Laboratory values such as blood glucose and acetone are only signs of the body's changing strategy and not causes; there is no need to measure glucose or blood pressure.
Original statement
انا مش عايز قياس لحاجه لا ضغط ولا سكر ولا الكلام ده كله
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
Laboratory values such as blood glucose and acetone are only signs of the body's changing strategy and not causes; there is no need to measure glucose or blood pressure.
Origin
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- ارتفاع السكر والأسيتون ؟خطر والا ده الطبيعي ؟#ضياء_العوضي (Open source)
- Published
- 23 December 2025
- Timestamp
- 0:28:42 (location in the original video’s automatic YouTube caption track; confirms where the words occur, not who speaks)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.
- Claimed mechanism
Lab values reflect adaptation, not disease.
- Claimed health effect
Abandoning monitoring
- Population concerned
People with diabetes
- Geographic restriction by Elawady
none found
Diverging source versions
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- بيان فلسفه النظريه (Open source)
- Published
- 14 February 2026
- Timestamp
- not available (transcript has no timings)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.
Scientific assessment
False – The statement contradicts the robust evidence.
Certainty of evidence: high – Further research is very unlikely to change the assessment.
1. What was claimed?
Measuring glucose and ketones is unnecessary/misleading.
2. What is demonstrably correct?
A single lab value should be interpreted in clinical context; treating numbers alone without regard to the person can cause harm (e.g. aggressive targets, C-INS-04). For people with type 2 diabetes who do not use insulin and are moderately controlled, routine daily finger-prick testing did not improve HbA1c or quality of life in a randomised trial (I-DIAB-111).
3. What is wrong or exaggerated?
Glucose and ketone measurements identify DKA, hyperosmolar states and hypoglycaemia (I-INS-07, I-INS-08). ADA 2026: 'Individuals at risk for DKA should measure ketones in the presence of symptoms and potential precipitating factors' (I-INS-10). HbA1c predicts complications (I-INS-04).
4. What remains unclear?
No data were found on how many followers stopped measuring glucose or blood pressure, or with what outcomes.
5. Which studies support it?
None.
6. Which studies contradict it?
I-INS-07, I-INS-08, I-INS-10, I-INS-04, I-DIAB-109 (blood ketone monitoring halved hospital/emergency visits), I-DIAB-110, I-DIAB-112 (BP lowering reduces death and stroke), I-DIAB-114, I-INS-133, I-INS-112.
7. What applies to Germany and Europe?
European (EASD) and German (DDG) guidance follow the same evidence base as the ADA/EASD consensus: individualised HbA1c targets, insulin as mandatory therapy in type 1 diabetes, and SGLT2 inhibitors/GLP-1 receptor agonists for people with cardiovascular or kidney disease. No country-specific difference changes the assessment.
8. What is known about Egypt?
Egypt has one of the highest diabetes prevalences in the region; the same drug classes and insulins are used. Access barriers and cost may make advice to stop medication attractive, which increases the practical risk of this claim. No Egypt-specific evidence changes the assessment.
9. What practical conclusion is appropriate?
People with diabetes should keep monitoring glucose (and ketones when indicated).
Assessment details
- Rationale for certainty of evidence
Glucose and ketone monitoring is the basis for preventing and detecting hypoglycaemia and DKA; ADA recommends ketone measurement for people at risk. Ignoring measurements removes the main safety net.
- Source quality
Own words, machine transcript.
- Regional transferability
Universal.
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Scientifically refuted – High-quality evidence shows the opposite, or the claim contradicts well-established physiology.
Research question: In people with diabetes, does measuring blood glucose, ketones and blood pressure improve outcomes compared with not measuring?
Research question in detail (PICO)
- Population
- People with type 1 and type 2 diabetes
- Intervention or exposure
- Glucose, ketone and blood-pressure monitoring
- Comparison
- No monitoring
- Geographic scope
- universal biology
- Outcomes
- DKA/hospitalisation
- HbA1c
- Mortality and cardiovascular events (BP)
- Hypoglycaemia
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
Daily finger-prick tests in type 2 diabetes without insulin
Young LA et al.. JAMA Intern Med 2017 · PMID 28600913 · DOI 10.1001/jamainternmed.2017.1233 Randomised controlled trialabstract checkednewly addedMonitor Trial: routine daily finger-prick testing in non-insulin-treated T2D.
