Rising blood glucose and acetone (ketones) during fasting are evidence that the liver is working properly, not a danger; high glucose plus acetone is not insulin deficiency.
Original statement
ارتفاع السكر والأسيتون في الصيام، بنظره، دليل عمل الكبد لا خطر.
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
Rising blood glucose and acetone (ketones) during fasting are evidence that the liver is working properly, not a danger; high glucose plus acetone is not insulin deficiency.
Origin
- Source status
- Archive editors
- Attribution
- Archive editors summarising Elawady's view (homepage summary; not the quote box)
- Origin
- https://eltayebat.com/
- Attribution uncertainty
- Homepage summary written by the archive operators describing Elawady's views; partly cites his 'statement of the theory' video (aEbRfVSJIOw), otherwise no video reference.
- Claimed mechanism
Glucose and ketones are liver products made under stress hormones; their rise shows intact liver mitochondria.
- Claimed health effect
Reassurance about high glucose and ketones
- Population concerned
Everyone, including people with diabetes
- Geographic restriction by Elawady
none found
Diverging source versions
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- حدوته السكر والأسيتو وإزاي خوفوك من الأسيتون وهو تصنيع كبدك بالكامل #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
- 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
- انت كبني آدم المفروض تاكل إيه ؟ #ضياء_العوضي (Open source)
- Published
- 3 January 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
Mostly false – Essential parts of the statement are not supported by the evidence or are strongly exaggerated.
Certainty of evidence: high – Further research is very unlikely to change the assessment.
1. What was claimed?
High glucose and acetone during fasting show healthy liver function and are not dangerous.
2. What is demonstrably correct?
In prolonged fasting, the liver makes ketone bodies from fat; beta-hydroxybutyrate becomes a key fuel for the brain and allows survival in starvation (I-FAST-01). Starvation ketosis is a recognised, usually mild state; the 2024 consensus distinguishes it from DKA by dietary history (I-INS-07). Stress hormones (cortisol, adrenaline, glucagon) do raise glucose and ketones.
3. What is wrong or exaggerated?
In healthy people fasting glucose does not rise to high levels; it stays in the normal range or falls. High glucose plus ketones and acidosis is the defining triad of DKA (I-INS-08); beta-hydroxybutyrate >=3.0 mmol/L correlates with acidosis and is used for diagnosis (I-INS-07). DKA results from insulin deficiency and is life-threatening without insulin and fluids (I-INS-07). SGLT2 inhibitors cause euglycaemic DKA (I-ODD-10, I-ODD-09). People with diabetes who fast (e.g. Ramadan) have higher rates of severe hypoglycaemia and, in type 1 diabetes, hyperglycaemic complications (I-FAST-10); guidelines therefore require risk stratification and monitoring (I-FAST-11, I-INS-10).
4. What remains unclear?
How often people following the system interpret rising glucose and ketones as harmless, and how many have developed ketoacidosis as a result, is unknown; no data were found.
5. Which studies support it?
I-FAST-01 (fasting ketosis is physiological).
6. Which studies contradict it?
I-INS-07, I-INS-08, I-ODD-09, I-ODD-10, I-FAST-10, I-FAST-11, I-INS-10.
7. What applies to Germany and Europe?
Same emergency criteria apply.
8. What is known about Egypt?
Many people with diabetes in Egypt fast during Ramadan; IDF-DAR guidelines (I-FAST-11) advise checking glucose and breaking the fast when glucose is too high or too low.
9. What practical conclusion is appropriate?
In healthy people, some ketones during fasting are normal. In people with diabetes, especially type 1 diabetes, insulin users and SGLT2 inhibitor users, high glucose and/or ketones during fasting are a warning sign that requires measurement and medical action.
Assessment details
- Rationale for certainty of evidence
Physiological fasting ketosis in healthy people is real (correct kernel), but in healthy people fasting glucose falls or stays normal, it does not rise markedly. The combination of high glucose and high ketones is the definition of diabetic ketoacidosis, an emergency caused by insulin deficiency (consensus). In SGLT2 users ketoacidosis can occur with near-normal glucose. High certainty for the danger in people with diabetes.
- Source quality
Homepage editorial plus several own-word videos (one titled about acetone being 'your liver's production').
- Regional transferability
Universal.
- Individual exceptions
Healthy non-diabetic adults: mild-moderate ketosis after 1-3 days of fasting is expected and usually harmless (pregnancy, children and certain metabolic disorders excepted).
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 25 October 2026 provisional
In plain language
When healthy people fast for a day or more, the liver makes ketones (acetone) from fat, and this is normal. But blood sugar in healthy people does not rise high during fasting. If someone with diabetes has high sugar and ketones together, this can be ketoacidosis, which is an emergency. Telling people with diabetes to ignore these signs can cost lives.
Studies on this claim
Studies supporting the claim (1)
-
How the body fuels itself during starvation
Cahill GF. Annu Rev Nutr 2006 · PMID 16848698 · DOI 10.1146/annurev.nutr.26.061505.111258Narrative reviewindependent cross-checkabstract only checkedDuring long fasting the brain uses ketones from fat, which allows survival.
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?
Fuel metabolism in prolonged starvation
- How was the study done?
Narrative/biographical review
- How many people, animals or samples were studied?
not applicable; Humans in starvation (historical studies)
- What was actually found?
Ketones fuel the brain in starvation.
- How large was the observed effect?
not reported
- What do the results mean in everyday life?
Fasting ketosis is normal physiology in healthy people.
- What are the study's limitations?
Narrative; No quantitative data in abstract
- What does it say about Elawady's specific claim?
Supports physiological kernels of C-FAST-01, C-FAST-03, C-FAST-04 (fasting ketosis is normal).
