Nezam El-Tayebat Fact CheckA scientific assessment of the “نظام الطيبات” nutrition system
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False Scientifically refuted Certainty of evidence: high provisional C-INS-10

People with diabetes can stop insulin and diabetes medication by following the Tayebat system ('zero medicine'), as shown by followers who stopped insulin and are 'perfectly fine'.

Safety note: Do not stop or reduce insulin on the basis of this claim. In type 1 diabetes and other insulin-deficient states, stopping insulin leads within hours to days to diabetic ketoacidosis, which is life-threatening. Medically accepted position (ADA Standards of Care 2026): insulin treatment is essential for people with type 1 diabetes; people on intensive insulin therapy should not stop basal insulin even when not eating. Any change of diabetes medication should be made together with the treating physician.
In short: This claim is false. Stopping insulin is the main trigger of diabetic ketoacidosis and is fatal in type 1 diabetes; some people with type 2 or ketosis-prone diabetes can reduce or stop medicines, but only step by step under medical supervision with glucose and ketone monitoring.
Conclusion: Stopping insulin on one's own is dangerous; any reduction belongs under medical supervision.
  1. Original statement
  2. Scientific assessment
  3. Scientific evidence in detail
  4. In plain language
  5. Studies on this claim
  6. Regional context
  7. What applies in my country?
  8. References

Original statement

ساره السيد بيقوللك بطل الانسولين الحمد لله زي الفل

verbatim according to source. Translation by the project; the Arabic wording is authoritative.

Translation

People with diabetes can stop insulin and diabetes medication by following the Tayebat system ('zero medicine'), as shown by followers who stopped insulin and are 'perfectly fine'.

Origin

Source status
Video transcript (own words)
Attribution
Elawady (machine transcript)
Video
Dr Diaa Al Awady د ضياء العوضي is live! الكورتيزون حياتك (Open source)
Published
17 October 2025
Timestamp
1:58:13 (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. The primary quote is a viewer's message ('Sarah El-Sayed tells you ...') that Elawady reads aloud and comments on approvingly during a live stream; it is not his own statement. His own statements are in the alternative sources, e.g. PBygUgVhUM8 ('I am the one who stopped it for him') and aEbRfVSJIOw ('zero medicine').
Claimed mechanism

Removing harmful food inputs restores the body, making insulin unnecessary.

Claimed health effect

Stopping insulin is safe/curative

Population concerned

People with type 1 and type 2 diabetes

Geographic restriction by Elawady

none found

Diverging source versions

Source status
Video transcript (own words)
Attribution
Elawady (machine transcript)
Video
Dr Diaa Al Awady د ضياء العوضي is live! ٢ (Open source)
Published
20 August 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! مفيش حاجه سعرات مفيش حاجه اسمها نشويات (Open source)
Published
7 August 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! السيليوليت (Open source)
Published
11 October 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
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.
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.

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?

Following the system allows people to stop insulin; testimonies show success; the method is 'zero medicine'.

2. What is demonstrably correct?

In type 2 diabetes of short duration, intensive weight loss can lead to remission off all glucose-lowering drugs in a substantial minority (46% at 1 year in DiRECT; participants on insulin were excluded) (I-FAST-12). Insulin doses in type 2 diabetes can often be reduced when weight falls or when metformin is added (A-INS-19); in a supervised ketogenic-diet programme insulin use fell by 62% (non-randomised, I-DIAB-105). Some adults who first present with ketoacidosis have ketosis-prone type 2 diabetes and could be weaned off insulin under medical supervision (26% at 5 years), whereas antibody-positive (type 1) patients rarely could (I-INS-128). Elawady also says that people who stop insulin are responsible for themselves, which is a disclaimer, not a safety instruction.

3. What is wrong or exaggerated?

Individual success stories told during live streams cannot show safety or efficacy; people who were harmed are not presented. People with type 1 diabetes or advanced insulin-deficient type 2 diabetes cannot stop insulin (I-ODD-16, I-INS-07). A 'zero medicine' rule contradicts the evidence that metformin, SGLT2 inhibitors and GLP-1 receptor agonists reduce death and organ damage in defined groups (I-ODD-01 to I-ODD-07).

4. What remains unclear?

How many followers stopped insulin and what happened to them is unknown; no registry or study exists.

