or 4.6 mmol/L most of the time. If this goal can be reached and maintained, further complications due to high blood sugar would stop, though earlier damage cannot be reversed. Diabetes is perfectly controlled, in effect "cured". (Bernstein 2011) The rationale behind the approach is what Bernstein calls "the law of small numbers" (Bernstein 2011). For Type 1 diabetics, there is always inevitable error in predicting the insulin dose to cover a meal, and this error is bigger when the meal is high-carb and the required insulin dose is bigger (inevitable error because the insulin absorption process is part of a complex system with non-linear dynamics, making exact predictions impossible). Restricting to small doses of both insulin and carbs reduces this error sharply and makes control more precise. In other words, taking small doses of insulin to cover a small dose of slow-acting carbs prevents inadvertent big under- or over- doses that could cause dangerous spikes or crashes in blood sugar. The logic extends somewhat to early-stage Type 2 diabetics who depend on their body's own erratic production of insulin. When smaller doses of insulin are needed from their body, their ability to control blood sugars improves. Bernstein's patients include vegetarians, for whom the low-carbohydrate meals include a variety of non-starchy vegetables, tofu, and cheese or yogurt where permitted. (Bernstein 2011) Controversy Dr. Bernstein contends that high blood sugars are the cause of all diabetic complications, and therefore that tightly controlling blood sugar eliminates complications. This contention was at first at odds with established medical opinion, as the sugar-complications link was not yet clearly established from scientific studies. A 1993 study supported Bernstein's position that tight control of blood sugar leads to better health. Bernstein's low-carbohydrate diet was initially opposed by the American Diabetes Association, which recommended a high-carbohydrate low-fat diet for diabetics. The ADA has since changed its position to allow a low-carbohydrate diet as an acceptable option for diabetics. The UK NHS has also introduced a low-carbohydrate plan for diabetics and prediabetics. Bernstein's focus on maintaining low blood sugar targets conflicts with mainstream guidance to maintain a higher fasting blood sugar target for insulin-dependent patients (such as Type 1 diabetics). This higher target is to reduce the risk of hypoglycemia which can be fatal. Type 1 diabetics on Bernstein's regime need to be constantly on guard against hypoglycemia. Bernstein claims however that the hypoglycemia risk is even higher