A driver is alleged to have received nine alarm notifications to check his blood glucose levels in the immediate lead up to the accident which killed five people outside a Daylesford hotel last month.
The driver has faced court with his defence lawyer describing the potential outcomes as "it's a lot of jail or no jail".
Mount Macedon man William Herbert Swale, 66, has appeared in the Melbourne Magistrates' Court by video link from custody at the Melbourne West Police Station, for a bail hearing after being charged on December 11.
The bail decision has been reserved until December 15, and Mr Swale will be remanded in custody until that date.
Mr Swale, who the court heard had a loving and supportive family, was silent throughout the process, appearing in a navy jumper and grey trousers, with a grey beard and moustache.
Defence lawyer indicates not-guilty plea to charges
Defence lawyer Martin Amad indicated Mr Swale intended to plead not guilty to all charges including five counts of culpable driving causing death.
He has also been charged with two counts of negligently causing serious injury and seven counts of reckless conduct endangering life.
Mr Swale was behind the wheel of the SUV that the prosecution said "failed to make a right hand turn" before colliding into picnic tables in Daylesford just after 6pm on November 5.
The prosecution said the retired father-of-two had lived with insulin-dependent diabetes since 1994 and had a conditional licence reliant on a medical assessment every two years.
The court heard he had one prior for speeding dating back to 1989 for which he was suspended for one month, and he had received 32 penalty notices - the latest in August 2022 - for driving matters including excessive speed.
Mr Swale had a low reading before the fatal collision
Mr Swale was described as "hypoglycemic aware" which meant he had the ability to sense warning signals such as hunger, tingling around the mouth and headaches.
The court also heard he had a continuous blood glucose monitoring device and could scan his arm to check his blood glucose, and receive an alarm through a mobile phone application.
The prosecution told the court Mr Swale completed his eighth scan for the day on the day of the Daylesford incident - November 5 - at 5.17pm and received a low reading of 2.9 mmol/L.
He then went into a local hospitality venue wanting to book a table but none were available.
He was then seen on CCTV driving in Camp Street at 5.42pm, when he stopped and performed a U-turn and then a right-turn into Albert Street.
He allegedly stopped halfway through Albert Street, which the prosecution alleged caused a witness to drive around him.
The fatal accident which killed five people then occurred at 6.07pm at wooden picnic tables outside the Royal Daylesford Hotel at the end of Albert Street.
Five killed in Daylesford tragedy from two families
A 38-year-old Tarneit man, his 11-year-old son and a Point Cook couple died at the scene - while a nine-year-old child of the Point Cook couple died later in hospital.
The court heard Mr Swale's vehicle hit a low steel power pole and a witness took the keys out of the the car.
The prosecution told the court he looked "sweaty, hot and clammy" and was described as unable to effectively communicate.
The prosecution allege Mr Swale received nine alarm notifications to check his blood glucose between 5.18pm and 6.06pm that evening before the accident.
His defence lawyer Mr Amad, in cross examining the police informant, put to him that the prosecution had no evidence that Mr Swale was in a "position to adequately understand the reading" of alarms beyond 5.17pm.
Detective Sergeant Peter Romanis agreed they did not have that evidence.
Court hears 'caveat' of traffic infringement history
Mr Amad said it was "inconsistent" with what his client had "always done" and that he may have been in the "midst of a medical episode".
"It must be looked at whether he voluntarily transgressed road laws," Mr Amad told the court.
While the court heard Mr Swale had no criminal priors, Magistrate Brett Sonnet highlighted the "caveat" that he had "an extensive history for traffic infringement notices".
The court heard the maximum penalty for culpable driving causing death was 20 years and Ms Swale faces five counts of this charge.
If he is found not guilty and the court deems the accident was caused by a medical episode, he may receive an acquittal.
Mr Swale's passport has been seized and he must not leave the state or country, nor drive.
A contested committal scheduled for April 2024 is expected to last for five days.
The court heard there were 140 potential witnesses although they were not all expected to be heard.
An independent endocrinologist is expected to be called, while the police prosecution have also approached the owners of the diabetes-related app about providing information for the case.