- Actual result
- HbA1c difference -0.05% (-0.27 to 0.17); no QoL benefit.
- Methodological quality
- high (pragmatic RCT)
- Relevance
- direct for a narrow subgroup (T2D without insulin, moderate control)
- Limitations
- Does not concern insulin users, ketones, HbA1c or BP.
What speaks against the claim?
Checking blood ketones on sick days in young people with type 1 diabetes
Laffel LM et al.. Diabet Med 2006 · PMID 16492211 · DOI 10.1111/j.1464-5491.2005.01771.x Randomised controlled trialabstract checkednewly addedBlood ketone monitoring on sick days in young people with T1D.
- Actual result
- Hospital/emergency visits 38 vs 75 per 100 patient-years.
- Methodological quality
- moderate (small RCT)
- Relevance
- direct
- Limitations
- Small; P=0.05.
Lowering blood pressure in type 2 diabetes
Emdin CA et al.. JAMA 2015 · PMID 25668264 · DOI 10.1001/jama.2014.18574 Meta-analysisabstract checkednewly addedMeta-analysis of BP lowering in T2D.
- Actual result
- Per 10 mmHg: death RR 0.87 (0.78-0.96), stroke 0.73 (0.64-0.83).
- Methodological quality
- high (40 RCTs)
- Relevance
- direct (BP must be measured to be treated)
- Limitations
- Fixed-effects.
International guideline on diabetic ketoacidosis
Umpierrez GE et al.. Diabetes Care 2024 · PMID 39052901 · DOI 10.2337/dci24-0032 Guideline / position statementfull text checked2024 hyperglycaemic crises consensus: glucose and ketone measurement define and guide DKA treatment.
- Actual result
- Treated DKA mortality <1%.
- Methodological quality
- high (international consensus)
- Relevance
- direct
- Limitations
- Consensus.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
Glucose, ketone and BP measurement are necessary safety tools; routine daily self-testing is of limited value only for non-insulin-treated T2D.
Why some studies weigh more
Guidelines, RCT and meta-analytic evidence on ketones and BP outweigh a single null trial in a low-risk subgroup.
Is a causal relationship established? Probable Monitoring enables treatment that has proven benefit (BP lowering, insulin adjustment, DKA treatment); monitoring itself is a tool.
Remaining uncertainty
Optimal frequency of self-testing in non-insulin T2D.
Justified conclusion
False as a general rule; dangerous for insulin users.
Why do studies seem to disagree?
The Monitor Trial (I-DIAB-111) answers a different question (routine SMBG in non-insulin T2D) from ketone monitoring in insulin-deficient people (I-DIAB-109) or BP measurement (I-DIAB-112).
Does this depend on the country?
- General biological effects
- Insulin physiology, autoimmune type 1 diabetes and ketoacidosis are universal human biology.
- Eating habits
- Egyptian and European diets differ, but no dietary pattern replaces insulin in insulin-deficient diabetes.
- Origin of the food
- Not relevant.
- Contaminants
- Not relevant.
- National production conditions
- Not relevant.
- Legal rules
- Insulin is an essential medicine (WHO list) in Egypt and the EU; prescription rules not relevant to the scientific question.
- Actual monitoring data
- In Egypt, severe DKA at presentation is common in children (I-INS-115); early ketone measurement is especially relevant.
