基本错误已被科学证据否定证据确定性: 高初步 C-FAST-03

禁食期间血糖和丙酮（酮体）升高，证明肝脏工作正常，而不是危险信号；高血糖加丙酮并不代表胰岛素缺乏。

安全提示: 血糖升高同时尿液或血液中出现酮体（丙酮），尤其伴有恶心、呕吐、腹痛、呼吸急促、口渴或嗜睡时，可能意味着糖尿病酮症酸中毒，这是一种医疗急症。在使用SGLT2抑制剂（例如达格列净/Forxiga、恩格列净）的人中，酮症酸中毒可能在血糖正常或仅轻度升高时发生。请立即寻求急诊治疗；不要等待，也不要试图靠禁食熬过去。希望禁食的糖尿病患者，只有在经过个体化风险评估（IDF-DAR指南）后才能禁食；如果血糖非常高（例如高于300 mg/dL）或过低（低于70 mg/dL），或者出现酮体，必须停止禁食。

简而言之: 该说法基本错误，对糖尿病患者来说是危险的。健康人禁食期间出现酮体是正常的，但健康人禁食时血糖会下降而不是升高；高血糖同时伴有酮体是胰岛素缺乏（酮症酸中毒）的典型征象，属于医疗急症。

结论: 基本错误，对糖尿病患者来说是危险的：健康人禁食时，血糖下降，酮体适度升高；高血糖加酮体则提示胰岛素缺乏，属于急症。

原始表述
科学评估
科学证据详解
通俗解释
与该说法相关的研究
地区背景
在我的国家适用什么？
参考文献

原始表述

ارتفاع السكر والأسيتون في الصيام، بنظره، دليل عمل الكبد لا خطر.

按来源为原话. 译文由本项目提供；以阿拉伯语原文为准。

译文

禁食期间血糖和丙酮（酮体）升高，证明肝脏工作正常，而不是危险信号；高血糖加丙酮并不代表胰岛素缺乏。

出处

来源状态: 档案网站编辑
归属: Archive editors summarising Elawady's view (homepage summary; not the quote box)
出处: https://eltayebat.com/
归属的不确定性: Homepage summary written by the archive operators describing Elawady's views; partly cites his 'statement of the theory' video (aEbRfVSJIOw), otherwise no video reference.

所声称的机制: Glucose and ketones are liver products made under stress hormones; their rise shows intact liver mitochondria.
所声称的健康影响: Reassurance about high glucose and ketones
涉及人群: Everyone, including people with diabetes
Elawady 设定的地域限制: none found

来源版本存在差异

来源状态: 视频转录文本（本人原话）
归属: Elawady (machine transcript)
视频: حدوته السكر والأسيتو وإزاي خوفوك من الأسيتون وهو تصنيع كبدك بالكامل #ضياء_العوضي (打开来源)
发布日期: 2025年12月23日
时间戳: 无（转录文本不含时间信息）
归属的不确定性: 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.

来源状态: 视频转录文本（本人原话）
归属: Elawady (machine transcript)
视频: ارتفاع السكر والأسيتون ؟خطر والا ده الطبيعي ؟#ضياء_العوضي (打开来源)
发布日期: 2025年12月23日
时间戳: 无（转录文本不含时间信息）
归属的不确定性: 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.

来源状态: 视频转录文本（本人原话）
归属: Elawady (machine transcript)
视频: انت كبني آدم المفروض تاكل إيه ؟ #ضياء_العوضي (打开来源)
发布日期: 2026年1月3日
时间戳: 无（转录文本不含时间信息）
归属的不确定性: 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.

科学评估

基本错误 – 该说法的主要部分没有证据支持，或被严重夸大。

证据确定性: 高 – 进一步研究极不可能改变该评估。

1. 说法是什么？

High glucose and acetone during fasting show healthy liver function and are not dangerous.

2. 哪些内容可证实是正确的？

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. 哪些内容是错误或夸大的？

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. 哪些内容仍不明确？

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. 哪些研究支持该说法？

I-FAST-01 (fasting ketosis is physiological).

6. 哪些研究与该说法相矛盾？

I-INS-07, I-INS-08, I-ODD-09, I-ODD-10, I-FAST-10, I-FAST-11, I-INS-10; IDF-DAR 2021 full guideline: break the fast if glucose >300 mg/dL or <70 mg/dL (I-FAST-108); healthy fasters' glucose stabilised at 4.7 mmol/L (I-FAST-111); type 1 diabetes and Ramadan: more complications and ER visits in high-risk adults (I-FAST-109) and frequent hypoglycaemia with some DKA in adolescents (I-FAST-110).

