Journal of Human Nutrition and Food Science

Inpatient Fasting Options for People with T1d in German-Speaking Countrie

Short Communication | Open Access | Volume 11 | Issue 3

  • 1. Faculty of Health/School of Medicine, Witten/Herdecke University, Germany
  • 2. Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes-Gutenberg-University, Germany
+ Show More - Show Less
Corresponding Authors
Bettina Berger, Faculty of Health/School of Medicine, Gerhard-Kienle-Chair at the Witten/Herdecke University, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany, Tel: 02330624763 /015227159336

Background: People with type 1 diabetes (t1d) are fasting with the intention to slow down or halt health deterioration or to improve their health condition. First promising results of research in this field are available. According to current fasting guidelines fasting is only recommended under medical supervision.

Objectives: To survey the number of fasting clinics in German-speaking countries and the circumstances and capacities in relation to the readiness to care for patients with t1d during fasting.

Methods: Based on the experiences of experts for fasting with t1d a structured interview guideline was developed. During the turn of the year 2020/2021 a telephone-based survey in German-speaking fasting clinics was conducted.

Results: Eight out of a total of 15 inpatient fasting clinics agreed to participate in this survey. Only one clinic accepts t1d patients as a main diagnosis and has cared for more than 50 such patients to date. Five clinics reported previous experience, with 10 or fewer patients with t1d patients as a secondary diagnosis the care of this type of patients is very different between the clinics and does not consider current research results.

Conclusions: Fasting under medical supervision in Germany for people with t1d seems to be challenging and should be enhanced using research. Furthermore, education for medical doctors in fasting clinics needs to be developed and provided.


Fasting,T1d, Inpatients, Survey


Berger B, Egert V, Martin D, Jenetzky E (2023) Inpatient Fasting Options for People with T1d in German-Speaking Countries. J Hum Nutr Food Sci 11(3): 1166.


There are more than 360.000 people in Germany living with insulin dependent autoimmune diabetes mellitus, type 1 diabetes (t1d). Even if there is more and more technical support to manage daily challenges of insulin substitution like insulin pumps and continuous blood sugar management systems, there is still much burden of disease [1,2]. On average people with t1d still have shorter life expectancy and a high number of long-term complications, e.g. cardio-vascular diseases and a threefold higher risk of developing depression. 28% of people living with t1d have a second autoimmune disease, e.g. Hashimoto [2]. The risk of developing metabolic syndrome or type 2 diabetes among people with t1d is tremendous (around 25%) [3]. To prevent metabolic syndrome and type 2 diabetes, and other long-term complications, fasting may be effectively used [4,5]. Since t1d patients are regarded as high-risk patients in fasting expert guidelines, fasting is only recommended for t1d when accompanied by an experienced fasting doctor within a stationary setting [6]. Usually, fasting in t1d is currently not recommended by diabetologists. Even experienced fasting doctors within a clinical setting say: “We do not believe in fasting for t1d (…). Types of diabetes with impaired beta cell function already have a high risk of ketoacidosis. If you also have fasting related ketonemia, the risk is far too high. It is not without reason that we do not hold vegetable days for type 1 and 3c diabetics.” (director of hospital in Germany, offering fasting as member of ÄGHE, personal communication, 2022/09/22). However, people with t1d are looking for opportunities to fast. A pilot study, proofing the principal possibility, was able to show that fasting in T1D can be safe and helpful, when carried out within a research context under supervision [7]. Other research could show persuading results as well [8-10]. Whereas fasting is recommended for several diseases [6,11], people with T1D have difficulties finding places where medical doctors are willing to support them during fasting. Hence, some of the patients already fast on their own [12]. To provide T1D patients the opportunity to use fasting under medical supervision as a safe and healthy intervention to improve their health-related outcomes, we investigated the opportunities currently offered by fasting clinics.


Our aim was to provide an overview of the care of people with t1d in fasting clinics in German-speaking countries. Affected people who want to use fasting to improve and maintain their health, told us about the challenges in finding a fasting clinic that accepts people with t1d to fast. Our hypothesis was that most fasting clinics do not allow patients with t1d to fast because diabetologists tend to contradict it [7]. Therefore, strived to find out whether fasting clinics accept people with t1dm and how fasting is structured for t1d patients in fasting clinics (e.g. preventing ketoacidosis, adjusting insulin dose). Particular attention was paid to possible termination criteria and the treatment of complications during the fast.


