Archive conclusion: insulin is indispensable in type 1 diabetes; in type 2 diabetes, evidence supports caution with intensive dosing, prioritising metformin, weight loss and dietary change before insulin escalation, and aiming for moderate rather than near-normal HbA1c; this is not the same as rejecting insulin.
Original statement
الخلاصة: الإنسولين ضرورة لا غنى عنها للنوع الأول، أما في النوع الثاني فالأدلة تدعو إلى التحفظ في الجرعات وتفضيل الميتفورمين والتدخل الغذائي قبل تكثيف الإنسولين، لا إلى رفض الإنسولين كاملًا كما يطرح العوضي.
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
Archive conclusion: insulin is indispensable in type 1 diabetes; in type 2 diabetes, evidence supports caution with intensive dosing, prioritising metformin, weight loss and dietary change before insulin escalation, and aiming for moderate rather than near-normal HbA1c; this is not the same as rejecting insulin.
Origin
- Source status
- Archive editors
- Attribution
- Archive editors (not Elawady)
- Origin
- https://eltayebat.com/rule/insulin-injections/
- Attribution uncertainty
- Editorial narrative and study selection written by the archive operators.
- Population concerned
People with diabetes
- Geographic restriction by Elawady
none found
Scientific assessment
Mostly true – Correct at its core, but with limitations or minor inaccuracies.
Certainty of evidence: high – Further research is very unlikely to change the assessment.
1. What was claimed?
Insulin essential in type 1; caution and moderation in type 2; not a rejection of insulin.
2. What is demonstrably correct?
ADA 2026: an HbA1c goal <7% is appropriate for many adults, less stringent goals for people with significant limitations, and hypoglycaemia-causing drugs (insulin, sulfonylureas) should be deintensified where risks outweigh benefits (I-INS-10). Metformin reduced diabetes-related endpoints and mortality in overweight patients in UKPDS 34 (I-ODD-01). Insulin is essential in type 1 diabetes (I-ODD-16). This archive conclusion contradicts Elawady's own position that insulin should be avoided.
3. What is wrong or exaggerated?
The archive omits that current guidelines recommend SGLT2 inhibitors or GLP-1 receptor agonists independently of HbA1c in people with cardiovascular disease, heart failure or kidney disease (I-ODD-16, I-ODD-17), and that insulin should be started regardless of other therapy when HbA1c >10%, glucose >=300 mg/dL or catabolic features are present (I-ODD-16).
4. What remains unclear?
Which HbA1c target and which order of drugs is best for an individual depends on age, other diseases, hypoglycaemia risk and preferences; guidelines give ranges rather than one rule. Whether the archive's emphasis on caution with insulin leads readers to delay insulin when it is needed was not studied.
5. Which studies support it?
A-INS-01, A-INS-19, I-INS-10, I-ODD-01, I-ODD-16, I-ODD-17.
6. Which studies contradict it?
None material.
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?
This is a reasonable summary and differs fundamentally from the claims attributed to Elawady.
Assessment details
- Rationale for certainty of evidence
Consistent with ADA Standards 2026 and ADA/EASD consensus. Not fully TRUE because current guidelines also prioritise SGLT2 inhibitors and GLP-1 receptor agonists with proven cardiorenal benefit and recommend early insulin when glucose is very high or catabolic features are present.
- Source quality
Archive editorial; it explicitly distances itself from Elawady's rejection of insulin.
- Regional transferability
Universal.
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 25 October 2026 provisional
In plain language
The archive's own summary says that insulin is life-saving in type 1 diabetes and that in type 2 diabetes doctors should avoid pushing blood sugar too low and should start with metformin, weight loss and diet. This matches current medical guidelines, which also recommend newer drugs that protect the heart and kidneys.
Studies on this claim
Studies supporting the claim (6)
-
Very aggressive blood sugar lowering in high-risk type 2 diabetes
Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein HC et al.. N Engl J Med 2008 · PMID 18539917 · DOI 10.1056/NEJMoa0802743Randomised controlled trialcited by the Tayebat archivefull text checked★ key studyPushing HbA1c below 6% increased deaths by about one-fifth and did not reduce heart attacks or strokes significantly.