7. 对德国和欧洲而言情况如何？

Same emergency criteria apply.

8. 关于埃及的已知情况是什么？

Many people with diabetes in Egypt fast during Ramadan. The IDF-DAR 2021 guideline, co-authored by Egyptian diabetologists, states that all individuals should break the fast if blood glucose is below 70 mg/dL or above 300 mg/dL, or with symptoms of hypoglycaemia or acute illness (I-FAST-108).

9. 合理的实际结论是什么？

在健康人中，禁食期间出现一些酮体是正常的。在糖尿病患者中，尤其是1型糖尿病患者、使用胰岛素的人和使用SGLT2抑制剂的人，禁食期间出现高血糖和/或酮体是一个警示信号，需要进行测量并采取医疗措施。

评估详情

证据确定性的依据: 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.
来源质量: Homepage editorial plus several own-word videos (one titled about acetone being 'your liver's production').
地区可推广性: Universal.
个体例外情况: 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).
说法的地域范围: 普遍性（生物学/医学）
最近审核: 2026年10月26日初步

科学证据详解

已被科学证据否定 – 高质量证据显示情况恰恰相反，或该说法与已确立的生理学知识相矛盾。

研究问题: During fasting, are rising blood glucose together with ketones a sign of normal liver function rather than insulin deficiency, in healthy people and in people with diabetes?

研究问题详解 (PECO)

人群

Healthy fasting adults; people with diabetes (T1D, insulin-treated T2D, SGLT2 inhibitor users) who fast

干预或暴露

Fasting (incl. Ramadan, multi-day)

对照

Fed state / non-fasting

地域范围

universal biology; Ramadan context (Egypt, Arab region)

结局指标

Blood glucose course
Ketones
DKA, hyperglycaemic emergencies, ER visits

研究结果按作者报告呈现。我们的评估见下文。

哪些证据支持该说法？

How the body fuels itself during starvation

Cahill GF. Annu Rev Nutr 2006 · PMID 16848698 · DOI 10.1146/annurev.nutr.26.061505.111258 叙述性综述已核查摘要

Fasting ketosis is physiological: the liver makes ketones that fuel the brain in starvation.

实际结果
Narrative; no numbers.
方法学质量
low (narrative review)
相关性
direct for 'ketones in fasting are normal'
局限
Does not address high glucose.

原始文献
Insulin after a 36-hour fast

Jørgensen SW et al.. Am J Physiol Endocrinol Metab 2021 · PMID 33284087 · DOI 10.1152/ajpendo.00433.2020 其他已核查摘要新增

Prolonged fasting produces a physiological, reversible whole-body insulin resistance.

实际结果
Increased whole-body insulin resistance after 36 h; higher insulin at refeeding.
方法学质量
moderate (n=13)
相关性
partial: explains a kernel, but fasting glucose itself was not reported to rise to high levels
局限
Small; abstract only.

原始文献

哪些证据不支持该说法？

Safety of medically supervised multi-day fasting

Wilhelmi de Toledo F et al.. PLoS One 2019 · PMID 30601864 · DOI 10.1371/journal.pone.0209353 队列研究已核查全文新增

In 1,422 non-diabetic people fasting 4-21 days, glucose fell and stabilised at 4.7 mmol/L while ketones rose.

实际结果
Glucose 4.7 mmol/L (about 85 mg/dL), p<0.001; ketones increased.
方法学质量
low-moderate (large uncontrolled cohort, full text read)
相关性
direct: healthy fasting means low-normal glucose with ketones, not high glucose
局限
Uncontrolled; COI.

原始文献
International guideline on diabetic ketoacidosis

Umpierrez GE et al.. Diabetes Care 2024 · PMID 39052901 · DOI 10.2337/dci24-0032 指南 / 立场声明已核查全文

High glucose plus ketones plus acidosis defines DKA, caused by insulin deficiency.

实际结果
BHB >=3.0 mmol/L correlates with acidosis; insulin is the cornerstone of treatment.
方法学质量
high (2024 international consensus)
相关性
direct
局限
Consensus document.

原始文献
Ramadan guidelines for people with diabetes

International Diabetes Federation and DAR International Alliance (ed. Hassanein M). IDF (Brussels) 2021 指南 / 立场声明已核查全文新增

IDF-DAR 2021: everyone with diabetes must break the fast if glucose exceeds 300 mg/dL or falls below 70 mg/dL; T1D is high/very high risk.

实际结果
Explicit thresholds; glucose falls in physiological fasting.
方法学质量
moderate (international guideline incl. Egyptian authors; full PDF read)
相关性
direct
局限
Consensus-based.