A questionnaire using closed questions was developed using experiences of fasting in t1d and research results. Directions of fasting clinics (lent clinics) were members of the medical society for therapeutic fasting in Germany (ÄGHE). All of them were contacted by sending an email asking for permission to send the questionnaire or to get the opportunity to answer the questions during a telephone conversation. Clinics, offering fasting and being members of ÄGHE in German-speaking countries (including Switzerland and Austria) are included. Wellness hotels without medical care (e.g. “fasting hotels”) are excluded. Patients aged < 18 years and a diagnosis of t1d for < 1 year were exclusion criteria in all the participants of this survey. Survey period was December 1st, 2020 – January 31st, 2021


We could contact all clinics listed as members of ÄGHE, meaning 15 fasting clinics. 8 took part in the survey (53.3%) (Table 1).

Table 1: Fasting clinics included in sample

Clinic Nr. Type of facility (inpatient clinic)  Places  Type of fasting method Is fasting for people with T1D possible?  Amount of patients per year 
1 Public insurance  60 Buchinger (2)  Yes, as second diagnosis  10
modified (600kcal)
2 Public insurance  54 Buchinger (2)  Yes, as second diagnosis 10
3 Private financed and  75 Buchinger (2)  Yes with education and if patient is compliant  7
Rehabilitation facility pension insurance financed
4       No 0
5 Privat, Rehabilitation facility pension insurance financed  128 Buchinger (2)  Yes >50
6 Privat 78 Buchinger (2)  No 0
7 Public insurance, privat 25 Buchinger (2) No 0
8 Privat, Rehabilitation facility pension insurance financed  70 Buchinger (2) Yes, with education, and if patient is compliant  3

5 clinics did not answer, two clinics did no longer work as a fasting clinic with medical super-vision and so they were also excluded. Only one clinic has cared for more than 50 patients with t1dm to date. Five had limited experience with t1d patients, having occasionally accepted patient with t1d, mostly as a secondary diagnosis behind an accepted fasting diagnosis. All of these have cared for 10 or fewer t1d patients. Clinics had clear exclusion criteria. All of them does not accept fasting for patients with t1d when patients are suffering of eating disorder, addictions, or psychotics. 4 clinics exclude patients with renal failures or hepatic insufficiency. An age below 18 or a missing hyperglycemia sensitivity might be an exclusion criterion as well (Table 2).

Table 2: When patients with t1d are excluded from fasting

  Exclusion criteria 
Clinic Eating disorder Addictions Psychotics Missing Compliance Hepatic insufficiency  Renal failure Hypoglykemy insensitivity  Age < 18  year Diagnosis  < 1 year 
1 X X X X          
2 X X X   X X X    
3 X X X   X X   X X
5 X X X   X X      
8 X X X X X X   X  

Clinics involving patients with type 1 diabetes in fasting, supervised daily blood sugar management and additional ketone measurements and followed a concept how to prevent ketoacidosis and how to care for people with nausea. No further adverse events have been reported (Table 3).

Table 3: How to handle fasting t1d patients during fasting

  How do you prevent diabetic ketoacidosis?  Which vital parameters were measured? What do you recommend in case of nausea?  What do you recommend regarding sports and exercises? 
1 Blood glucose measurements RR + Pulse daily, current body temperature 1/2 glass apple juice Exercise 3x daily, 1x relaxation according to preference and training condition
(3x daily and once per night) 
urine ketone 3x during fasting time Adaption of Insulin, daily consultations 
2 At least 3x blood sugar per day., possibly 2 x during night, 2x fasting lab (with ketone in urine), insulin adjustment, mixed measurement, daily consultation, 3x urine pH 2x RR + Pulse Blood glucose measurements, physical examination, Iberogast-drops, gruel, dextrose, honey, juice generally permitted, individually assessed by physician 
4 4x blood glucose per day, daily ketone i.S., insulin adjustment,  3x per week RR + Pulse, weight blood glucose measurement, orange juice, honey, dextrose generally permitted, patients decide depending on stress group
2 x consultation per week (more if necessary) 
5 Patients are measuring themselves at least 3x, daily consultation, insulin adjustment Patients doing their own daily RR + Pulse  blood glucose measurement, honey or Jubin, juices should participate according to training condition, 
restrained in the event of derailment or wrongly adjusted, 10 hours during weekend
8 Ketone content in urine, sometimes Ketostix, insulin dose adjustment, mixed blood glucose measurement, daily control ECG on first day, RR + Pulse,  blood glucose measurement, apple juice generally permitted, decision together
 (Blood glucose level needs to fit, preferably >100 mg/dl)

The fasting clinics we contacted were applying the Buchinger fasting protocol: Buchinger and his followers developed a multidisciplinary and multimodal treatment concept for inpatients, centered on fasting therapy, in which physiotherapy, nutrition, mind-body methods, and psychotherapy as well as physical activity are combined within a complex health education program. Aspects of the religious fasting tradition have remained fundamental components within the concept: the dimension of mindfulness and social group support [6].


