An expert doctor has identified diabetes as the likely cause of death for a woman who was warned off her insulin by a Chinese herbalist.
Suspended Chinese medicine practitioner Yun Sen Luo, 56 this month, pleaded not guilty to the manslaughter of the 56-year-old mother on June 8, 2018.
In evidence tendered to Sydney's Downing Centre District Court on Tuesday, cardiologist Cameron Holloway identified diabetic ketoacidosis - a condition caused when the body doesn't have enough insulin to survive - as the likely cause of death.
While the woman had suffered cardiac arrest, that was most likely triggered by her body's lack of insulin, Dr Holloway said.
Luo is accused of unlawfully killing the woman by gross criminal negligence, with the Crown alleging he had told her Western medications had caused toxins to form inside her body.
The herbalist and acupuncturist disputes that he was ever told of the mother's diabetes.
However, in a video of a search warrant played to the court last week, Luo can be heard telling police the woman was on medication for high blood sugar, which he had told her to discontinue.
Luo also said he was surprised to learn of the woman's death, telling detectives she had seemed OK, even the morning she died.
The woman's family has previously told the trial she struggled to eat, sleep and stay lucid in the days before her death, and was eventually placed in adult nappies.
However, Luo's barrister Peter Skinner is arguing it can't be proven beyond reasonable doubt that the omission of diabetic medicine was the main cause of death.
The Crown prosecutor on Tuesday asked Dr Holloway about whether indications of underlying heart disease gleaned from the woman's autopsy would warrant particular attention when determining why she died.
It was not unusual for a woman of that age, Dr Holloway said, but doctors could "never be sure" coronary disease wasn't a cause.
"There is no evidence of a heart attack, but I don't think it can be excluded."
The trial, before Judge John Pickering without a jury, continues.