原始文献

总体证据说明了什么？

基于上述研究的编辑评估——其本身并非研究结果。

哪种观点有更好的证据支持？

In healthy people, fasting lowers glucose to the low-normal range and raises ketones moderately (physiological ketosis). High glucose together with ketones is the hallmark of insulin deficiency (DKA) and is an emergency, especially in type 1 diabetes and with SGLT2 inhibitors (where ketoacidosis can occur at near-normal glucose).

为什么有些研究权重更大

International consensus and guidelines (I-INS-07, I-INS-10, I-FAST-108) plus large observational data on fasting physiology outweigh the single physiological kernel (fasting insulin resistance).

因果关系是否已确立？ 是，已确立 Insulin deficiency causes DKA (established pathophysiology; reversal with insulin).

仍存在的不确定性

How many followers have delayed care because of this message (no data).

合理的结论

Ketones during fasting can be normal in healthy people; high glucose with ketones is not a sign of a healthy liver but a warning sign of insulin deficiency.

为什么研究结果看起来互相矛盾？

The kernel (physiological fasting insulin resistance and ketosis) and the danger (DKA) concern different populations and glucose levels; they do not truly conflict.

这是否取决于国家？

一般生物学效应: Universal.
饮食习惯: Many people with diabetes in Egypt fast during Ramadan; the IDF-DAR guideline, co-written by Egyptian diabetologists, requires breaking the fast at glucose >300 mg/dL.
食品原产地: Not applicable.
污染物: Not applicable.
本国生产条件: Not applicable.
法律规则: Not applicable.
实际监测数据: Regional data (Saudi Arabia) show emergency visits among fasting people with T1D (I-FAST-109); no Egyptian registry data found.

足以改变结论的地区差异没有可靠数据支持。

统计复核

OR interpretation and CI symmetry – OR 0.53 (0.34-0.82) log-symmetric; '47% lower odds' is an odds ratio from self-reported cross-sectional data, not a causal risk reduction. 已重新计算
Unit conversion of fasting glucose – 4.7 mmol/L = about 85 mg/dL (low-normal). 已重新计算

总体证据的确定性（GRADE，简化版）

主要结局

Risk of DKA/hyperglycaemic emergency when high glucose plus ketones in fasting people with diabetes are ignored

起始等级

低（观察性研究）

升级理由

large effect and established mechanism (untreated DKA is lethal; insulin reverses it)
consistent consensus across guidelines

结果

高

由单名审查者参照 GRADE 方法进行的简化评估；并非正式的 GRADE 专家组评估。GRADE 评价的是针对某一结局的整体证据，而非单项研究。

已核查的临床指南和官方声明

IDF and DAR International Alliance: Diabetes and Ramadan: Practical Guidelines 2021 (2021) · 原始文献
All individuals should break the fast if blood glucose <70 mg/dL (3.9 mmol/L) or >300 mg/dL (16.7 mmol/L) or with symptoms of hypoglycaemia or acute illness; people with T1DM are high/very high risk; during fasting glucose falls and insulin secretion is suppressed; when glycogen is depleted and insulin is low, fat is converted to ketones.
ADA: Standards of Care in Diabetes-2026, Section 6 (Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises) (2026) · 原始文献
Previously verified by the diabetes team (I-INS-10 full text): people on intensive insulin therapy should not stop or hold basal insulin even if not eating; individuals at risk for DKA should measure ketones; consider holding SGLT2 inhibitors when oral intake cannot be maintained. Not re-fetched in this phase (diabetesjournals.org returned 403).
ADA/EASD/JBDS/AACE/DTS: Hyperglycemic Crises in Adults With Diabetes: A Consensus Report (I-INS-07) (2024) · 原始文献
Insulin therapy is the cornerstone of DKA management; SGLT2 inhibitors account for most euglycaemic DKA; starvation ketosis distinguished by history.

