There is no such thing as type 1 diabetes; 'type 1' is a state of high sugar seen mainly in athletes with high needs; type 1 patients do not develop complications; insulin before puberty is a catastrophe (short stature, thyroid problems, cysts).
Original statement
لان ما فيش حاجه اسمها نوع اول اصلا
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
There is no such thing as type 1 diabetes; 'type 1' is a state of high sugar seen mainly in athletes with high needs; type 1 patients do not develop complications; insulin before puberty is a catastrophe (short stature, thyroid problems, cysts).
Origin
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- حلقه علميه قويه تواجه التضليل العلمي بالحقيقه (Open source)
- Published
- 17 April 2026
- Timestamp
- 0:30:07 (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
High glucose is an adaptive stress response (athletes, fighters), not insulin deficiency.
- Claimed health effect
Denial of type 1 diabetes as a disease; insulin in children harmful
- Population concerned
Children and adults with type 1 diabetes
- Geographic restriction by Elawady
none found
Diverging source versions
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr.D Clinics - Diaa Al Awady is live! (Open source)
- Published
- 12 January 2025
- 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.
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- السكر جاي منين و الأسيتون رايح فين و الوريد الكبدي المغذي الأوحد في جسم الإنسان (Open source)
- Published
- 19 September 2025
- 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.
- 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
- 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.
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! الموت المفاجيء (Open source)
- Published
- 14 July 2025
- 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.
انت كلامك صح بس احنا برده النوع الاول يا جماعه ينفع معاه النظام بس لازم تكونوا فاهمين حاجه بتاع النوع الاول ده هو مش نوع اول وانسولين صفر مش قصه كده هي القصه ان الاستاذ ابو ابو الصغير الطفل ده اللي بطنه بتتفخ بسرعه قوي >> القذريه عنده [ضحك] بتقع بسرعه قوي فيخش
The system also works for type 1 diabetes; type 1 is 'not a story of zero insulin' but is linked to a child's abdomen bloating very quickly.
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! (Open source)
- Published
- 25 December 2025
- Timestamp
- 0:32:32 (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.
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?
Type 1 diabetes does not exist; it occurs in athletes; type 1 patients do not suffer complications; insulin before puberty is a catastrophe.
2. What is demonstrably correct?
Classification of diabetes types has become more detailed (e.g. LADA, MODY, gestational diabetes), which Elawady cites as proof of confusion; this refinement is real but reflects better diagnostics. Poorly controlled diabetes in children can impair growth.
3. What is wrong or exaggerated?
Type 1 diabetes is an autoimmune destruction of insulin-producing cells, leading to absolute insulin deficiency (I-INS-132); without insulin it causes ketoacidosis and death: before insulin most children with diabetes died of coma within months to a few years despite strict diets (I-INS-101), in 2021 about 35,000 undiagnosed people died within 12 months of symptom onset, while a 10-year-old diagnosed in a low-income country can expect about 13 more years of life versus 65 in a high-income country (I-INS-102). 'Lifelong insulin therapy is essential in type 1 diabetes' (ADA/EASD 2026, I-INS-133; ADA 2026, I-ODD-16). Type 1 diabetes is not caused by sport. People with type 1 diabetes do develop retinopathy, nephropathy, neuropathy and heart disease: intensive insulin therapy reduced retinopathy by 76% in the DCCT (I-INS-03), and in Sweden people with T1D had 3.5 times the mortality of controls, 8.5 times with very high HbA1c (I-INS-103). Growth problems in children are caused by poorly controlled diabetes, not by insulin: poor control was associated with 2-3 cm lower adult height (I-INS-105), children on intensive insulin regimens grow normally (I-INS-106), and growth failure from under-treatment (Mauriac syndrome) improves when insulin management is intensified (I-INS-107). Thyroid disease is screened for because autoimmune thyroiditis clusters with type 1 diabetes, not because insulin causes it (I-INS-131).
4. What remains unclear?
Nothing material.
5. Which studies support it?
None.
6. Which studies contradict it?
I-INS-03, I-INS-07, I-INS-08, I-ODD-16, I-INS-101, I-INS-102, I-INS-103, I-INS-105, I-INS-106, I-INS-107, I-INS-131, I-INS-132, I-INS-133.