- Do the results apply to Germany and Europe?
Physiology universal.
- What can explicitly not be concluded from this study?
That high glucose plus ketones is harmless in diabetes.
No study in this group is marked as key.
Studies contradicting or limiting the claim (7)
-
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 checkedDKA 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.
-
SGLT2 drugs and ketoacidosis
Douros A et al.. Ann Intern Med 2020 · PMID 32716707 · DOI 10.7326/M20-0289Cohort studyindependent cross-checkabstract only checked★ key studyAbout 2 per 1,000 users per year developed ketoacidosis, nearly 3 times more than with DPP-4 drugs.
Does the study support the specific claim? Yes · 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?
SGLT2 vs DPP-4 inhibitors and DKA risk
- How was the study done?
Multicentre population-based cohort (prevalent new-user design, propensity-matched)
- How many people, animals or samples were studied?
208,757 matched pairs; Type 2 diabetes new users
- What was actually found?
HR 2.85.
- How large was the observed effect?
HR 2.85 (1.99-4.08)
- What do the results mean in everyday life?
Rare but real; caution with fasting/illness.
- What are the study's limitations?
No lab data; Unmeasured confounding
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
UK data included.
- What can explicitly not be concluded from this study?
That the drugs are net harmful.
-
Ketoacidosis with normal blood sugar on SGLT2 drugs
Peters AL et al.. Diabetes Care 2015 · PMID 26078479 · DOI 10.2337/dc15-0843Case series / case reportindependent cross-checkfull text checkedSeveral patients developed ketoacidosis with near-normal sugar, so it was recognised late.
Does the study support the specific claim? Yes · Methodological quality: very 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 euglycaemic DKA with SGLT2 inhibitors
- How was the study done?
Case series
- How many people, animals or samples were studied?
9 individuals, 13 episodes; Patients with T1D or T2D on SGLT2 inhibitors
- What was actually found?
13 episodes in 9 patients on canagliflozin (7 with off-label type 1 diabetes); glucose often near normal, delaying diagnosis; all recovered with IV fluids and insulin.
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
Check ketones when unwell on SGLT2 drugs.
- What are the study's limitations?
Incidental case collection, no denominator, mostly off-label type 1 use, all on canagliflozin.
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
US.
- What can explicitly not be concluded from this study?
How often this happens; that every SGLT2 inhibitor (e.g. dapagliflozin) carries the same risk (inferred, not shown here).
-
Fasting in Ramadan with diabetes (EPIDIAR)
Salti I et al.. Diabetes Care 2004 · PMID 15451892 · DOI 10.2337/diacare.27.10.2306Cross-sectional studyindependent cross-checkabstract only checked★ key studySevere low blood sugar was 4.7 times (type 1) and 7.5 times (type 2) more common during Ramadan.
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?
Diabetes characteristics and effects of Ramadan fasting
- How was the study done?
Population-based retrospective cross-sectional survey (EPIDIAR)
- How many people, animals or samples were studied?
12,243; Muslims with type 1 or type 2 diabetes
- What was actually found?
Severe hypoglycaemia increased.
- How large was the observed effect?
0.14 vs 0.03/month (T1D)
- What do the results mean in everyday life?
People with diabetes need a plan before fasting.
- What are the study's limitations?
Retrospective, recall
- What does it say about Elawady's specific claim?
Contradicts safety implications of C-FAST-03, C-FAST-05, C-FAST-07; relevant to C-ODD-11.
- Do the results apply to Germany and Europe?
Relevant to Muslim communities in Europe.
- What can explicitly not be concluded from this study?
Mortality effects.
-
IDF-DAR Ramadan guidelines 2021
Hassanein M et al.. Diabetes Res Clin Pract 2022 · PMID 35016991 · DOI 10.1016/j.diabres.2021.109185Guideline / position statementindependent cross-checkabstract only checkedPeople with diabetes who fast need individual risk assessment and medical guidance.
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?
Management of diabetes during Ramadan fasting
- How was the study done?
Practical guideline (IDF and DaR International Alliance)
- How many people, animals or samples were studied?
not applicable; People with diabetes who fast
- What was actually found?
Guidance on risk stratification.
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
Fast only with a medical plan.
- What are the study's limitations?
Abstract only read
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
Applicable to fasting Muslims in Europe.
- What can explicitly not be concluded from this study?
Specific thresholds (not in abstract).
-
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.
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
Same emergency criteria apply.
Egypt
Many people with diabetes in Egypt fast during Ramadan; IDF-DAR guidelines (I-FAST-11) advise checking glucose and breaking the fast when glucose is too high or too low.
What applies in my country?
General scientific assessment
Mostly false Fasting ketones are normal in healthy people; high sugar plus ketones in diabetes is an emergency.
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
- Fuel metabolism in starvation.. Cahill GF. Annu Rev Nutr 2006 · PMID 16848698 · DOI 10.1146/annurev.nutr.26.061505.111258
- 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
- Sodium-Glucose Cotransporter-2 Inhibitors and the Risk for Diabetic Ketoacidosis : A Multicenter Cohort Study.. Douros A et al.. Ann Intern Med 2020 · PMID 32716707 · DOI 10.7326/M20-0289
- Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment With Sodium-Glucose Cotransporter 2 Inhibition.. Peters AL et al.. Diabetes Care 2015 · PMID 26078479 · DOI 10.2337/dc15-0843
- A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study.. Salti I et al.. Diabetes Care 2004 · PMID 15451892 · DOI 10.2337/diacare.27.10.2306
- Diabetes and Ramadan: Practical guidelines 2021.. Hassanein M et al.. Diabetes Res Clin Pract 2022 · PMID 35016991 · DOI 10.1016/j.diabres.2021.109185
- 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