检索策略

本次审查的文献检索记录（检索式采用原数据库语法）。

数据库	日期	检索式	检索目标	命中数
Europe PMC	2026年10月26日	`Ramadan AND ("type 1 diabetes") AND (ketoacidosis OR DKA OR hyperglycaemia OR hyperglycemia) AND ("systematic review" OR "meta-analysis")`	反对性证据	241
Europe PMC	2026年10月26日	`Ramadan AND diabetes AND (ketoacidosis OR "hyperglycemic emergencies" OR "hospital admissions") AND (Egypt OR Egyptian OR Saudi OR Arab)`	反对性证据	328
Web (WebSearch + direct fetch)	2026年10月26日	`IDF-DAR Diabetes and Ramadan Practical Guidelines 2021 break the fast glucose 300 mg/dL 70 mg/dL; PDF downloaded from media.idf.org (daralliance.org not resolvable)`	指南	10
Europe PMC	2026年10月26日	`("prolonged fasting" OR "periodic fasting" OR "water-only fasting" OR "long-term fasting") AND (safety OR "adverse events") AND (subjects OR participants) AND (observational OR "chart review" OR cohort)`	支持性证据	1199
PubMed	2026年10月26日	`("starvation ketosis"[tiab] OR "fasting ketosis"[tiab]) AND (physiological OR benign OR normal)`	支持性证据	41
PubMed	2026年10月26日	`(fasting[ti]) AND (glucose[ti] OR ketone*[ti]) AND healthy AND (days OR prolonged)`	支持性证据	38
PubMed	2026年10月26日	`Ramadan[ti] AND (diabetes[ti]) AND (ketoacidosis OR hyperglycemia OR hyperglycaemia) AND (meta-analysis[pt] OR cohort OR guideline)`	反对性证据	22
PubMed	2026年10月26日	`(euglycemic[ti] OR euglycaemic[ti]) AND ketoacidosis[ti] AND (fasting OR "SGLT2")`	反对性证据	256

待解决的问题

Case reports of DKA in people following the system (none found).

核查深度如何？

13 项相关研究：6 项核查了全文（其中 2 项进行了结构化偏倚风险评估），7 项基于摘要核查，0 项仅核查了文献信息。尚未进行由两名独立审查者完成的正式评估，也尚未进行独立的人类专家审核。

最近一次科学审核: 2026年10月26日

评定结论的变更历史

2026年10月25日 · 第 1 阶段 · 初始评估: 基本错误 (高)
2026年10月26日 · 第 4 阶段（系统证据审查） · 在扩展证据后重新审查；评定结论不变: 基本错误 (高)
New evidence (IDF-DAR full text, regional T1D Ramadan data, large fasting cohort showing glucose falls) confirms the existing verdict; the correct kernel (fasting ketosis) keeps it at mostly false rather than false.
新来源: I-FAST-108 I-FAST-109 I-FAST-110 I-FAST-111 I-FAST-102

通俗解释

健康人禁食一天或更长时间时，肝脏会利用脂肪生成酮体（丙酮），这是正常的。但健康人在禁食期间血糖不会升得很高。如果糖尿病患者同时出现高血糖和酮体，这可能是酮症酸中毒，属于急症。告诉糖尿病患者忽视这些信号可能会危及生命。

与该说法相关的研究

支持该说法的研究 (1)

How the body fuels itself during starvation

Cahill GF. Annu Rev Nutr 2006 · PMID 16848698 · DOI 10.1146/annurev.nutr.26.061505.111258

叙述性综述独立交叉核查已核查摘要

During long fasting the brain uses ketones from fat, which allows survival.

该研究是否支持这一具体说法？部分支持 · 方法学质量: 中 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
Fuel metabolism in prolonged starvation
研究是如何开展的？
Narrative/biographical review
研究了多少人、动物或样本？
not applicable; Humans in starvation (historical studies)
实际发现了什么？
Ketones fuel the brain in starvation.
观察到的效应有多大？
not reported
研究结果对日常生活意味着什么？
Fasting ketosis is normal physiology in healthy people.
该研究有哪些局限？
Narrative; No quantitative data in abstract
它对 Elawady 的具体说法说明了什么？
Supports physiological kernels of C-FAST-01, C-FAST-03, C-FAST-04 (fasting ketosis is normal).
研究结果是否适用于德国和欧洲？
Physiology universal.
从该研究中明确不能得出什么结论？
That high glucose plus ketones is harmless in diabetes.
科学细节 →

与该说法相矛盾或限制该说法的研究 (11)

International guideline on diabetic ketoacidosis

Umpierrez GE et al.. Diabetes Care 2024 · PMID 39052901 · DOI 10.2337/dci24-0032

指南 / 立场声明独立交叉核查已核查全文★ 关键研究

Insulin, fluids and potassium are the core treatment; with this, fewer than 1% of adults die.