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?
Children and adults with type 1 diabetes need lifelong insulin. Any dietary approach can only be used in addition to insulin, under medical supervision.
Assessment details
- Rationale for certainty of evidence
Type 1 diabetes as autoimmune beta-cell destruction with absolute insulin deficiency is among the best-established facts of medicine; before insulin was available (1922) it was fatal. Insulin is essential (ADA 2026). DCCT (RCT, 1,441 patients) proved that better insulin treatment reduces complications, which also contradicts 'no complications'.
- Source quality
Several machine transcripts, consistent over 2025-2026.
- Regional transferability
Universal.
- Individual exceptions
None. Rare forms (e.g. MODY, some LADA) may initially not need insulin, but this requires specialist diagnosis.
- 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: Does type 1 diabetes exist as an insulin-deficient disease that is fatal without insulin and causes complications, and does insulin in children cause short stature or thyroid disease?
Research question in detail (PECO)
- Population
- Children and adults with type 1 diabetes
- Intervention or exposure
- Insulin treatment (vs none/insufficient)
- Comparison
- No or inadequate insulin
- Geographic scope
- universal biology; Egyptian/Arab-region data on DKA and growth failure
- Outcomes
- Survival
- Complications
- Growth/adult height
- Thyroid disease
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
No high-quality evidence supporting the claim was found.
What speaks against the claim?
What happened to people with diabetes before insulin existed
Mazur A. Nutr J 2011 · PMID 21396115 · DOI 10.1186/1475-2891-10-23 Narrative reviewfull text checkednewly addedPre-insulin era natural history.
- Actual result
- Most children died of coma within months to a few years; 43% of 76 diet-treated patients dead within a few years.
- Methodological quality
- low (historical) with very large effect
- Relevance
- direct
- Limitations
- Uncontrolled historical data.
DCCT: better insulin treatment in type 1 diabetes
Diabetes Control and Complications Trial Research Group; Nathan DM et al.. N Engl J Med 1993 · PMID 8366922 · DOI 10.1056/NEJM199309303291401 Randomised controlled trialabstract checkedDCCT: insulin intensity and complications in T1D.
- Actual result
- Retinopathy -76%, neuropathy -60%.
- Methodological quality
- high (RCT)
- Relevance
- direct (complications exist and are reduced by insulin)
- Limitations
- Hypoglycaemia increased.
Blood sugar control in childhood type 1 diabetes and adult height
Smew AI et al.. J Clin Endocrinol Metab 2025 · PMID 39556501 · DOI 10.1210/clinem/dgae809 Cohort studyabstract checkednewly addedNationwide Swedish cohort: adult height by glycaemic control.
- Actual result
- Poor control -2.91 cm (males), -1.83 cm (females).
- Methodological quality
- moderate
- Relevance
- direct (growth impairment linked to poor control, not to insulin)
- Limitations
- Observational.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
Type 1 diabetes is autoimmune absolute insulin deficiency, fatal without insulin, causes complications, and insulin protects growth in children.
Why some studies weigh more
Natural history, RCTs, nationwide cohorts and all guidelines agree; no supporting evidence was found.
Is a causal relationship established? Yes, established Insulin deficiency causes DKA and death; insulin treatment prevents them; poor control impairs growth.
Remaining uncertainty
None material.
Justified conclusion
False and dangerous.
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 on the WHO Model List of Essential Medicines (not re-verified in this phase).
- Actual monitoring data
- Egyptian children often present with severe DKA (I-INS-115); growth failure from under-treatment (Mauriac syndrome) still occurs in the region (Sudan, I-INS-107).
