 Hey guys, this is Dr. Ahmed Ergen. I am an endocrinologist Obviously I treat diabetes frequently well every day actually and I love it Actually, I do love it and I have a lot of type 1 diabetic patients and today the topic is The type 1 diabetes and how to manage it If you were diagnosed with type 1 diabetes recently, which sucks, but that's life Somebody will be diagnosed with something one day. It's actually not the worst thing to have in life right now because if you have so much Technology I would prefer type 1 over a lot of other diseases I hope that cheers you up, but really the worst thing you want to do is not given an F So when you do that, that's really not gonna help you because you will end up with complications And I am sure since you're watching this video You do not want to end up with complications and you want to get your hands on it. So let's get started Okay, so couple things that I see when a type 1 diabetic patient comes to me They have like 10 15 years of diabetes, you know, they think that they know what they're doing and half the time They don't And the bottom line is they need to open their eyes and start listening and sometimes that doesn't happen So I think the first advice that I will give you guys is just to be open-minded Just because you have some experience in the past It's like you're bringing your baggage from a previous relationship with another doctor or you're with your own experience Doesn't mean that your relationship with your new doctor is gonna be the same. So this number one Make sure that if you are not happy with your endocrinologist, it's perfectly okay to go see another one You know, sometimes the personalities don't match and whatever the case may be But that's number one find a good physician that you have a good report with so you can talk about your problems And then second of all, you need to understand certain things like how much insulin do you really need? We come up with certain numbers initially But then in time everything changes and people start playing with your insulin amount And then you end up with a very weird numbers recently somebody came to me with three different insolence and it was like Mixed insolence the fast-acting insolence long-acting insolence is all sorts of Complicated regimen. There's no need for that. Just keep it simple and stupid now number one You have to remember guys that as a type 1 diabetic You do not need a lot of basal insulin biggest problem that I see all the time is patients are on a lot of basal insulin You can be on an insulin pump or you can be taking a basal insulin such as 2j or terceba that could be Lantus or Levenmeer whatever it is if you're on say for example 50 units of Lantus And you're only taking say total of 10 units of hemologue a day for your carbohydrates That doesn't make any sense. That's why you're having a lot of low blood sugars and you're wondering like what's going on I don't even take insulin Let's say you take hemologue in the morning And then you are having you know you expect the hemologue to disappear in you from your blood within three hours But then you realize that you're having a crash like at three o'clock in the afternoon You're like what the hell is going on here? You don't realize that the Lantus you have taken the night before which is 50 units is still chasing you Because it stays in your blood for 24 hours So if you're taking a lot of basal insulin that's going to crush your blood sugars now How do you know that you're taking too much insulin? Number one you should always check your blood sugar at bedtime and in the morning If your blood sugars are coming up from like 200 250 down to 150 You may be happy with that number in the morning But don't be so happy because you're actually coming down all the way from 250 Which is a problem because if you start with 150 What you're gonna wake up with probably nothing you're gonna end up with zero blood sugars Well, hopefully that won't happen with your body's You know response system, but still that's very risky now You need to make sure that you are using basal insulin to keep your blood sugar steady That's the best number one thing if you are fasting for a long time And if your blood sugar is dropping that means that you are having too much insulin So if you're eating nothing you should be taking basal insulin because you have type 1 diabetes, right? Even if you are fasting for a long time, you should not have a very low blood sugar So your blood sugar should not be creeping down too much So that's number one rule if that's the case with you immediately talk to your doctor Preferably an iconologist to make sure that your basal insulin is not too much And when you have a low blood sugar frequently What happens is you end up, you know, shoving all the carbohydrates trying to keep your blood sugar up And if that's a recurrent event, guess what that causes weight gain. So that's one thing you definitely don't want to do Now second thing is Understanding how your short acting insulins work your short acting insulins take time to get to your blood So it takes 15 to 20 minutes for most short acting insulin that includes hemologue your novel log Theosophist faster. There is an inhaled insulin called aphreza which is extremely fast But not a lot of people can get that because insurance coverage is poor for the aphreza But for the hemologue and novel log, which is most commonly used insulins for short acting for the mealtime People take it right before the meal The problem is if you're not on a good carbohydrate regimen if you're not on a good diabetic diet that has very healthy carbs and you're just eating any carb You find your blood sugar will spike to the peak within 30 minutes Now the poor insulin that you're trying to take the novel log or hemologue is just trying to get to your system by 20 minutes So and then it spikes to the maximum level in your blood that the hemologue and novel log within 62 to 90 minutes Now then by that time your blood sugar may already be too high So so people who are using like dexcom or Libre like the continuous glucose monitoring systems will see that and they'll be shocked Well, they when they don't see it. They don't know but when you see it you would like what is going on here So yes, it is a problem to take the insulin You know like who thinks that I mean I had to take insulin 20 minutes before I eat that really doesn't happen And my wife says oh, hey, there is ready like that's sorry there I'm not gonna tell her. Hey, you know, I think my insulin I'm coming back in 20 minutes It just doesn't happen like that unless your wife is very or your significant other Is really helping you with that and telling you hey, then it's going to be already in 20 minutes That may be a good thing to do But sometimes I if there's a huge problem, I tell patients, hey, you know what try fiasp Maybe that's a fast-acting insulin you can take right before the meal or right in the middle of the meal Even they say the company says you can take it even after the meal Which is an option and for people who are having problems With that I think fiasp is a good option a fresa is a good option A fresa is an inhaled insulin Some people cannot tolerate it due to coughing and stuff like that if you know, it's like a like an asthma medicine You just take it quickly and then