Diabetic ketoacidosis (DKA) does not kill anyone; it should be treated with corticosteroids and complete fasting from food and drink for days, without insulin and without intravenous fluids; giving insulin in this situation is 'the black disaster'.

Original statement

مش عايز محاليل محاليل ايه كورتيكوست لحد ما يفك وصيام اكل وشرب ان بي او لا ايام مش عايز علاج ديكي ايه

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

Translation

Diabetic ketoacidosis (DKA) does not kill anyone; it should be treated with corticosteroids and complete fasting from food and drink for days, without insulin and without intravenous fluids; giving insulin in this situation is 'the black disaster'.

Origin

Source status

Video transcript (own words)

Attribution

Elawady (machine transcript)

Video

الغيبوبات السكرية ؟! (Open source)

Published

30 April 2025

Timestamp

0:49:40 (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

Coma in DKA is due to blood pooling in a congested liver/gut; cortisone restores circulation; ketones and glucose are liver products.

Claimed health effect

Denial of DKA as deadly; rejection of insulin and fluids in DKA

Population concerned

People with diabetes in hyperglycaemic crisis

Geographic restriction by Elawady

none found

Diverging source versions

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?

DKA is harmless; treatment should be cortisone plus multi-day fasting without food, drink, insulin or fluids.

2. What is demonstrably correct?

Elawady correctly lists three hyperglycaemic emergencies (DKA, hyperosmolar state, lactic acidosis), correctly notes that SGLT2 inhibitors can cause ketoacidosis, sometimes with near-normal glucose (I-ODD-10), and that ketosis occurs in starvation.

3. What is wrong or exaggerated?

DKA is a life-threatening emergency. The 2024 consensus states: 'Insulin therapy is the cornerstone of DKA management and should be started as soon as possible after diagnosis', with isotonic fluids at 500-1,000 mL/h initially and potassium replacement; 'Appropriate treatment has reduced mortality owing to DKA to <1%' (I-INS-07). Without optimal treatment DKA has 'appreciable, although largely preventable, morbidity and mortality' (I-INS-08). In the canagliflozin programme, DKA cases were driven by insulin deficiency (autoimmune diabetes, insulin omission or dose reduction) and acute illness, with glucose above 300 mg/dL, which supports insulin treatment rather than withholding it (A-ODD-10). Patients with DKA are severely dehydrated, so withholding fluids and imposing a dry fast would worsen shock and kidney failure. Glucocorticoids 'may precipitate acute and sustained hyperglycemia by countering insulin action' (I-INS-07). The hypothesis of hepatic/intestinal blood pooling as the cause of DKA coma has no supporting evidence.

4. What remains unclear?

Nothing material.

5. Which studies support it?

None for the treatment claim.

6. Which studies contradict it?

I-INS-07, I-INS-08, I-INS-10, A-ODD-10.

7. What applies to Germany and Europe?

German and European emergency practice follows the same consensus (EASD and JBDS are co-authors of I-INS-07).

8. What is known about Egypt?

DKA is a common cause of emergency admission of children and young adults with diabetes in Egypt and the region; delayed treatment increases mortality. Advice to avoid hospitals and insulin is particularly dangerous where access to care is already delayed.

9. What practical conclusion is appropriate?

Suspected DKA requires immediate emergency medical treatment with insulin, fluids and electrolytes. Corticosteroids and fasting are not treatments for DKA.

Assessment details

Rationale for certainty of evidence

International consensus (ADA/EASD/JBDS/AACE/DTS 2024) based on decades of evidence: insulin is 'the cornerstone of DKA management', with IV fluids and potassium. DKA mortality is <1% only with appropriate treatment. Glucocorticoids raise glucose and can precipitate hyperglycaemic crises. Elawady himself says in the same video that cortisone increases ketones and glucose.

Source quality

Own words, machine transcripts of two separate videos (identical lecture published as live and edited version).

Regional transferability

Universal.

Individual exceptions

None.

Regional scope of the claim

general (biological/medical)

Last reviewed

25 October 2026 provisional

In plain language

Diabetic ketoacidosis happens when the body has far too little insulin: blood sugar and acids rise, and the body loses a lot of water. It is an emergency. Hospitals treat it with fluids through a drip, insulin and salts such as potassium; with this treatment fewer than 1 in 100 adults die. Cortisone raises blood sugar and fasting without water makes dehydration worse, so the advice in this video could be fatal.

Studies on this claim

Regional context

Germany / EU

German and European emergency practice follows the same consensus (EASD and JBDS are co-authors of I-INS-07).

Egypt

DKA is a common cause of emergency admission of children and young adults with diabetes in Egypt and the region; delayed treatment increases mortality. Advice to avoid hospitals and insulin is particularly dangerous where access to care is already delayed.

What applies in my country?

General scientific assessment

False DKA is deadly without treatment; insulin and fluids save lives, cortisone and dry fasting do not.

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. Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.. Umpierrez GE et al.. Diabetes Care 2024 · PMID 39052901 · DOI 10.2337/dci24-0032
2. Diabetic ketoacidosis.. Dhatariya KK et al.. Nat Rev Dis Primers 2020 · PMID 32409703 · DOI 10.1038/s41572-020-0165-1
3. 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
4. Diabetic Ketoacidosis and Related Events in the Canagliflozin Type 2 Diabetes Clinical Program.. Erondu N et al.. Diabetes Care 2015 · PMID 26203064 · DOI 10.2337/dc15-1251