该研究是否支持这一具体说法？否 · 方法学质量: 高 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
Diagnosis and management of DKA and HHS in adults
研究是如何开展的？
International consensus report based on systematic examination of literature since 2009 (ADA, EASD, JBDS, AACE, DTS)
研究了多少人、动物或样本？
not applicable; Adults with diabetes
实际发现了什么？
Insulin is the cornerstone; glucocorticoids worsen hyperglycaemia.
观察到的效应有多大？
Mortality <1% with treatment
研究结果对日常生活意味着什么？
Ketoacidosis needs hospital treatment with insulin.
该研究有哪些局限？
Consensus, not trial
它对 Elawady 的具体说法说明了什么？
Directly contradicts C-INS-08; supports danger in C-FAST-03; contradicts C-INS-07, C-INS-10.
研究结果是否适用于德国和欧洲？
EASD and JBDS (UK) co-authored; directly applicable.
从该研究中明确不能得出什么结论？
Outcomes of untreated DKA quantitatively.
科学细节 →
Review on diabetic ketoacidosis

Dhatariya KK et al.. Nat Rev Dis Primers 2020 · PMID 32409703 · DOI 10.1038/s41572-020-0165-1

叙述性综述独立交叉核查全文，含结构化偏倚风险评估

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.

该研究是否支持这一具体说法？否 · 方法学质量: 中 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
Epidemiology, pathogenesis, diagnosis and management of DKA
研究是如何开展的？
Narrative expert review (Nature Reviews Disease Primers)
研究了多少人、动物或样本？
not applicable; Adults and children with diabetes
实际发现了什么？
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.
观察到的效应有多大？
not applicable
研究结果对日常生活意味着什么？
DKA is an emergency.
该研究有哪些局限？
Narrative expert review without systematic methods; one author has research support from insulin makers.
它对 Elawady 的具体说法说明了什么？
Contradicts C-INS-08, C-INS-02, C-FAST-01, C-FAST-03.
研究结果是否适用于德国和欧洲？
International.
从该研究中明确不能得出什么结论？
Quantitative estimates.
科学细节 →
SGLT2 drugs and ketoacidosis

Douros A et al.. Ann Intern Med 2020 · PMID 32716707 · DOI 10.7326/M20-0289

队列研究独立交叉核查已核查摘要★ 关键研究

About 2 per 1,000 users per year developed ketoacidosis, nearly 3 times more than with DPP-4 drugs.

该研究是否支持这一具体说法？是 · 方法学质量: 高 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
SGLT2 vs DPP-4 inhibitors and DKA risk
研究是如何开展的？
Multicentre population-based cohort (prevalent new-user design, propensity-matched)
研究了多少人、动物或样本？
208,757 matched pairs; Type 2 diabetes new users
实际发现了什么？
HR 2.85.
观察到的效应有多大？
HR 2.85 (1.99-4.08)
研究结果对日常生活意味着什么？
Rare but real; caution with fasting/illness.
该研究有哪些局限？
No lab data; Unmeasured confounding
它对 Elawady 的具体说法说明了什么？
Supports C-ODD-02; relevant to C-FAST-03.
研究结果是否适用于德国和欧洲？
UK data included.
从该研究中明确不能得出什么结论？
That the drugs are net harmful.
科学细节 →
Ketoacidosis with normal blood sugar on SGLT2 drugs

Peters AL et al.. Diabetes Care 2015 · PMID 26078479 · DOI 10.2337/dc15-0843

病例系列 / 病例报告独立交叉核查全文，含结构化偏倚风险评估

Several patients developed ketoacidosis with near-normal sugar, so it was recognised late.

该研究是否支持这一具体说法？是 · 方法学质量: 极低 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
Describe euglycaemic DKA with SGLT2 inhibitors
研究是如何开展的？
Case series
研究了多少人、动物或样本？
9 individuals, 13 episodes; Patients with T1D or T2D on SGLT2 inhibitors
实际发现了什么？
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.
观察到的效应有多大？
not applicable
研究结果对日常生活意味着什么？
Check ketones when unwell on SGLT2 drugs.
该研究有哪些局限？
Incidental case collection, no denominator, mostly off-label type 1 use, all on canagliflozin.
它对 Elawady 的具体说法说明了什么？
Supports C-ODD-02; key for C-FAST-03 safety.
研究结果是否适用于德国和欧洲？
US.
从该研究中明确不能得出什么结论？
How often this happens; that every SGLT2 inhibitor (e.g. dapagliflozin) carries the same risk (inferred, not shown here).
科学细节 →
Fasting in Ramadan with diabetes (EPIDIAR)

Salti I et al.. Diabetes Care 2004 · PMID 15451892 · DOI 10.2337/diacare.27.10.2306

横断面研究独立交叉核查已核查摘要★ 关键研究

Severe low blood sugar was 4.7 times (type 1) and 7.5 times (type 2) more common during Ramadan.