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- Rate ratio of hospital/emergency visits – About 0.51; CI not recomputable from abstract recalculated
- Relative vs absolute effect – RR 0.87 for death corresponds to an ARR of 3.16 per 1000 patient-years (reported) not recalculable from the published data
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Hospitalisation/DKA and cardiovascular outcomes with vs without monitoring
- Starting level
- high (randomised trials)
- Reasons for downgrading
- indirectness (monitoring as enabler of treatment)
- Result
- moderate
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- ADA: 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026 (2026) · Original publication
People at risk for DKA should have ketone testing tools and sick-day advice; people on intensive insulin therapy should not stop or hold basal insulin even if not eating; caution with near-normal A1C goals in long-standing T2D using hypoglycaemia-prone drugs (ACCORD). - ADA: 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2026 (2026) · Original publication
Rec 10.1: measure blood pressure at every routine visit or at least every 6 months; rec 10.2 (A): home BP monitoring for people with hypertension and diabetes. - ADA/EASD: The management of type 1 diabetes in adults: updated 2026 consensus report (2026) · Original publication
'Lifelong insulin therapy is essential in type 1 diabetes'; all individuals need glucose and ketone testing supplies; insulin omission or under-dosing is a DKA precipitant. - NICE: NG17 Type 1 diabetes in adults (last updated 17 August 2022) (2022) · Original publication
Basal-bolus insulin for all adults with T1D (1.7.1); ketone monitoring in sick-day rules (1.10.1); DKA: isotonic saline and IV insulin infusion (1.10.5-1.10.7). - NICE: NG18 Diabetes in children and young people (last updated 11 May 2023) (2023) · Original publication
Basal-bolus insulin from diagnosis (1.2.18); blood ketone testing and sick-day rules (1.2.82-1.2.83); DKA is serious and needs urgent hospital IV fluids and insulin (1.4.6, 1.4.21); DKA can occur with normal glucose (1.4.3). - ADA/EASD/JBDS/AACE/DTS: Hyperglycemic Crises in Adults With Diabetes: A Consensus Report (I-INS-07) (2024) · Original publication
Insulin is 'the cornerstone of DKA management'; isotonic fluids 500-1,000 mL/h initially; potassium replacement; treated DKA mortality <1%; glucocorticoids can precipitate hyperglycaemia.
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| PubMed | 26 October 2026 | "self-monitoring of blood glucose" AND "non-insulin" AND "type 2 diabetes" AND randomized AND JAMA Intern Med[ta] | supporting evidence | 1 | |
| PubMed | 26 October 2026 | (laboratory monitoring OR "glucose monitoring") AND diabetes AND (unnecessary OR "no benefit" OR overuse) AND randomized | supporting evidence | 15 | |
| Europe PMC | 26 October 2026 | ("self-monitoring of blood glucose") AND ("non-insulin" OR "not using insulin") AND (TITLE:"meta-analysis" OR TITLE:"systematic review") | supporting evidence | 96 | |
| PubMed | 26 October 2026 | (blood ketone OR beta-hydroxybutyrate) AND (sick day OR "sick-day") AND randomized | contradicting evidence | 5 | |
| PubMed | 26 October 2026 | "self-monitoring of blood glucose" AND "type 1 diabetes" AND HbA1c AND frequency AND (registry OR exchange) | contradicting evidence | 15 | |
| Europe PMC | 26 October 2026 | ("blood ketone" OR "ketone monitoring" OR "ketone testing") AND ("diabetic ketoacidosis") AND (prevention OR hospitalization OR admission) AND (type 1 diabetes) | contradicting evidence | 722 | |
| Europe PMC | 26 October 2026 | "ketone" AND "diabetic ketoacidosis" AND ("sick day" OR "sick-day") AND (TITLE:"monitoring" OR TITLE:"ketone") | contradicting evidence | 19 | |
| PubMed | 26 October 2026 | Emdin CA[au] AND "blood pressure lowering" AND diabetes AND JAMA[ta] | contradicting evidence | 1 | |
| PMC (publisher full text) | 26 October 2026 | Fetched ADA Standards of Care 2026 sections 2, 6, 8, 10, 14, 16 at pmc.ncbi.nlm.nih.gov/articles/PMC12690183, PMC12690178, PMC12690172, PMC12690187, PMC12690182, PMC12690180 | guidelines | 6 | |
| Springer (publisher full text) | 26 October 2026 | Fetched https://link.springer.com/article/10.1007/s00125-026-06833-z (ADA/EASD 2026 T1D consensus) | guidelines | 1 | |
| Guideline websites (NICE) | 26 October 2026 | Fetched https://www.nice.org.uk/guidance/ng17/chapter/Recommendations and /ng18/chapter/Recommendations | guidelines | 2 |
How deeply was this checked?
13 linked studies: 6 checked in full text (1 of them with a structured risk-of-bias assessment), 7 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: False (high)
- 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: False (high)
The claim's core (no need to measure glucose, ketones or blood pressure) is contradicted by guidelines and trial evidence. The new Monitor Trial adds a fair nuance for non-insulin T2D but does not change the verdict.
New sources: I-DIAB-109 I-DIAB-110 I-DIAB-111 I-DIAB-112 I-DIAB-114 I-INS-133 I-INS-112
In plain language
Blood sugar and ketone tests are like warning lights. They show early when sugar is dangerously high or low, or when acids are building up. Not measuring removes the chance to act before an emergency.