5. Which studies support it?

I-FAST-12 (diet-induced remission in early, non-insulin type 2 diabetes; limited relevance).

6. Which studies contradict it?

I-INS-07, I-INS-08, I-ODD-16, I-INS-03, I-INS-108 and I-INS-109 (stopping insulin causes about two-thirds of DKA episodes), I-INS-101, I-INS-102.

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?

Reducing diabetes medication is possible for some people with type 2 diabetes, but only step by step with glucose monitoring and medical supervision. Insulin must never be stopped by people with type 1 diabetes.

Assessment details

Rationale for certainty of evidence

Anecdotes read out in live streams are not evidence; no outcome data on the system exist. In type 1 diabetes stopping insulin is reliably fatal without treatment. In type 2 diabetes, some people can reduce or stop medication after substantial weight loss under supervision (DiRECT, which excluded insulin users), so the claim is false as a general statement and dangerous for insulin-deficient people.

Source quality

Own words; testimonies are second-hand and unverifiable. Elawady also states that whoever stops insulin is responsible for himself.

Regional transferability

Universal.

Individual exceptions

Some people with early type 2 diabetes and weight loss can come off medication under medical supervision (see C-DIAB-03).

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: Can people with diabetes safely stop insulin and diabetes medication by following a diet ('zero medicine')?

Research question in detail (PICO)
Population
People with type 1 and type 2 diabetes on insulin/medication
Intervention or exposure
Stopping insulin/medication while following a diet
Comparison
Continuing medication with supervised adjustment
Geographic scope
universal biology
Outcomes
  • DKA
  • Mortality
  • Glycaemic control
  • Successful supervised deprescribing

Study results as reported by the authors. Our assessment follows below.

What speaks for the claim?

What speaks against the claim?

What does the overall evidence say?

Editorial assessment based on the studies above – not itself a study result.

Which position is better supported?

Stopping insulin causes DKA in insulin-deficient people; in selected type 2 or ketosis-prone diabetes, medication can be reduced or stopped only step by step under medical supervision with monitoring.

Why some studies weigh more

Direct evidence of harm from insulin cessation and natural-history data outweigh anecdotes; supervised deprescribing evidence is limited to specific T2D phenotypes.

Is a causal relationship established? Yes, established Insulin omission causes DKA.

Remaining uncertainty

Outcomes among followers are unknown.

Justified conclusion

False as a general statement.

Why do studies seem to disagree?

Supervised T2D deprescribing (I-DIAB-105, I-INS-128) and remission trials concern selected people with preserved insulin secretion under medical monitoring; they do not support unsupervised stopping or stopping in T1D.

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
No registry of Tayebat followers who stopped insulin exists; harms would not appear in the testimonials presented.

A regional difference that changes the conclusion is not supported by robust data.

Statistical re-check
  • Wilson CI for insulin-cessation share – 66.7% (51.6-79.0%) recalculated
Certainty of the overall evidence (GRADE, simplified)
Main outcome
DKA and death after stopping insulin in insulin-deficient diabetes
Starting level
low (observational studies)
Reasons for upgrading
  • very large effect (natural history)
  • consistent mechanism
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: 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: 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: 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/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: NG28 Type 2 diabetes in adults: management (last updated 18 February 2026) (2026) · Original publication
    Low-energy and very-low-energy diets via the NHS Type 2 Diabetes Path to Remission Programme (1.3.4); evidence on stopping/switching medicines is limited (research recommendation).
Search strategy

Documented literature searches for this review (search strings in the original database syntax).

DatabaseDateSearchLooking forHitsIncluded
PubMed26 October 2026"type 2 diabetes" AND ("insulin withdrawal" OR "insulin discontinuation" OR "deprescribing insulin") AND (diet OR lifestyle OR "weight loss")supporting evidence20
PubMed26 October 2026Athinarayanan SJ[au] AND "type 2 diabetes" AND 2 yearssupporting evidence18
PubMed26 October 2026"ketosis-prone" AND (insulin discontinuation OR "insulin independence" OR remission)both directions56
Europe PMC26 October 2026(TITLE:"stopping insulin" OR TITLE:"insulin omission" OR TITLE:"discontinuation of insulin") AND (outcome OR mortality OR ketoacidosis)contradicting evidence15
PubMed26 October 2026("insulin omission" OR "cessation of insulin" OR "discontinuation of insulin") AND "diabetic ketoacidosis" AND (precipitat* OR cause)contradicting evidence72
PubMed26 October 2026Musey VC[au] AND ketoacidosiscontradicting evidence1
PubMed26 October 2026Randall L[au] AND recurrent diabetic ketoacidosiscontradicting evidence1
PubMed26 October 2026(insulin access OR insulin availability) AND "type 1 diabetes" AND (mortality OR "life expectancy") AND (Africa OR "low-income")contradicting evidence19
Europe PMC26 October 2026TITLE:"type 1 diabetes" AND (TITLE:"global" AND TITLE:"mortality") AND PUB_YEAR:[2020 TO 2026]contradicting evidence10