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- Crude risks and CI symmetry – 8.0% vs 2.9% deaths; aHR 3.52 (3.06-4.04) symmetric recalculated
- Crude cumulative mortality by DCCT arm – 6.0% vs 8.8% over about 27 years; HR 0.67 (0.46-0.99) recalculated
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Survival and complications in type 1 diabetes with vs without adequate insulin
- Starting level
- low (observational studies)
- Reasons for upgrading
- very large effect (natural history: near-universal early death without insulin)
- dose-response (HbA1c-mortality gradient)
- Result
- high
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: 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2026 (2026) · Original publication
Type 1 diabetes is autoimmune beta-cell destruction usually leading to absolute insulin deficiency; partial remission phase is common after diagnosis. - ADA: 14. Children and Adolescents: Standards of Care in Diabetes-2026 (2026) · Original publication
For type 1 diabetes 'insulin therapy is paramount'; rec 14.36: start insulin in ketoacidosis; thyroid screening because of autoimmune clustering; in youth T2D maximise non-insulin therapy and consider reducing insulin when goals are met (14.39-14.40). - ADA: 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2026 (I-ODD-16) (2026) · Original publication
'Insulin treatment is essential for individuals with type 1 diabetes'; insulin to be considered in T2D when A1C >10%, glucose >=300 mg/dL or catabolic features (as recorded for I-ODD-16). - 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). - WHO: Diabetes fact sheet (14 November 2024) (2024) · Original publication
Type 1 diabetes 'requires daily administration of insulin'; chronic hyperglycaemia leads to serious damage to many body systems. - ISPAD: ISPAD Clinical Practice Consensus Guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state (Glaser N et al., PMID 36250645) (2022) · Original publication could not be retrieved; content not used
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 | "type 1 diabetes" AND (athletes OR "physical activity" OR exercise) AND (incidence OR risk) AND (cause OR etiology OR onset) | supporting evidence | 707 | |
| PubMed | 26 October 2026 | (insulin therapy OR insulin treatment) AND children AND ("short stature" OR "growth retardation" OR "growth failure") AND cause | supporting evidence | 851 | |
| Europe PMC | 26 October 2026 | ("type 1 diabetes") AND (TITLE:"without insulin" OR TITLE:"insulin-free" OR TITLE:"off insulin") AND (diet OR "low-carbohydrate" OR survival) | supporting evidence | 7 | |
| PubMed | 26 October 2026 | "type 1 diabetes" AND (prognosis OR survival OR "life expectancy") AND (pre-insulin OR "before insulin" OR "insulin era" OR "discovery of insulin") | contradicting evidence | 4561 | |
| PubMed | 26 October 2026 | (insulin access OR insulin availability) AND "type 1 diabetes" AND (mortality OR "life expectancy") AND (Africa OR "low-income") | contradicting evidence | 19 | |
| Europe PMC | 26 October 2026 | (TITLE:"starvation" OR TITLE:"Allen") AND (TITLE:"diabetes") AND (TITLE:"insulin" OR TITLE:"pre-insulin") | contradicting evidence | 24 | |
| Europe PMC | 26 October 2026 | TITLE:"type 1 diabetes" AND (TITLE:"global" AND TITLE:"mortality") AND PUB_YEAR:[2020 TO 2026] | contradicting evidence | 10 | |
| PubMed | 26 October 2026 | Banting[au] AND pancreatic extracts[ti] | contradicting evidence | 6 | |
| PubMed | 26 October 2026 | Lind M[au] AND "Glycemic control and excess mortality in type 1 diabetes" | contradicting evidence | 6 | |
| PubMed | 26 October 2026 | "type 1 diabetes" AND (children OR adolescents) AND (height OR growth OR "final height" OR "adult height") AND (HbA1c OR "metabolic control") AND (cohort OR registry) | contradicting evidence | 145 | |
| PubMed | 26 October 2026 | (Mauriac syndrome) AND (insulin deficiency OR underinsulinization) | contradicting evidence | 7 | |
| Europe PMC | 26 October 2026 | "type 1 diabetes" AND (TITLE:"height" OR TITLE:"growth") AND (TITLE:"children" OR TITLE:"adolescents") AND (TITLE:"glycemic control" OR TITLE:"metabolic control" OR TITLE:"HbA1c" OR TITLE:"glycaemic") | contradicting evidence | 13 | |
| Europe PMC | 26 October 2026 | TITLE:"Standards of Care in Diabetes-2026" | guidelines | 21 | |
| PubMed | 26 October 2026 | ISPAD Clinical Practice Consensus Guidelines 2024 | guidelines | 8 | |
| 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 | |
| WHO website | 26 October 2026 | Fetched https://www.who.int/news-room/fact-sheets/detail/diabetes | guidelines | 1 |
How deeply was this checked?