In relation to other conditions, the care of patients with t1d is quite different. Surprisingly, some fasting clinics have had multiple experiences with patients with t1d. Experience shows that fasting is basically possible for t1d patients – if there is a certain level of training and compliance on the part of the clinicians and the patients. Some clinics have strict admission indications, while others make an individual assessment of patients. The clinics also differed in the way they care for their patients. The variable picture of care is most likely due to the lack of fasting guidelines for t1d. The current therapy concepts have been developed based on medical expertise and experience.


In Germany fasting under medical supervision for people with t1d seems to be difficult. The existing evidence seems to be persuading. Fasting might be possible if considering the results of existing research and the experiences of experienced fasting patients with t1d. A program for further education for fasting clinics has been developed and piloted and can be offered in further fasting clinics. Based on existing research, patients with t1d should be provided the opportunity to fast under medical supervision as a safe and healthy intervention to improve their health-related outcomes. Ideally, this should be done in the frame of research projects to further increase knowledge on the ideal type of fasting and long-term benefits.


We thank Andrea Chiapas for supporting this study with offering us the contact data to fasting clinics in Germany. We thank the clinics for contribution to this survey. We thank Katja Boehm for language supervision.


1. Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep. 2020; 10: 14790.

2. Rydén A, Sörstadius E, Bergenheim K, Romanovschi A, Thorén F,Witt EA, et al. The Humanistic Burden of Type 1 Diabetes Mellitus in Europe: Examining Health Outcomes and the Role of Complications. PLoS One. 2016; 11: e0164977.

3. Merger SR, Kerner W, Stadler M, Zeyfang A, Jehle P, Muller-Korbsch M, et al. Prevalence and comorbidities of double diabetes. Diabetes Res Clin Pract. 2016; 119: 48-56.

4. Michalsen A, Li C. Fasting therapy for treating and preventing disease - current state of evidence. Forsch Komplementmed. 2013; 20: 444- 453.

5. Li C, Ostermann T, Hardt M, Ludtke R, Broecker-Preuss M, Dobos G, et al. Metabolic and psychological response to 7-day fasting in obese patients with and without metabolic syndrome. Forsch Komplementmed. 2013; 20: 413-420.

6. Wilhelmi de Toledo F, Buchinger A, Burggrabe H, Holz G, Kuhn C, Lischka E, et al. Fasting therapy - an expert panel update of the 2002 consensus guidelines. Forsch Komplementmed. 2013; 20: 434-443.

7. Berger B, Jenetzky E, Köblös D, Stange R, Baumann A, Simstich J, et al. Seven-day fasting as a multimodal complex intervention for adults with type 1 diabetes: Feasibility, benefit and safety in a controlled pilot study. Nutrition. 2021; 86:111169.

8. Musil F, Blaha V, Ticha A, Hyspler R, Haluzik M, Lesna J, et al. Effects ofbody weight reduction on plasma leptin and adiponectin/leptin ratio in obese patients with type 1 diabetes mellitus. Physiol Res. 2015; 64: 221-228.

9. Moser O, Eckstein ML, Mueller A, Tripolt NJ, Yildirim H, Abbas F, et al. Impact of a Single 36 Hours Prolonged Fasting Period in Adults With Type 1 Diabetes - A Cross-Over Controlled Trial. Frontiers in endocrinology. 2021; 12: 656346.

10. Musil F, Smahelova A, Blaha V, Hyspler R, Ticha A, Lesna J, et al. Effect of low calorie diet and controlled fasting on insulin sensitivity and glucose metabolism in obese patients with type 1 diabetes mellitus. Physiol Res. 2013; 62: 267-276.

11. Wilhelmi de Toledo F, Grundler F, Bergouignan A, Drinda S, Michalsen A. Safety, health improvement and well-being during a 4 to 21-day fasting period in an observational study including 1422 subjects. PLoS One. 2019; 14: e0209353.

12. Berger B, Martin DD, Stange R, Michalsen A. Fasten bei Type 1 Diabetes mellitus - ein Case Report. 17 Fastenärztekongress der ÄGHE, Heilfasten: Original belassen, supplementieren, imitieren” - Internationaler Kongress der Ärztegesellschaft für Heilfasten und At: Überlingen “.2017.

Berger B, Egert V, Martin D, Jenetzky E (2023) Inpatient Fasting Options for People with T1d in German-Speaking Countries. J Hum Nutr Food Sci 11(3): 1167.

Received : 24 Jun 2023
Accepted : 30 Jul 2023
Published : 31 Jul 2023
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X