described as one of the cornerstones of diabetes care “… unfortunately, it is the cornerstone which may be least understood, most under- researched, and to which there is the poorest adherence.” -Peter Swift, Secretary-General, ISPAD, 2002

4. Current recommendations eg. “ Carbohydrate foods … need to be the basis of the eating plan and contribute 50% of the total energy intake. ” = 4 glucose tolerance tests daily = 56 spoons of sugar daily Diabetes Australia & Royal Aust College of GPs, Diabetes Management in General Practice 2009-10, p. 22

5. Increased insulin needs “ Both the quantity of carbohydrate and the quality of carbohydrate will affect blood glucose levels. The amount of carbohydrate has a larger effect on glycaemia than the quality. ” Diabetes Australia & Royal Aust College of GPs, Diabetes Management in General Practice 2009-10, p. 22

6. 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 R. Raab

8. Low Carbohydrate Diet is Better Because Smaller Quantity of CHO Less Insulin Required Much More Predictability and Much Less Variation In Blood Glucose Levels

9. “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 R. Raab

10. The effect on blood glucose of a 20% error in estimating CHO in a high CHO meal compared to a low CHO meal is much greater.

11. The timing of CHO as it enters the blood as glucose is “ significantly” Variable and unpredictable R. Raab

12. The effect on blood glucose of a 20% variation in insulin action (absorption) of a “large” insulin dose compared to a “low” insulin dose is much greater.

13. Severity of hypos Can be greatly reduced Less insulin = less risk of dangerously over-estimating and hypos R. Raab

14. Delayed stomach emptying resulting from nerve damage Mild discomfort to acute pain Carbohydrate processing becomes highly unpredictable High carb diets are very problematic Gastroparesis

15. Why did the high CHO diet advice evolve as part of the treatment of diabetes? R. Raab

16. World Diabetes Day Diabetes Association Breakfast

17. Don’t Confuse the Low Carb / Low GI Diet with “Radical” or “Fad” Diets R. Raab

18. In developing countries insulin costs families as much as 50% of their annual income. As a result of parents being unable to afford to buy insulin, a lot of children like me die. Helping children with Type 1 diabetes can be easier than you think.

19. Insulin for Life saves lives with insulin that would otherwise be wasted

20. Further information about Low Carb and Diabetes Metabolism Society nmsociety.org Diabetes Low Carb Resources, by Ron Raab www.diabetes-low-carb.org R. Raab