该研究是否支持这一具体说法？否 · 方法学质量: 中 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
Diabetes characteristics and effects of Ramadan fasting
研究是如何开展的？
Population-based retrospective cross-sectional survey (EPIDIAR)
研究了多少人、动物或样本？
12,243; Muslims with type 1 or type 2 diabetes
实际发现了什么？
Severe hypoglycaemia increased.
观察到的效应有多大？
0.14 vs 0.03/month (T1D)
研究结果对日常生活意味着什么？
People with diabetes need a plan before fasting.
该研究有哪些局限？
Retrospective, recall
它对 Elawady 的具体说法说明了什么？
Contradicts safety implications of C-FAST-03, C-FAST-05, C-FAST-07; relevant to C-ODD-11.
研究结果是否适用于德国和欧洲？
Relevant to Muslim communities in Europe.
从该研究中明确不能得出什么结论？
Mortality effects.
科学细节 →
IDF-DAR Ramadan guidelines 2021

Hassanein M et al.. Diabetes Res Clin Pract 2022 · PMID 35016991 · DOI 10.1016/j.diabres.2021.109185

指南 / 立场声明独立交叉核查已核查摘要

People with diabetes who fast need individual risk assessment and medical guidance.

该研究是否支持这一具体说法？否 · 方法学质量: 中 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
Management of diabetes during Ramadan fasting
研究是如何开展的？
Practical guideline (IDF and DaR International Alliance)
研究了多少人、动物或样本？
not applicable; People with diabetes who fast
实际发现了什么？
Guidance on risk stratification.
观察到的效应有多大？
not applicable
研究结果对日常生活意味着什么？
Fast only with a medical plan.
该研究有哪些局限？
Abstract only read
它对 Elawady 的具体说法说明了什么？
Contradicts C-FAST-03 and C-FAST-10 safety implications.
研究结果是否适用于德国和欧洲？
Applicable to fasting Muslims in Europe.
从该研究中明确不能得出什么结论？
Specific thresholds (not in abstract).
科学细节 →
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-S006

指南 / 立场声明独立交叉核查已核查全文★ 关键研究

Most adults should aim for HbA1c below 7%, avoid low sugar, and measure ketones when at risk.

该研究是否支持这一具体说法？部分支持 · 方法学质量: 高 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
Glycaemic goals, hypoglycaemia and hyperglycaemic crises
研究是如何开展的？
Clinical practice guideline (ADA Standards of Care 2026, Section 6)
研究了多少人、动物或样本？
not applicable; People with diabetes
实际发现了什么？
Individual targets; do not stop basal insulin when not eating.
观察到的效应有多大？
not applicable
研究结果对日常生活意味着什么？
Moderate targets and safety rules.
该研究有哪些局限？
US-centred; Partially read
它对 Elawady 的具体说法说明了什么？
Supports C-INS-04, C-INS-11; contradicts C-FAST-01, C-FAST-03, C-DIAB-02.
研究结果是否适用于德国和欧洲？
Consistent with EASD guidance.
从该研究中明确不能得出什么结论？
Not applicable.
科学细节 →
Ramadan guidelines for people with diabetes

International Diabetes Federation and DAR International Alliance (ed. Hassanein M). IDF (Brussels) 2021

指南 / 立场声明独立交叉核查已核查全文★ 关键研究

People with diabetes who fast must stop fasting if blood sugar goes above 300 mg/dL or below 70 mg/dL.

Break the fast if glucose >300 mg/dL or <70 mg/dL; T1D is high/very high risk; glucose falls in normal fasting.

该研究是否支持这一具体说法？否 · 方法学质量: 中 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
Give practical advice for safe fasting with diabetes.
研究是如何开展的？
International expert guideline.
研究了多少人、动物或样本？
not applicable
实际发现了什么？
Risk stratification; break-fast thresholds; T1D high risk.
观察到的效应有多大？
not applicable
研究结果对日常生活意味着什么？
High blood sugar during fasting is a reason to stop fasting and check for danger, not a sign of health.
该研究有哪些局限？
Consensus-based.
它对 Elawady 的具体说法说明了什么？
Contradicts the claim for people with diabetes.
研究结果是否适用于德国和欧洲？
Used by clinicians in Egypt and the Gulf and by European diabetes services for Muslim patients.
从该研究中明确不能得出什么结论？
Precise risk of DKA per fasting day.
科学细节 →
Type 1 diabetes and Ramadan complications

Alguwaihes AM et al.. Clin Med Insights Endocrinol Diabetes 2025 · PMID 41001082 · DOI 10.1177/11795514251376888

横断面研究独立交叉核查已核查摘要★ 关键研究

Among 963 Saudi adults with type 1 diabetes, those rated high risk had more complications and emergency visits when fasting.

In 963 adults with T1D, high-risk fasters had more complications and ER visits.

