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Fasting, lack of water and ketoacidosis in type 1 diabetes
Differential effects of fasting and dehydration in the pathogenesis of diabetic ketoacidosis.
Overview
Burge MR et al.. Metabolism 2001 · PMID 11229425 · DOI 10.1053/meta.2001.20194
When insulin was stopped, prior fasting lowered blood sugar but made ketones and acid build up faster; lack of water raised both sugar and ketones.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Study how fasting and dehydration influence DKA development.
- How was the study done?
Short insulin withdrawal experiments.
- How many people, animals or samples were studied?
25 adults with T1D.
- What was actually found?
Fasting: lower glucose but faster ketosis; dehydration: higher glucose and faster ketosis.
- How large was the observed effect?
Not given in abstract.
- What do the results mean in everyday life?
Fasting can hide danger: sugar falls while acid rises.
- What are the study's limitations?
Small study.
- What does it say about Elawady's specific claim?
Contradicts dry fasting as DKA treatment.
- Do the results apply to Germany and Europe?
Universal physiology.
- What can explicitly not be concluded from this study?
Cannot give clinical outcome rates.
Scientific in-depth review
1. Full reference
- Authors
- Burge MR et al.
- Journal
- Metabolism
- Year
- 2001
- Identifier
- PMID 11229425 DOI 10.1053/meta.2001.20194
- Verification
- verified – PubMed efetch 2026-10-26; Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
NIH grants (record).
2. Research question
How do fasting and dehydration affect glucose and ketosis during insulin withdrawal in T1D?
3. Study design and population
- Study design
- Other – Experimental physiology study: 5-hour insulin withdrawal before (control) and after 32-h fasting or dehydration
- Population
Adults with T1D
- Country
USA
- Period
Not stated in abstract
- Sample size
25 (fasting n=10; dehydration n=15)
- Inclusion and exclusion criteria
Type 1 diabetes
4. Methods and endpoints
- Exposure / intervention
32 h fasting or dehydration (4.1% body weight) before insulin withdrawal
- Comparator
Insulin withdrawal without prior fasting/dehydration
- Endpoints
Glucose, glucose production/disposal, glucagon, ketosis, acidosis
- Statistical methods
Within-subject comparison
5. Actual results
- Results
Fasting lowered plasma glucose but dehydration raised it (P<.001). Glucagon and the rate of development of ketosis and metabolic acidosis were increased during both fasting and dehydration compared with control.
- Absolute risks
not reported
- Authors' conclusion
Fasting and dehydration have differential effects on glycaemia during insulin deficiency; both accelerate ketosis and acidosis.
6. Strengths
- Controlled physiological experiment in T1D
7. Weaknesses
- Small
- Short experimental exposure
- Old
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Small physiological study.
9. Assessment of the statistical interpretation
Mechanistic; direction of effects clear, magnitudes not given in abstract.
10. Relevance to the specific claim
Fasting may lower glucose (a correct observation), but fasting and dehydration both speed up ketoacidosis when insulin is lacking; a dry fast without insulin therefore worsens DKA.
11. Independent contrary findings
12. Transferability to Germany and Europe
Directly applicable; same biology and clinical standards in Europe.
13. Overall methodological judgement
Mechanistic evidence against 'complete fasting from food and drink' as DKA treatment.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | low |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
15. Linked fact checks
- 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'. – Studies contradicting or limiting the claim
- Laboratory values such as blood glucose and acetone are only signs of the body's changing strategy and not causes; there is no need to measure glucose or blood pressure. – Studies contradicting or limiting the claim