Studies on this claim
Studies supporting the claim (0)
No studies in this group.
Studies contradicting or limiting the claim (12)
-
International guideline on diabetic ketoacidosis
Umpierrez GE et al.. Diabetes Care 2024 · PMID 39052901 · DOI 10.2337/dci24-0032Guideline / position statementindependent cross-checkfull text checked★ key studyInsulin, fluids and potassium are the core treatment; with this, fewer than 1% of adults die.
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Diagnosis and management of DKA and HHS in adults
- How was the study done?
International consensus report based on systematic examination of literature since 2009 (ADA, EASD, JBDS, AACE, DTS)
- How many people, animals or samples were studied?
not applicable; Adults with diabetes
- What was actually found?
Insulin is the cornerstone; glucocorticoids worsen hyperglycaemia.
- How large was the observed effect?
Mortality <1% with treatment
- What do the results mean in everyday life?
Ketoacidosis needs hospital treatment with insulin.
- What are the study's limitations?
Consensus, not trial
- What does it say about Elawady's specific claim?
Directly contradicts C-INS-08; supports danger in C-FAST-03; contradicts C-INS-07, C-INS-10.
- Do the results apply to Germany and Europe?
EASD and JBDS (UK) co-authored; directly applicable.
- What can explicitly not be concluded from this study?
Outcomes of untreated DKA quantitatively.
-
Review on diabetic ketoacidosis
Dhatariya KK et al.. Nat Rev Dis Primers 2020 · PMID 32409703 · DOI 10.1038/s41572-020-0165-1Narrative reviewindependent cross-checkfull text, structured risk-of-bias assessmentDKA is an emergency that can kill; it is treated with fluids, insulin and salts, and insulin must not be stopped in type 1 diabetes even when not eating.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Epidemiology, pathogenesis, diagnosis and management of DKA
- How was the study done?
Narrative expert review (Nature Reviews Disease Primers)
- How many people, animals or samples were studied?
not applicable; Adults and children with diabetes
- What was actually found?
DKA is diagnosed by high glucose, ketones and acid; it kills <1% when treated in rich countries but up to 26-41% where treatment is lacking; treatment is fluids, insulin and potassium, and insulin must never be stopped in type 1 diabetes even when not eating.
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
DKA is an emergency.
- What are the study's limitations?
Narrative expert review without systematic methods; one author has research support from insulin makers.
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
International.
- What can explicitly not be concluded from this study?
Quantitative estimates.
-
ADA guideline 2026: blood sugar goals and emergencies
American Diabetes Association Professional Practice Committee for Diabetes* . Diabetes Care 2026 · PMID 41358894 · DOI 10.2337/dc26-S006Guideline / position statementindependent cross-checkfull text checked★ key studyMost adults should aim for HbA1c below 7%, avoid low sugar, and measure ketones when at risk.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Glycaemic goals, hypoglycaemia and hyperglycaemic crises
- How was the study done?
Clinical practice guideline (ADA Standards of Care 2026, Section 6)
- How many people, animals or samples were studied?
not applicable; People with diabetes
- What was actually found?
Individual targets; do not stop basal insulin when not eating.
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
Moderate targets and safety rules.
- What are the study's limitations?
US-centred; Partially read
- What does it say about Elawady's specific claim?
Supports C-INS-04, C-INS-11; contradicts C-FAST-01, C-FAST-03, C-DIAB-02.
- Do the results apply to Germany and Europe?
Consistent with EASD guidance.
- What can explicitly not be concluded from this study?
Not applicable.
-
How much long-term blood sugar matters (UKPDS 35)
Stratton IM et al.. BMJ 2000 · PMID 10938048 · DOI 10.1136/bmj.321.7258.405Cohort studyindependent cross-checkabstract checked★ key studyEach 1% lower HbA1c was linked to 21% fewer diabetes deaths and 37% fewer eye/kidney complications.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Relation of glycaemia over time to complications
- How was the study done?
Prospective observational analysis within UKPDS (UKPDS 35)
- How many people, animals or samples were studied?
4,585 (3,642 for RR); UKPDS patients (white, Asian Indian, Afro-Caribbean)
- What was actually found?