16 linked studies: 10 checked in full text (1 of them with a structured risk-of-bias assessment), 6 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)
Historical, modelling, registry and growth evidence plus current guidelines unanimously contradict the claim; no supporting evidence was found.
New sources: I-INS-101 I-INS-102 I-INS-103 I-INS-105 I-INS-106 I-INS-107 I-INS-131 I-INS-132 I-INS-133 I-INS-134 I-INS-135 I-INS-137
In plain language
Type 1 diabetes is a real disease in which the body's immune system destroys the cells that make insulin. Without insulin injections, people with type 1 diabetes, including children, become severely ill within days and can die. Insulin treatment protects their eyes, kidneys and nerves. Saying that type 1 diabetes does not exist is wrong and dangerous.
Studies on this claim
Studies supporting the claim (0)
No studies in this group.
Studies contradicting or limiting the claim (16)
-
DCCT: better insulin treatment in type 1 diabetes
Diabetes Control and Complications Trial Research Group; Nathan DM et al.. N Engl J Med 1993 · PMID 8366922 · DOI 10.1056/NEJM199309303291401Randomised controlled trialindependent cross-checkabstract checked★ key studyIntensive insulin cut the risk of eye damage by three-quarters and nerve damage by 60%, with more low-sugar episodes.
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?
Does intensive insulin therapy reduce long-term complications in type 1 diabetes?
- How was the study done?
Multicentre RCT (DCCT)
- How many people, animals or samples were studied?
1,441; Insulin-dependent (type 1) diabetes
- What was actually found?
Large reductions in all microvascular complications.
- How large was the observed effect?
Retinopathy -76%
- What do the results mean in everyday life?
Insulin protects eyes, kidneys and nerves in type 1 diabetes.
- What are the study's limitations?
Open-label; Selected young population
- What does it say about Elawady's specific claim?
Contradicts C-INS-07, C-INS-09, C-DIAB-01; shows insulin efficacy and hypoglycaemia cost (C-INS-02 kernel).
- Do the results apply to Germany and Europe?
North American; universally accepted.
- What can explicitly not be concluded from this study?
Effects in type 2 diabetes directly.
-
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: diabetes medicines
American Diabetes Association Professional Practice Committee for Diabetes*. Diabetes Care 2026 · PMID 41358900 · DOI 10.2337/dc26-S009Guideline / position statementindependent cross-checkfull text checked★ key studyInsulin is essential in type 1 diabetes; SGLT2/GLP-1 drugs are recommended for heart and kidney protection; side effects listed.
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?
Pharmacologic glycaemic treatment
- How was the study done?
Clinical practice guideline (ADA Standards of Care 2026, Section 9)
- How many people, animals or samples were studied?
not applicable; People with type 1 and type 2 diabetes
- What was actually found?
See results.
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
Medicines chosen by benefit-risk.
- What are the study's limitations?
Partially read
- What does it say about Elawady's specific claim?
Contradicts C-INS-07, C-INS-10, C-ODD-06; supports C-ODD-07, C-INS-11.
- Do the results apply to Germany and Europe?
Consistent with ADA/EASD consensus.
- What can explicitly not be concluded from this study?
Not applicable.
-
What happened to people with diabetes before insulin existed
Mazur A. Nutr J 2011 · PMID 21396115 · DOI 10.1186/1475-2891-10-23Narrative reviewindependent cross-checkfull text checked★ key studyBefore 1922, children with diabetes usually died of diabetic coma within months to a few years, even on strict fasting diets; some starved to death.
Before insulin, type 1-like diabetes in children was fatal within months to years despite diet.
Does the study support the specific claim? No · 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?
To explain why fasting diets were used for diabetes before insulin and how patients fared.
- How was the study done?
Historical analysis of published case series and textbooks.
- How many people, animals or samples were studied?
Patients of Allen (76 published cases) and Joslin, 1914-1922.
- What was actually found?