该研究是否支持这一具体说法？否 · 方法学质量: 低 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
Test a fasting risk tool.
研究是如何开展的？
Online survey after Ramadan 2022.
研究了多少人、动物或样本？
963 adults with T1D.
实际发现了什么？
High-risk group: more ER visits; education linked to fewer visits.
观察到的效应有多大？
OR 0.53 (0.34-0.82) for education.
研究结果对日常生活意味着什么？
Fasting with type 1 diabetes can lead to emergencies; preparation with doctors helps.
该研究有哪些局限？
Self-reported; no lab confirmation.
它对 Elawady 的具体说法说明了什么？
Contradicts the idea that high sugar during fasting is harmless.
研究结果是否适用于德国和欧洲？
Directly relevant to Arab populations including Egypt.
从该研究中明确不能得出什么结论？
Exact DKA rates.
科学细节 →
Teenagers with type 1 diabetes fasting Ramadan

Safari O et al.. BMC Endocr Disord 2025 · PMID 39966830 · DOI 10.1186/s12902-025-01835-1

Meta分析独立交叉核查已核查摘要★ 关键研究

Low blood sugar was very common and high sugar and ketoacidosis also occurred in fasting teenagers with type 1 diabetes.

Adolescents with T1D fasting Ramadan: hypoglycaemia 50.79/100 observations; hyperglycaemia and DKA reported.

该研究是否支持这一具体说法？否 · 方法学质量: 低 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
Summarise risks of Ramadan fasting for teenagers with T1D.
研究是如何开展的？
Meta-analysis of 9 studies.
研究了多少人、动物或样本？
458 adolescents.
实际发现了什么？
No change in HbA1c; frequent hypoglycaemia; some hyperglycaemia and DKA.
观察到的效应有多大？
Hypoglycaemia 50.79/100 observations.
研究结果对日常生活意味着什么？
Children with type 1 diabetes need close supervision if they fast.
该研究有哪些局限？
Small observational studies.
它对 Elawady 的具体说法说明了什么？
Contradicts a relaxed attitude to high glucose and ketones in fasting people with diabetes.
研究结果是否适用于德国和欧洲？
Relevant to Muslim families in Europe and Egypt.
从该研究中明确不能得出什么结论？
Exact DKA risk.
科学细节 →
Safety of medically supervised multi-day fasting

Wilhelmi de Toledo F et al.. PLoS One 2019 · PMID 30601864 · DOI 10.1371/journal.pone.0209353

队列研究独立交叉核查已核查全文★ 关键研究

In 1,422 clinic guests, supervised fasting with small amounts of juice and soup was mostly well tolerated; blood sugar fell to the low-normal range.

In non-diabetic fasters glucose fell and stabilised at 4.7 mmol/L (about 85 mg/dL) while ketones rose.

该研究是否支持这一具体说法？部分支持 · 方法学质量: 低 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
Document safety and changes during Buchinger fasting.
研究是如何开展的？
One-year observational study, before-after measurements.
研究了多少人、动物或样本？
1,422 adults at a German fasting clinic.
实际发现了什么？
Weight and BP fell; glucose 4.7 mmol/L; ketones rose; adverse effects 0.7%; 2 hospital admissions.
观察到的效应有多大？
p<0.001 for weight, BP, glucose changes.
研究结果对日常生活意味着什么？
Short fasts under medical care with fluids and minimal calories are usually tolerated by selected healthy adults.
该研究有哪些局限？
No control group; clinic-run study; selected participants.
它对 Elawady 的具体说法说明了什么？
Does not support 'zero inputs'; contradicts rising glucose as a normal fasting sign.
研究结果是否适用于德国和欧洲？
German setting (Heilfasten); applicable to supervised fasting in Europe.
从该研究中明确不能得出什么结论？
Long-term health benefits; safety for excluded groups.
科学细节 →

结果不一或不明确的研究 (1)

Insulin after a 36-hour fast

Jørgensen SW et al.. Am J Physiol Endocrinol Metab 2021 · PMID 33284087 · DOI 10.1152/ajpendo.00433.2020

其他独立交叉核查已核查摘要★ 关键研究

In 13 healthy men, a 36-hour fast only slightly reduced early insulin release; the body became more insulin resistant for a while.

Prolonged fasting causes a physiological whole-body insulin resistance in healthy people - a real kernel - but this is not hyperglycaemia with ketoacidosis.