Graded risk with HbA1c, no threshold.
- How large was the observed effect?
-21% per 1% HbA1c
- What do the results mean in everyday life?
High sugar damages the body.
- What are the study's limitations?
Observational
- What does it say about Elawady's specific claim?
Contradicts C-DIAB-01, C-DIAB-02, C-ODD-06 (hyperglycaemia causes complications incl. amputation).
- Do the results apply to Germany and Europe?
UK.
- What can explicitly not be concluded from this study?
That pushing HbA1c to normal is always safe.
-
Checking blood ketones on sick days in young people with type 1 diabetes
Laffel LM et al.. Diabet Med 2006 · PMID 16492211 · DOI 10.1111/j.1464-5491.2005.01771.xRandomised controlled trialindependent cross-checkabstract checked★ key studyYoung people who checked blood ketones when sick needed hospital or emergency care about half as often as those using urine strips.
Blood ketone monitoring halved hospital/emergency visits (38 vs 75 per 100 PY).
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Compare blood vs urine ketone testing.
- How was the study done?
Randomised trial.
- How many people, animals or samples were studied?
123 young people.
- What was actually found?
38 vs 75 hospital/emergency visits per 100 patient-years.
- How large was the observed effect?
Rate ratio about 0.51.
- What do the results mean in everyday life?
Measuring ketones helps avoid emergencies.
- What are the study's limitations?
Small; borderline P.
- What does it say about Elawady's specific claim?
Contradicts 'no need to measure acetone'.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot give exact size of benefit.
-
Checking blood sugar more often goes with better control in type 1 diabetes
Miller KM et al.. Diabetes Care 2013 · PMID 23378621 · DOI 10.2337/dc12-1770Cross-sectional studyindependent cross-checkabstract checked★ key studyAmong 20,555 people with type 1 diabetes, those who checked blood sugar more often had lower HbA1c.
More frequent glucose checks associated with lower HbA1c in T1D.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Relate glucose testing frequency to HbA1c.
- How was the study done?
Registry analysis.
- How many people, animals or samples were studied?
20,555 people.
- What was actually found?
More checks, lower HbA1c.
- How large was the observed effect?
Not in abstract.
- What do the results mean in everyday life?
Measuring helps people on insulin manage diabetes.
- What are the study's limitations?
Observational.
- What does it say about Elawady's specific claim?
Contradicts 'no need to measure glucose'.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot prove causation.
-
Lowering blood pressure in type 2 diabetes
Emdin CA et al.. JAMA 2015 · PMID 25668264 · DOI 10.1001/jama.2014.18574Meta-analysisindependent cross-checkabstract checked★ key studyIn 40 trials with 100,354 people, each 10 mmHg lower systolic pressure reduced deaths by 13% and strokes by 27%.
BP lowering reduces mortality (RR 0.87 per 10 mmHg) in T2D; requires measurement.
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Quantify benefits of BP lowering in T2D.
- How was the study done?
Meta-analysis of 40 RCTs.
- How many people, animals or samples were studied?
100,354 people.
- What was actually found?
Death RR 0.87, stroke 0.73 per 10 mmHg.
- How large was the observed effect?
ARR 3.16 deaths per 1000 patient-years.
- What do the results mean in everyday life?
Measuring and treating blood pressure protects people with diabetes.
- What are the study's limitations?
Fixed-effects model.
- What does it say about Elawady's specific claim?
Contradicts 'no need to measure blood pressure'.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot define the optimal BP target for every person.
-
US diabetes standards 2026: blood pressure
American Diabetes Association Professional Practice Committee for Diabetes. Diabetes Care 2026 · PMID 41358899 · DOI 10.2337/dc26-S010Guideline / position statementindependent cross-checkfull text checked★ key studyBlood pressure should be measured at every visit, and people with diabetes and hypertension should check it at home.
BP at every visit; home monitoring for hypertension (A).
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Guide CV risk care.
- How was the study done?
Guideline.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
Measure BP every visit.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Regular BP checks protect heart, brain and kidneys.
- What are the study's limitations?
Guideline.
- What does it say about Elawady's specific claim?
Contradicts C-DIAB-02.
- Do the results apply to Germany and Europe?
European guidance agrees.
- What can explicitly not be concluded from this study?
Not applicable.