How deeply was this checked?

13 linked studies: 4 checked in full text (1 of them with a structured risk-of-bias assessment), 9 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
  1. 25 October 2026 · Phase 1 · Initial assessment: False (high)
  2. 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: False (high)
    Insulin-omission data and natural history confirm the verdict; supervised deprescribing studies add a fair nuance for selected type 2 phenotypes.
    New sources: I-INS-101 I-INS-102 I-INS-108 I-INS-109 I-INS-128 I-INS-129 I-DIAB-105

In plain language

The videos present people who say they stopped insulin and feel well. Such stories cannot tell us how many others became ill. People with type 1 diabetes die without insulin. Some people with type 2 diabetes can reduce or stop medicines after losing a lot of weight, but this must be done with a doctor and regular blood sugar checks.

Studies on this claim

Studies supporting the claim (1)

  • DiRECT: weight loss to put type 2 diabetes into remission

    Lean ME et al.. Lancet 2018 · PMID 29221645 · DOI 10.1016/S0140-6736(17)33102-1
    Randomised controlled trialindependent cross-checkabstract checked★ key study

    46% of people in the programme were free of diabetes and medication after one year.

    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?

    Can intensive weight management in primary care achieve T2D remission?

    How was the study done?

    Open-label cluster-randomised trial (DiRECT)

    How many people, animals or samples were studied?

    306 (149 per group ITT); 49 practices; Age 20-65, T2D <6 years, BMI 27-45, not on insulin

    What was actually found?

    Remission 46% vs 4%.

    How large was the observed effect?

    OR 19.7

    What do the results mean in everyday life?

    Losing 10-15 kg can reverse early type 2 diabetes.

    What are the study's limitations?

    Open-label; Selected population; Formula diet

    What does it say about Elawady's specific claim?

    Supports C-DIAB-03 (with conditions); limited relevance to C-INS-10 (insulin users excluded).

    Do the results apply to Germany and Europe?

    UK; directly relevant.

    What can explicitly not be concluded from this study?

    Effect of the Tayebat diet; effect in type 1 or insulin-treated diabetes.

    Scientific details →

Studies contradicting or limiting the claim (8)

  • International guideline on diabetic ketoacidosis

    Umpierrez GE et al.. Diabetes Care 2024 · PMID 39052901 · DOI 10.2337/dci24-0032
    Guideline / position statementindependent cross-checkfull text checked★ key study

    Insulin, 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.

    Scientific details →

  • Review on diabetic ketoacidosis

    Dhatariya KK et al.. Nat Rev Dis Primers 2020 · PMID 32409703 · DOI 10.1038/s41572-020-0165-1
    Narrative reviewindependent cross-checkfull text, structured risk-of-bias assessment

    DKA 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?

    Contradicts C-INS-08, C-INS-02, C-FAST-01, C-FAST-03.

    Do the results apply to Germany and Europe?

    International.

    What can explicitly not be concluded from this study?

    Quantitative estimates.

    Scientific details →

  • ADA guideline 2026: diabetes medicines

    American Diabetes Association Professional Practice Committee for Diabetes*. Diabetes Care 2026 · PMID 41358900 · DOI 10.2337/dc26-S009
    Guideline / position statementindependent cross-checkfull text checked★ key study

    Insulin 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.

    Scientific details →

  • 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 trialindependent cross-checkabstract checked★ key study

    Intensive 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.

    Scientific details →

  • Stopping insulin is the main cause of ketoacidosis in an urban US hospital

    Musey VC et al.. Diabetes Care 1995 · PMID 7497857 · DOI 10.2337/diacare.18.4.483
    Case series / case reportindependent cross-checkabstract checked★ key study

    Two out of three ketoacidosis episodes in people with known diabetes followed stopping insulin.