Most children died of coma within months to years; 43% of Allen's cases were dead by 1917; four died of starvation; diabetes was not cured.
- How large was the observed effect?
43% mortality within a few years (Allen's series).
- What do the results mean in everyday life?
Diet and fasting alone cannot keep insulin-deficient diabetes alive; insulin changed this.
- What are the study's limitations?
Historical, uncontrolled data; diabetes types not distinguished.
- What does it say about Elawady's specific claim?
Contradicts claims that diet can replace insulin or that ketoacidosis does not kill.
- Do the results apply to Germany and Europe?
Universal biology.
- What can explicitly not be concluded from this study?
Cannot give exact survival curves or separate type 1 from type 2 cases.
-
How many people have type 1 diabetes worldwide and how long they live
Gregory GA et al.. Lancet Diabetes Endocrinol 2022 · PMID 36113507 · DOI 10.1016/S2213-8587(22)00218-2Otherindependent cross-checkabstract checked★ key studyAbout 8.4 million people had type 1 diabetes in 2021; a 10-year-old diagnosed in a low-income country could expect about 13 more years of life, versus 65 in a high-income country.
T1D exists in 8.4 million people; without diagnosis/treatment death within a year; life expectancy 13 vs 65 years by country income.
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?
Estimate the global burden of type 1 diabetes.
- How was the study done?
Computer model fitted to registry and published data from many countries.
- How many people, animals or samples were studied?
Model of 201 countries.
- What was actually found?
8.4 million cases; 35,000 undiagnosed deaths within a year of symptoms; life expectancy gap 13 vs 65 years.
- How large was the observed effect?
Life expectancy difference about 52 years for a child diagnosed at 10.
- What do the results mean in everyday life?
Where insulin and care are hard to get, children with type 1 diabetes die young.
- What are the study's limitations?
Model estimates with uncertainty; funded by a T1D charity.
- What does it say about Elawady's specific claim?
Contradicts 'type 1 does not exist' and any advice to stop insulin.
- Do the results apply to Germany and Europe?
Europe is in the high-income group with long survival under insulin treatment.
- What can explicitly not be concluded from this study?
Cannot attribute individual deaths to specific causes.
-
Blood sugar control and death in type 1 diabetes in Sweden
Lind M et al.. N Engl J Med 2014 · PMID 25409370 · DOI 10.1056/NEJMoa1408214Cohort studyindependent cross-checkabstract checked★ key studyPeople with type 1 diabetes died about 3.5 times as often as matched controls; with very high HbA1c the risk was about 8.5 times higher.
Excess CV death in T1D (HR 4.60) contradicts 'no complications'.
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?
Measure excess mortality in T1D by glucose control.
- How was the study done?
Nationwide register with matched controls.
- How many people, animals or samples were studied?
33,915 patients, 169,249 controls.
- What was actually found?
Higher HbA1c, higher death risk; excess risk even with good control.
- How large was the observed effect?
HR 3.52 overall; 8.51 at HbA1c >=9.7%.
- What do the results mean in everyday life?
Type 1 diabetes shortens life, especially with high sugar.
- What are the study's limitations?
Observational data.
- What does it say about Elawady's specific claim?
Contradicts denial of T1D complications and 'high sugar protects'.
- Do the results apply to Germany and Europe?
Swedish data, directly applicable to Europe.
- What can explicitly not be concluded from this study?
Cannot prove that lowering HbA1c alone removes all excess risk.
-
Blood sugar control in childhood type 1 diabetes and adult height
Smew AI et al.. J Clin Endocrinol Metab 2025 · PMID 39556501 · DOI 10.1210/clinem/dgae809Cohort studyindependent cross-checkabstract checked★ key studyChildren with poorly controlled type 1 diabetes ended up about 2-3 cm shorter as adults than those with good control.
Short stature associated with poor control, not with insulin treatment.
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 childhood glucose control to adult height.
- How was the study done?
Nationwide register study.
- How many people, animals or samples were studied?
Swedish children with T1D.
- What was actually found?
Poor control = lower adult height.
- How large was the observed effect?
-2.9 cm (males), -1.8 cm (females).
- What do the results mean in everyday life?
Keeping blood sugar well controlled with insulin protects growth.