-
European and US consensus 2026 on type 1 diabetes in adults
Holt RIG et al.. Diabetologia 2026 · PMID 42747450 · DOI 10.1007/s00125-026-06833-zGuideline / position statementindependent cross-checkfull text checked★ key studyLifelong insulin is essential in type 1 diabetes, and everyone with type 1 diabetes should be able to test glucose and ketones.
All people with T1D need glucose and ketone testing supplies.
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Update guidance on adult T1D care.
- How was the study done?
Consensus report.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
Insulin lifelong and essential; ketone testing for all.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
People with type 1 diabetes must never stop insulin.
- What are the study's limitations?
Consensus.
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
European (EASD) guidance.
- What can explicitly not be concluded from this study?
Not applicable.
-
Fasting, lack of water and ketoacidosis in type 1 diabetes
Burge MR et al.. Metabolism 2001 · PMID 11229425 · DOI 10.1053/meta.2001.20194Otherindependent cross-checkabstract checked★ key studyWhen insulin was stopped, prior fasting lowered blood sugar but made ketones and acid build up faster; lack of water raised both sugar and ketones.
Glucose can be lower during fasting while ketoacidosis progresses; ketone measurement is needed.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Study how fasting and dehydration influence DKA development.
- How was the study done?
Short insulin withdrawal experiments.
- How many people, animals or samples were studied?
25 adults with T1D.
- What was actually found?
Fasting: lower glucose but faster ketosis; dehydration: higher glucose and faster ketosis.
- How large was the observed effect?
Not given in abstract.
- What do the results mean in everyday life?
Fasting can hide danger: sugar falls while acid rises.
- What are the study's limitations?
Small study.
- What does it say about Elawady's specific claim?
Contradicts dry fasting as DKA treatment.
- Do the results apply to Germany and Europe?
Universal physiology.
- What can explicitly not be concluded from this study?
Cannot give clinical outcome rates.
-
NICE guideline NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management
National Institute for Health and Care Excellence (NICE). NICE guideline 2015Guideline / position statementindependent cross-checkfull text checked★ key studyUK paediatric guideline: insulin from diagnosis; DKA needs urgent hospital IV fluids and insulin; honeymoon phase is temporary.
Blood ketone testing and sick-day rules.
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
National guidance.
- How was the study done?
Evidence-based guideline.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
Rec 1.2.18: offer children and young people with T1D a multiple daily injection basal-bolus insulin regimen from diagnosis. Recs 1.2.82-1.2.83: sick-day rules including blood ketone monitoring; offer blood ketone strips and meter. Rec 1.4.3: children taking insulin may develop DKA with normal blood glucose. Rec 1.4.6: explain that DKA is serious and needs urgent hospital assessment. Rec 1.4.21: treat DKA with intravenous fluids and intravenous insulin if the child is not alert, nauseated/vomiting or clinically dehydrated. Rec 1.2.25: explain the partial remission ('honeymoon') phase with low insulin needs.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
UK paediatric guideline: insulin from diagnosis; DKA needs urgent hospital IV fluids and insulin; honeymoon phase is temporary.
- What are the study's limitations?
Guideline.
- What does it say about Elawady's specific claim?
Contradicts insulin-free management.
- Do the results apply to Germany and Europe?
UK.
- What can explicitly not be concluded from this study?
Not applicable.
-
Ketoacidosis during very-low-carbohydrate diets
Roberts CGP et al.. Diabetes Obes Metab 2025 · PMID 39996364 · DOI 10.1111/dom.16252Cohort studyindependent cross-checkabstract checked★ key studyDKA was rare (about 1 per 1000 patient-years in type 2 diabetes) in a supervised programme, but almost three times higher with SGLT2 inhibitors.
Authors recommend home ketone monitoring to manage DKA risk.
Does the study support the specific claim? Partly · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Measure ketosis-related illness on ketogenic diets.
- How was the study done?
Retrospective programme data.
- How many people, animals or samples were studied?
72,751 patient-years.
- What was actually found?
DKA 1.01/1000 PY in T2D; 2.90 with SGLT2 inhibitors.
- How large was the observed effect?
Rates as reported.
- What do the results mean in everyday life?
Diet changes in diabetes need medical supervision and ketone checks.
- What are the study's limitations?
Programme data; no T1D.
- What does it say about Elawady's specific claim?