该研究是否支持这一具体说法？部分支持 · 方法学质量: 中 · 证据确定性：见该说法的总体评估

原始文献 · 科学细节

研究通俗解读
研究人员想了解什么？
Understand how insulin release and action change with a longer fast.
研究是如何开展的？
Compared 36-h and 12-h fasts with glucose tolerance testing and tracers.
研究了多少人、动物或样本？
13 healthy young men in Denmark.
实际发现了什么？
Insulin secretion persisted with a minor reduction; whole-body insulin resistance increased.
观察到的效应有多大？
Not available (abstract only).
研究结果对日常生活意味着什么？
Healthy bodies keep making some insulin even after a day and a half without food.
该研究有哪些局限？
Tiny sample, men only, short fast.
它对 Elawady 的具体说法说明了什么？
Insulin does not go to zero; physiological insulin resistance during fasting is real but different from diabetes.
研究结果是否适用于德国和欧洲？
Applies; same physiology.
从该研究中明确不能得出什么结论？
Effects of fasts longer than 36 h; women; people with diabetes.
科学细节 →

地区背景

德国 / 欧盟

Same emergency criteria apply.

埃及

在我的国家适用什么？

一般科学评估

基本错误基本错误，对糖尿病患者来说是危险的：健康人禁食时，血糖下降，酮体适度升高；高血糖加酮体则提示胰岛素缺乏，属于急症。

该说法涉及生物学或医学关系。上述科学评估不论在哪个国家都适用；各国食品数据不会改变这一评估。

参考文献

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
Diabetes and Ramadan: Practical Guidelines 2021 (IDF-DAR), International Diabetes Federation and DAR International Alliance. International Diabetes Federation and DAR International Alliance (ed. Hassanein M). IDF (Brussels) 2021
Assessment of the IDF-DAR Fasting Risk Assessment Tool to Predict Type 1 Diabetes-Related Complications During Ramadan in a Real-World Setting.. Alguwaihes AM et al.. Clin Med Insights Endocrinol Diabetes 2025 · PMID 41001082 · DOI 10.1177/11795514251376888
Ramadan fasting among adolescents with type 1 diabetes: a systematic review and meta-analysis.. Safari O et al.. BMC Endocr Disord 2025 · PMID 39966830 · DOI 10.1186/s12902-025-01835-1
Safety, health improvement and well-being during a 4 to 21-day fasting period in an observational study including 1422 subjects.. Wilhelmi de Toledo F et al.. PLoS One 2019 · PMID 30601864 · DOI 10.1371/journal.pone.0209353
Impact of prolonged fasting on insulin secretion, insulin action, and hepatic versus whole body insulin secretion disposition indices in healthy young males.. Jørgensen SW et al.. Am J Physiol Endocrinol Metab 2021 · PMID 33284087 · DOI 10.1152/ajpendo.00433.2020

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禁食期间血糖和丙酮（酮体）升高，证明肝脏工作正常，而不是危险信号；高血糖加丙酮并不代表胰岛素缺乏。

原始表述

译文

出处

来源版本存在差异

科学评估

1. 说法是什么？

2. 哪些内容可证实是正确的？

3. 哪些内容是错误或夸大的？

4. 哪些内容仍不明确？

5. 哪些研究支持该说法？

6. 哪些研究与该说法相矛盾？

7. 对德国和欧洲而言情况如何？

8. 关于埃及的已知情况是什么？

9. 合理的实际结论是什么？

评估详情

科学证据详解

哪些证据支持该说法？

How the body fuels itself during starvation

Insulin after a 36-hour fast

哪些证据不支持该说法？

Safety of medically supervised multi-day fasting

International guideline on diabetic ketoacidosis

Ramadan guidelines for people with diabetes

总体证据说明了什么？

哪种观点有更好的证据支持？

为什么有些研究权重更大

仍存在的不确定性

合理的结论

待解决的问题

核查深度如何？

通俗解释

与该说法相关的研究

支持该说法的研究 (1)

How the body fuels itself during starvation

与该说法相矛盾或限制该说法的研究 (11)

International guideline on diabetic ketoacidosis

Review on diabetic ketoacidosis

SGLT2 drugs and ketoacidosis

Ketoacidosis with normal blood sugar on SGLT2 drugs

Fasting in Ramadan with diabetes (EPIDIAR)

IDF-DAR Ramadan guidelines 2021

ADA guideline 2026: blood sugar goals and emergencies

Ramadan guidelines for people with diabetes

Type 1 diabetes and Ramadan complications

Teenagers with type 1 diabetes fasting Ramadan

Safety of medically supervised multi-day fasting

结果不一或不明确的研究 (1)

Insulin after a 36-hour fast

地区背景

德国 / 欧盟

埃及

在我的国家适用什么？

一般科学评估

参考文献