- What are the study's limitations?
Observational.
- What does it say about Elawady's specific claim?
Contradicts the idea that insulin itself causes short stature.
- Do the results apply to Germany and Europe?
Swedish data; applicable to Europe.
- What can explicitly not be concluded from this study?
Cannot exclude other factors linked to poor control.
-
Height of children with type 1 diabetes and their insulin treatment
Svensson J et al.. Pediatr Diabetes 2018 · PMID 30105887 · DOI 10.1111/pedi.12751Cross-sectional studyindependent cross-checkabstract checked★ key studyIn about 23,000 young people, those on more intensive insulin treatment were taller; major growth problems were virtually absent with modern care.
Intensive insulin (pumps) associated with taller stature; growth disturbances virtually eliminated with modern care.
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?
Describe height by treatment and control in youth with T1D.
- How was the study done?
International registry, cross-sectional.
- How many people, animals or samples were studied?
22,941 young people.
- What was actually found?
Height normal or above; pumps and good control linked to taller height.
- How large was the observed effect?
z-score 0.35 vs 0.19.
- What do the results mean in everyday life?
Modern insulin treatment lets children grow normally.
- What are the study's limitations?
Cross-sectional; industry funding.
- What does it say about Elawady's specific claim?
Contradicts 'insulin before puberty is a catastrophe'.
- Do the results apply to Germany and Europe?
Includes European centres.
- What can explicitly not be concluded from this study?
Cannot prove causality.
-
Growth failure from poorly controlled type 1 diabetes in Sudan
Ismail MM et al.. Pediatr Diabetes 2025 · PMID 40904852 · DOI 10.1155/pedi/7047312Case series / case reportindependent cross-checkabstract checked★ key studyChildren with long-standing poor control were short and had enlarged livers; most improved when their insulin treatment was intensified.
Short stature arises from poor control and improved with intensified insulin management.
Does the study support the specific claim? No · 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?
Describe Mauriac syndrome in Sudanese children.
- How was the study done?
Record review with follow-up.
- How many people, animals or samples were studied?
37 children.
- What was actually found?
57% improved with better control; nephropathy in one third.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Too little insulin effect, not insulin itself, stunts growth.
- What are the study's limitations?
Small, no control group.
- What does it say about Elawady's specific claim?
Contradicts 'insulin causes short stature'.
- Do the results apply to Germany and Europe?
Rare in Europe today.
- What can explicitly not be concluded from this study?
Cannot give exact effect sizes.
-
US diabetes standards 2026: children and adolescents
American Diabetes Association Professional Practice Committee for Diabetes. Diabetes Care 2026 · PMID 41358890 · DOI 10.2337/dc26-S014Guideline / position statementindependent cross-checkfull text checked★ key studyInsulin is essential for children with type 1 diabetes; in youth with type 2 diabetes, insulin can be reduced when goals are met.
Insulin therapy paramount for children with T1D; thyroid screening because of autoimmune clustering.
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 paediatric diabetes care.
- How was the study done?
Evidence-graded guideline.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
Insulin paramount in T1D; insulin for ketoacidosis.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Children with type 1 diabetes need insulin.
- What are the study's limitations?
Guideline.
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
European paediatric guidance (ISPAD, NICE NG18) agrees.
- What can explicitly not be concluded from this study?
Not applicable.
-
US diabetes standards 2026: what type 1 diabetes is
American Diabetes Association Professional Practice Committee for Diabetes. Diabetes Care 2026 · PMID 41358893 · DOI 10.2337/dc26-S002Guideline / position statementindependent cross-checkfull text checked★ key studyType 1 diabetes is an autoimmune destruction of insulin-producing cells that leads to absolute insulin deficiency.
T1D = autoimmune beta-cell destruction with absolute insulin deficiency.
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?
Define diabetes types.
- How was the study done?
Guideline.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
T1D = autoimmune, insulin-deficient; 5-10% of diabetes.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Type 1 diabetes is real and needs insulin.
- What are the study's limitations?
Guideline.
- What does it say about Elawady's specific claim?
Contradicts C-INS-07.
- Do the results apply to Germany and Europe?