Supports supervision and monitoring, not stopping medicines alone.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot address type 1 diabetes.
No study in this group is marked as key.
Studies with mixed or unclear results (1)
-
Daily finger-prick tests in type 2 diabetes without insulin
Young LA et al.. JAMA Intern Med 2017 · PMID 28600913 · DOI 10.1001/jamainternmed.2017.1233Randomised controlled trialindependent cross-checkabstract checked★ key studyFor people with type 2 diabetes not using insulin, daily self-testing did not improve HbA1c or quality of life over one year.
Routine SMBG did not help non-insulin-treated T2D; does not apply to insulin users, ketones or BP.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Test routine SMBG in non-insulin T2D.
- How was the study done?
Pragmatic RCT.
- How many people, animals or samples were studied?
450 patients.
- What was actually found?
No HbA1c difference.
- How large was the observed effect?
-0.05% (-0.27 to 0.17).
- What do the results mean in everyday life?
Routine self-testing is not always needed in type 2 diabetes without insulin; regular HbA1c checks still are.
- What are the study's limitations?
Moderately controlled patients only.
- What does it say about Elawady's specific claim?
Supports a narrow kernel; not 'no measurement at all'.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot justify stopping monitoring in insulin users.
No study in this group is marked as key.
Regional context
Germany / EU
European (EASD) and German (DDG) guidance follow the same evidence base as the ADA/EASD consensus: individualised HbA1c targets, insulin as mandatory therapy in type 1 diabetes, and SGLT2 inhibitors/GLP-1 receptor agonists for people with cardiovascular or kidney disease. No country-specific difference changes the assessment.
Egypt
Egypt has one of the highest diabetes prevalences in the region; the same drug classes and insulins are used. Access barriers and cost may make advice to stop medication attractive, which increases the practical risk of this claim. No Egypt-specific evidence changes the assessment.
What applies in my country?
General scientific assessment
False Monitoring glucose and ketones prevents emergencies; abandoning it is dangerous.
This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.
References
- Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.. Umpierrez GE et al.. Diabetes Care 2024 · PMID 39052901 · DOI 10.2337/dci24-0032
- Diabetic ketoacidosis.. Dhatariya KK et al.. Nat Rev Dis Primers 2020 · PMID 32409703 · DOI 10.1038/s41572-020-0165-1
- 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026.. American Diabetes Association Professional Practice Committee for Diabetes* . Diabetes Care 2026 · PMID 41358894 · DOI 10.2337/dc26-S006
- Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.. Stratton IM et al.. BMJ 2000 · PMID 10938048 · DOI 10.1136/bmj.321.7258.405
- Sick day management using blood 3-hydroxybutyrate (3-OHB) compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trial.. Laffel LM et al.. Diabet Med 2006 · PMID 16492211 · DOI 10.1111/j.1464-5491.2005.01771.x
- Evidence of a strong association between frequency of self-monitoring of blood glucose and hemoglobin A1c levels in T1D exchange clinic registry participants.. Miller KM et al.. Diabetes Care 2013 · PMID 23378621 · DOI 10.2337/dc12-1770
- Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis.. Emdin CA et al.. JAMA 2015 · PMID 25668264 · DOI 10.1001/jama.2014.18574
- 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2026.. American Diabetes Association Professional Practice Committee for Diabetes. Diabetes Care 2026 · PMID 41358899 · DOI 10.2337/dc26-S010
- The management of type 1 diabetes in adults. The updated 2026 consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).. Holt RIG et al.. Diabetologia 2026 · PMID 42747450 · DOI 10.1007/s00125-026-06833-z
- Differential effects of fasting and dehydration in the pathogenesis of diabetic ketoacidosis.. Burge MR et al.. Metabolism 2001 · PMID 11229425 · DOI 10.1053/meta.2001.20194
- NICE guideline NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management. National Institute for Health and Care Excellence (NICE). NICE guideline 2015
- Illnesses associated with ketosis including diabetic ketoacidosis during very low carbohydrate and ketogenic diets.. Roberts CGP et al.. Diabetes Obes Metab 2025 · PMID 39996364 · DOI 10.1111/dom.16252
- Glucose Self-monitoring in Non-Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings: A Randomized Trial.. Young LA et al.. JAMA Intern Med 2017 · PMID 28600913 · DOI 10.1001/jamainternmed.2017.1233