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?
Does targeting a normal HbA1c (<6.0%) reduce cardiovascular events in type 2 diabetes with high cardiovascular risk?
- How was the study done?
Multicentre randomised controlled trial (open-label treatment strategies), mean 3.5 years of intensive therapy
- How many people, animals or samples were studied?
10,251; Type 2 diabetes, mean age 62.2, median HbA1c 8.1%, established CVD or additional risk factors
- What was actually found?
More deaths (HR 1.22) and more severe hypoglycaemia with intensive therapy; primary CV outcome not significantly reduced.
- How large was the observed effect?
HR 1.22 (1.01-1.46) all-cause death; HR 0.90 (0.78-1.04) primary outcome
- What do the results mean in everyday life?
Very strict sugar targets are not good for everyone, especially older people with heart disease.
- What are the study's limitations?
Strategy trial: cannot attribute harm to a specific drug; Intensive arm stopped early; High-risk population; not generalisable to early diabetes
- What does it say about Elawady's specific claim?
Core evidence that near-normal HbA1c targets can harm high-risk type 2 patients (C-INS-04).
- Do the results apply to Germany and Europe?
Multinational/US/UK/European data; directly transferable to Germany/EU clinical practice.
- What can explicitly not be concluded from this study?
That insulin specifically caused the deaths, or that lowering high glucose to moderate targets is harmful.
-
Adding metformin to insulin
Wulffelé MG et al.. Diabetes Care 2002 · PMID 12453950 · DOI 10.2337/diacare.25.12.2133Randomised controlled trialcited by the Tayebat archiveabstract only checkedMetformin 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?
- Do the results apply to Germany and Europe?
Dutch data.
- What can explicitly not be concluded from this study?
That insulin can be stopped.
-
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.
-
Metformin in overweight type 2 diabetes (UKPDS 34)
UKPDS Group. Lancet 1998 · PMID 9742977Randomised controlled trialindependent cross-checkabstract only checked★ key studyMetformin reduced deaths from any cause by about a third over 10 years.
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?
Intensive control with metformin in overweight type 2 diabetes
- How was the study done?
RCT within UKPDS (UKPDS 34)
- How many people, animals or samples were studied?
753 (main comparison); Overweight newly diagnosed type 2 diabetes, mean age 53
- What was actually found?
Mortality -36%.
- How large was the observed effect?
RR reduction 36% (9-55)
- What do the results mean in everyday life?
Metformin is protective.
- What are the study's limitations?
Small arms; Open-label; Conflicting supplementary result
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
UK.
- What can explicitly not be concluded from this study?
Effects in non-overweight patients.
-
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.
-
ADA/EASD consensus 2022
Davies MJ et al.. Diabetes Care 2022 · PMID 36148880 · DOI 10.2337/dci22-0034Guideline / position statementindependent cross-checkabstract only checkedWeight management plus heart- and kidney-protective drugs are central to type 2 diabetes care.
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?
Management of hyperglycaemia in type 2 diabetes
- How was the study done?
ADA/EASD consensus report based on systematic examination of publications since 2018
- How many people, animals or samples were studied?
not applicable; Adults with type 2 diabetes
- What was actually found?
Cardiorenal protection and weight focus.
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
Guideline direction.
- 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?
EASD co-authored; directly applicable to EU.
- What can explicitly not be concluded from this study?
Not applicable.
No study in this group is marked as key.
Studies contradicting or limiting the claim (0)
No studies in this group.
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
Mostly true The archive's conclusion broadly matches guidelines and contradicts the rejection of insulin.
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
- Effects of intensive glucose lowering in type 2 diabetes.. Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein HC et al.. N Engl J Med 2008 · PMID 18539917 · DOI 10.1056/NEJMoa0802743
- 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
- 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
- Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group.. UKPDS Group. Lancet 1998 · PMID 9742977
- 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
- Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).. Davies MJ et al.. Diabetes Care 2022 · PMID 36148880 · DOI 10.2337/dci22-0034