    Insulin cessation caused two-thirds of DKA episodes in known diabetes.

    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?

    Find the causes of DKA.

    How was the study done?

    Interviews and records of consecutive patients.

    How many people, animals or samples were studied?

    56 DKA episodes.

    What was actually found?

    Stopping insulin caused 67% of episodes in known diabetes.

    How large was the observed effect?

    67% (95% CI about 52-79%).

    What do the results mean in everyday life?

    Stopping insulin, even when not eating, can lead to ketoacidosis.

    What are the study's limitations?

    Small, old, single centre.

    What does it say about Elawady's specific claim?

    Contradicts advice to treat or prevent DKA without insulin.

    Do the results apply to Germany and Europe?

    Mechanism universal; social reasons vary.

    What can explicitly not be concluded from this study?

    Cannot give population rates.

    Scientific details →

  • Why people with diabetes end up in hospital with ketoacidosis again and again

    Randall L et al.. Diabetes Care 2011 · PMID 21775761 · DOI 10.2337/dc11-0701
    Cross-sectional studyindependent cross-checkabstract checked★ key study

    In 164 adults admitted with ketoacidosis, stopping insulin was the main trigger in 68%.

    Stopping insulin leads to DKA.

    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?

    Find the drivers of recurrent DKA.

    How was the study done?

    Bedside interviews.

    How many people, animals or samples were studied?

    164 adults.

    What was actually found?

    Insulin stopped in 68%.

    How large was the observed effect?

    68% (about 60-74%).

    What do the results mean in everyday life?

    Stopping insulin is dangerous.

    What are the study's limitations?

    Single centre.

    What does it say about Elawady's specific claim?

    Contradicts insulin-free management of DKA.

    Do the results apply to Germany and Europe?

    Mechanism universal.

    What can explicitly not be concluded from this study?

    Cannot give population incidence.

    Scientific details →

  • What happened to people with diabetes before insulin existed

    Mazur A. Nutr J 2011 · PMID 21396115 · DOI 10.1186/1475-2891-10-23
    Narrative reviewindependent cross-checkfull text checked★ key study

    Before 1922, children with diabetes usually died of diabetic coma within months to a few years, even on strict fasting diets; some starved to death.

    Diet-only treatment of insulin-deficient diabetes led to death from coma or starvation.

    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.

    Scientific details →

  • 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)00218-2
    Otherindependent cross-checkabstract checked★ key study

    About 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.

    Lack of insulin and care is associated with drastically shorter life expectancy.

    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.

    Scientific details →

Studies with mixed or unclear results (4)

  • Adding metformin to insulin

    Wulffelé MG et al.. Diabetes Care 2002 · PMID 12453950 · DOI 10.2337/diacare.25.12.2133
    Randomised controlled trialcited by the Tayebat archiveabstract checked

    Metformin improved sugar control and reduced insulin need and weight gain.

    Does the study support the specific claim? Yes · 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?

    Metformin added to intensive insulin in type 2 diabetes

    How was the study done?

    Double-blind placebo-controlled RCT

    How many people, animals or samples were studied?

    390; Insulin-treated type 2 diabetes

    What was actually found?

    Better control, less insulin, less weight gain.

    How large was the observed effect?

    GHb -0.7%

    What do the results mean in everyday life?

    Combination lowers insulin needs.

    What are the study's limitations?

    Short duration; Dropouts higher with metformin

    What does it say about Elawady's specific claim?

    Supports C-INS-11; context for C-INS-10.

    Do the results apply to Germany and Europe?

    Dutch data.

    What can explicitly not be concluded from this study?

    That insulin can be stopped.

    Scientific details →

  • Who can stop insulin after a first episode of ketoacidosis?

    Raubenheimer PJ et al.. Diabetologia 2024 · PMID 38240751 · DOI 10.1007/s00125-023-06067-3
    Cohort studyindependent cross-checkabstract checked★ key study

    In Cape Town, about a quarter of adults could stay off insulin for 5 years, mostly those with a type 2-like profile; people with type 1 antibodies rarely could.

    Some ketosis-prone T2D can come off insulin under supervision; antibody-positive (T1D) rarely.

    Does the study support the specific claim? Partly · 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?

    Find predictors of insulin independence after DKA.

    How was the study done?