just eat right after But that's number two number three Is that you need to understand how long these insulins stay in your system Like hemalogue and novel log, especially hemalogue can stay in your system for quite a bit of time like four or five hours So don't be surprised if you're having a dinner at like seven o'clock and your blood sugar is crashing at 11 30 in the evening By the bedtime that may still be due to your hemalogue or novel log Hopefully you're not on too much basic insulin after Understanding this what we talked in the in the first place in the beginning of the video But basically you will need to understand how long they last so And if if you're having low blood sugars because you're for example eating simple carbs with spikes in your blood sugar But then disappears within two hours Number one, you need to make sure you are incorporating some healthy fats in your diet That way, you know your blood sugar doesn't spike as much and when you're eating carbs The carbs should be full of fiber which also prevents your blood sugar spiking too much For example, if you eat a cereal in the morning, which I don't recommend Versus you are eating a steel cut oatmeal. There are a lot of people out there trashed steel cut oatmeal I think it's still great. I love it with some milk and stuff. It's great With some nuts on it, you know, why not? Some splenda it's still gonna be very tasty great for your cholesterol But if you prefer oatmeal for example over cereal, you're still gonna be Doing a favor for yourself because your blood sugar is not going to spike As fast and that's gonna give your insulin time to catch up with it Same thing with if you're having a banana having some peanut butter with it will delay that spike So your insulin will have some time to catch it And then also that that time it takes to for blood sugar to spike and disappear will be longer So you will have a more steady blood sugars in in your bloodstream That will prevent later spikes But if you're eating cereal for example, you are first of all not catching the spike that happens Because you're not taking the insulin on time unless you're taking it 20 minutes before That may not be even sometimes enough if you think about the the time it takes to spike for the insulin but if you are on If you're if you're on these insulins and you're eating something healthier with high fiber with some healthy fat Some avocado at the breakfast with some eggs and stuff like that definitely will help prevent that happen If nothing is helping then I would suggest You know using something like a fresa a fresa is an inhaled insulin disappears from your blood in two hours Now fiasp we talked about is a fast-acting insulin Very fast acting it doesn't really take time to get to your blood Which you can take right before the meal, but it still stays in your blood the same amount of time So if you are having low blood sugars three or four hours after eating If you cannot adjust your diet, which I strongly recommend to do that But using a fresa may be an option as well Again, this is not a sponsored video guys don't think that i'm getting paid if i'm getting paid I always tell you i'm getting paid and even if i'm getting paid I would never tell you something that I do not believe in or scientifically incorrect For me, I think ethics is the most important thing And I want to make sure that you guys are treated fairly and you get the correct information from the correct person so Number I don't know what number I kind of lost track, but I will say four So another thing you guys have to pay attention if you're eating a high carb meal it's very Hard to estimate exactly how much you are going to How you're going to respond to that the meal because it's hard to estimate even with the labels There's so many there's up to 10 to 20 percent allowance for them to be in error Which means that if they are saying that there's 60 grams of carbs on the label per per serving, for example It may be 50 grams. It may be 75 grams. You don't really know exactly They don't really know exactly how much and there is an error right there So that's that's another thing to consider the higher the amount of carbs you're having the higher the error rate If you think about percentages, right? So 10 percent 20 percent error rate will give you a more error rate if your Total amount of carbs are higher Also, number five when you take insulin you think that you're taking 10 units of insulin But your body is not always absorbing 10 units of insulin sometimes absorbing eight units sometimes nine units Sometimes 10 units and if you're insulin sensitive individual You will definitely have a problem with The insulin response the higher insulin amount you take the more chance of error So as a result, you know, my patients will say my blood sugars no matter what I do I eat the same thing and I take the same insulin my blood sugar still fluctuates. That's exactly why So when you're not diabetic your body knows exactly how to adjust it It's like a second to second adjustment. So, um, you know, that's that's easier But the ease the the the closest thing to what your body does right now for tight one diabetics I would say closed loop insulin pumps. So if you're doing three four shots a day I know some people don't want to carry, you know, like devices on their body But um, you know, it's really like you forget. It's like a glasses. First you get the glasses You're like, what the hell I cannot really deal with this But the next thing you know, you're looking for your glass, although it's on your eye So same thing with the pumps, you know, it's really not a big deal once you start using it Most people say that saved my life that they for example, tandem control IQ system is great You know, you're using your dexcom cgm with the pump pump adjust the insulin based on the blood sugar numbers that comes from dexcom It's a life saver for a lot of for a lot of individuals Same thing with the metronik. They also have a closed loop system In my opinion, it's not as great as the dexcom and the insulin pump with the tandem But metronik has a much better customer service So depending on what you value, if you're a younger individual, I'll probably go to dexcom and tandem But if you are older and you may have difficulty with technology Dexcom people are not going to help you. They're too busy. Their lines are always freaking long It takes forever to get to them. Same thing with tandem, you know, they have their support staff But very limited you may have to wait a week or two or three weeks for somebody to get back to you Metronik, that's not the case. But the bottom line, they all do similar things. Metronik is a little bit more work You have to do a little bit, you know, you have to still do finger sticks for collaborations But it pays off and your blood sugars can stay very well under control and you can avoid low blood sugars as well So guys, I am looking at my time right now. I we are right around 14 minutes I think that's been a that's been a good summary for you guys I hope that was helpful and if you like this video, make sure you subscribe And I will be talking more about type 1 diabetes tips and tricks And I hope that video was helpful now if that is please give a thumbs up And give a subscribe to our channel for more videos to come talk to you soon