Identical European definitions.
- 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.
Lifelong insulin essential in T1D.
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.
-
NICE guideline NG17: Type 1 diabetes in adults: diagnosis and management
National Institute for Health and Care Excellence (NICE). NICE guideline 2015Guideline / position statementindependent cross-checkfull text checked★ key studyUK guideline: insulin is standard for all adults with T1D; DKA treated with IV saline and IV insulin.
Basal-bolus insulin for all adults with T1D.
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 1.7.1: offer multiple daily injection basal-bolus insulin regimens as the regimen of choice for all adults with T1D. Rec 1.10.1: consider ketone monitoring as part of sick-day rules. Recs 1.10.5-1.10.7: use isotonic saline for fluid replacement in DKA and give intravenous insulin by infusion. Misdiagnosis of T1D as T2D 'could lead to the person not receiving insulin treatment and a subsequent risk of diabetic ketoacidosis'.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
UK guideline: insulin is standard for all adults with T1D; DKA treated with IV saline and IV insulin.
- 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.
-
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.
Children with T1D: basal-bolus insulin from diagnosis.
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.
-
WHO: key facts on diabetes
World Health Organization. WHO fact sheet 2024Guideline / position statementindependent cross-checkfull text checked★ key studyType 1 diabetes requires daily insulin; long-term high blood sugar damages nerves, blood vessels and organs.
T1D requires daily insulin.
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?
Inform the public.
- How was the study done?
Fact sheet.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
T1D needs daily insulin.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Type 1 diabetes needs insulin every day.
- What are the study's limitations?
Not graded.
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
Global.
- What can explicitly not be concluded from this study?
Not applicable.
No study in this group is marked as key.
Studies with mixed or unclear results (0)
No studies in this group.
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 Type 1 diabetes exists, is fatal without insulin, and insulin is essential at every age.
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
- The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.. Diabetes Control and Complications Trial Research Group; Nathan DM et al.. N Engl J Med 1993 · PMID 8366922 · DOI 10.1056/NEJM199309303291401
- 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
- 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2026.. American Diabetes Association Professional Practice Committee for Diabetes*. Diabetes Care 2026 · PMID 41358900 · DOI 10.2337/dc26-S009
- Why were "starvation diets" promoted for diabetes in the pre-insulin period?. Mazur A. Nutr J 2011 · PMID 21396115 · DOI 10.1186/1475-2891-10-23
- Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study.. Gregory GA et al.. Lancet Diabetes Endocrinol 2022 · PMID 36113507 · DOI 10.1016/S2213-8587(22)00218-2
- Glycemic control and excess mortality in type 1 diabetes.. Lind M et al.. N Engl J Med 2014 · PMID 25409370 · DOI 10.1056/NEJMoa1408214
- Glycemic Control and Adult Height: A Nationwide Swedish Cohort Study on Childhood Type 1 Diabetes.. Smew AI et al.. J Clin Endocrinol Metab 2025 · PMID 39556501 · DOI 10.1210/clinem/dgae809
- The influence of treatment, age at onset, and metabolic control on height in children and adolescents with type 1 diabetes-A SWEET collaborative study.. Svensson J et al.. Pediatr Diabetes 2018 · PMID 30105887 · DOI 10.1111/pedi.12751
- Mauriac Syndrome in Sudanese Children: An Old Syndrome Still Existing in Resource-Limited Countries.. Ismail MM et al.. Pediatr Diabetes 2025 · PMID 40904852 · DOI 10.1155/pedi/7047312
- 14. Children and Adolescents: Standards of Care in Diabetes-2026.. American Diabetes Association Professional Practice Committee for Diabetes. Diabetes Care 2026 · PMID 41358890 · DOI 10.2337/dc26-S014
- 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2026.. American Diabetes Association Professional Practice Committee for Diabetes. Diabetes Care 2026 · PMID 41358893 · DOI 10.2337/dc26-S002
- 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
- NICE guideline NG17: Type 1 diabetes in adults: diagnosis and management. National Institute for Health and Care Excellence (NICE). NICE guideline 2015
- 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
- Diabetes (fact sheet). World Health Organization. WHO fact sheet 2024