    Prospective cohort with supervised weaning.

    How many people, animals or samples were studied?

    88 adults.

    What was actually found?

    46% at 1 year, 26% at 5 years off insulin; antibodies predict dependence.

    How large was the observed effect?

    OR 11.5 (acanthosis); 0.10 (antibodies).

    What do the results mean in everyday life?

    Stopping insulin is possible for some people with a specific type 2 profile, under medical supervision only.

    What are the study's limitations?

    Small study.

    What does it say about Elawady's specific claim?

    Partly qualifies 'nobody can stop insulin'; contradicts stopping it in type 1.

    Do the results apply to Germany and Europe?

    Phenotype rarer in Europe.

    What can explicitly not be concluded from this study?

    Cannot support stopping insulin without testing and supervision.

    Scientific details →

  • Supervised ketogenic diet programme in type 2 diabetes over 2 years

    Athinarayanan SJ et al.. Front Endocrinol (Lausanne) 2019 · PMID 31231311 · DOI 10.3389/fendo.2019.00348
    Otherindependent cross-checkabstract checked★ key study

    Many participants reduced or stopped diabetes medicines, including insulin, while doctors adjusted doses remotely; the study was not randomised.

    Insulin use fell 62% in T2D under physician-supervised ketogenic care; non-randomised; not T1D.

    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?

    Evaluate a remote ketogenic-care programme.

    How was the study done?

    Non-randomised trial.

    How many people, animals or samples were studied?

    349 adults with T2D.

    What was actually found?

    Insulin use -62%; remission 17.6%.

    How large was the observed effect?

    Within-group changes.

    What do the results mean in everyday life?

    Medicines can sometimes be reduced in type 2 diabetes, but only with medical supervision.

    What are the study's limitations?

    Not randomised; sponsor.

    What does it say about Elawady's specific claim?

    Partly supports reduction of medication in T2D; not in T1D.

    Do the results apply to Germany and Europe?

    US programme.

    What can explicitly not be concluded from this study?

    Cannot show safety of unsupervised stopping.

    Scientific details →

  • Ketoacidosis during very-low-carbohydrate diets

    Roberts CGP et al.. Diabetes Obes Metab 2025 · PMID 39996364 · DOI 10.1111/dom.16252
    Cohort studyindependent cross-checkabstract checked★ key study

    DKA was rare (about 1 per 1000 patient-years in type 2 diabetes) in a supervised programme, but almost three times higher with SGLT2 inhibitors.

    Supervised low-carb programmes in T2D have low but real DKA rates; monitoring required.

    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.

    Scientific details →

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 Stopping insulin on one's own is dangerous; any reduction belongs under medical supervision.

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

  1. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial.. Lean ME et al.. Lancet 2018 · PMID 29221645 · DOI 10.1016/S0140-6736(17)33102-1
  2. Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.. Umpierrez GE et al.. Diabetes Care 2024 · PMID 39052901 · DOI 10.2337/dci24-0032
  3. Diabetic ketoacidosis.. Dhatariya KK et al.. Nat Rev Dis Primers 2020 · PMID 32409703 · DOI 10.1038/s41572-020-0165-1
  4. 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
  5. 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
  6. Diabetes in urban African-Americans. I. Cessation of insulin therapy is the major precipitating cause of diabetic ketoacidosis.. Musey VC et al.. Diabetes Care 1995 · PMID 7497857 · DOI 10.2337/diacare.18.4.483
  7. Recurrent diabetic ketoacidosis in inner-city minority patients: behavioral, socioeconomic, and psychosocial factors.. Randall L et al.. Diabetes Care 2011 · PMID 21775761 · DOI 10.2337/dc11-0701
  8. 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
  9. 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
  10. Combination of insulin and metformin in the treatment of type 2 diabetes.. Wulffelé MG et al.. Diabetes Care 2002 · PMID 12453950 · DOI 10.2337/diacare.25.12.2133
  11. Phenotype and predictors of insulin independence in adults presenting with diabetic ketoacidosis: a prospective cohort study.. Raubenheimer PJ et al.. Diabetologia 2024 · PMID 38240751 · DOI 10.1007/s00125-023-06067-3
  12. Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial.. Athinarayanan SJ et al.. Front Endocrinol (Lausanne) 2019 · PMID 31231311 · DOI 10.3389/fendo.2019.00348
  13. 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

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