 Hi guys, this is dr. Ahmet. They're gonna take my microphone is going away. Wait a minute. All right So this is sugar MD ultimate diabetes channel today. I'm answering a Question from a follow from a subscriber. So this is a lengthy one, but I think it is Intriguing so I think you will find is enjoyable for me to answer the question here I may not be able to give it like exactly. Hey, this is what it is but I'll tell you all the possibilities that this is happening and Here is the question listen carefully. So this is his name is Trout Tamer sounds like Tamer in Turkish. I don't know if he's a Turkish guy or not But his English is pretty good. So we'll see in Turkey people don't speak English that much. So no offense All right, so he's saying that I have been watching your videos Veraciously and it really helped my understanding of type 2. I'm glad I had a Diagnose about 20 years ago and when my A1c was around 7 I am 6'4. That's tall and Wait around 210 pounds I made a little lost 10 pounds and dropped my A1c down to 5.7. Good job Over the last 10 years my A1c has averaged around 5 But my blood sugar when taken is rarely below 120 Now 120 is in milligram per deciliter I don't know. What was it? I'll put on the screen right here in a second. Okay in like millimole per liter So 120 Rarely less than 120 about four years ago. My endocrinologist prescribed farsiga on top of my Lumbaglise I feel like he actually is in America with his medications I immediately dropped another 13 pounds and now average around 174 pounds. Well, that's a lot of weight loss buddy. Good job. Very good My doctor has been unable to understand how my A1c remains so low But my blood sugar remains relatively high. They did hook me up for Libre for two weeks Libre is the continuous glucose monitoring device if you guys don't know yet If you're a follower you probably know because we have a lot of videos about that But anyway, they did it Libre just to see what's going on But the results were inconclusive and I don't know what exactly they mimited They didn't any attach any pictures or anything like that. So they also ran a fructosamine as well But yielded no conclusions as well So fructosamine is another test that tells you the blood sugar averages in the last two to three weeks It's not a very well-established test like the A1c But we typically do this if I want to know what has happened in the last few weeks Compared to three months and that also yielded no results. So I have neuropathy in my feet and very frequent urination So I do well, I'll tell you what that is So I do have the symptoms of type 2. He is from Northern European ancestry Well, obviously he's not Turkish No skill cell in the background. My doc remains stumped That's an interesting word But my A1c is so reliably low. He seems unconcerned Oh, we got an unconcerned doctor. So is that a good or bad thing? We'll see I try to eat healthy, but I pretty much eat what I want although in moderation Okay, you're relying on the medications a little bit, huh? But I continue to lose weight Well, again medications help actually a lot sometimes Two of my brothers not that I'm a pro medication guy, but they do help I mean, I've seen patients losing weight on some medications up to 80 pounds. I was like surprised myself Two of my brothers and my father 96 years old. Well, that's good genes have type 2 But my brothers have both they're both overweight and any thoughts as I remain concerned and again Thank you very much for your YouTube channel. Well, thank you for the question It's interesting and I will go over a few things here I'm gonna hold the phone in my hand because Really, I have a few things to point out here So number one congratulations on doing a great job on maintaining your A1c below 5.7 or 5% etc. So couple things I mean, we have an A1c video, but the how correct is the A1c is totally reliant on Your red blood cell health. So if you're anemic, for example, your A1c can be falsely high If you are taking iron supplements, if you are getting some sort of treatment for your iron deficiency or Anemia, it may be falsely low So there's a lot of reasons that A1c may not be correct in this case I would definitely rely on more to the blood sugars that you get with the finger stick Now we have problems with finger sticks as well. And then that's that's here's the fear is the fact the finger sticks are Not 100% accurate either. So how do you know how close is your glucose meter to the real measurement? Now the gold standard in this case is drawing blood and immediately testing Even sometimes when they draw blood, they send it to the lab like a couple hours later, your blood sugar may be falsely low So typically if we are concerned about somebody's blood sugar levels, if it is correct or not Especially if somebody's having a lot of low blood sugars, for example We're not sure if there's a real low or if it is artificial low or if it is fictitious low, whatever We order a stat glucose level to see so that they can immediately check the blood sugar from the vein And now at that point to what you can do you can have your or you can check with your lab See how long they keep the you know in in quest or lab coordinates taste are pretty fast I don't think they're keeping the tubes too long sitting around But you know when you check your blood sugar through the vein and then do a finger stick You will see the difference if your vein shows 100 and then your finger stick shows 110 Then you know that you're looking around 10 percent variability And again, they when you look at the statistics if you know about this a little bit Every test has a margin of error So if your meter has a margin of error 10 percent You will probably get around 10 percent higher or lower reading And some meters can be up to 20 percent and 20 percent at a very high or very low number can make a big difference Like if your blood sugar is 200 or 300, right? So 20 percent of that will be 60 So if your meter is kind of a cheapy meter and you're getting like 20 percent of variability every time You can check your blood sugar now from this finger and then check it again from this finger in five minutes You make it a 60 per 60 point difference if your blood sugars are running running really high because of the 20 Valiability it can be even more than that because think about this 20 plus minus can be a huge difference So let's you may get as as low as 240 you may get as high as like 340 especially at this high range Now same thing is also true for continuous glucose monitoring systems like librae or dexcom Now librae improved their accuracy with librae 2 version of the librae But you cannot use them with the phone and so it's kind of a pain in the neck, you know Dexcom remains a little bit better overall, but they're way more expensive than librae So the bottom line is When blood sugar changes very rapidly with those glucose monitoring systems Or at the very high or very low range The variability can happen and there's some delay in in the blood sugars So if they did your librae and your blood sugars, I don't know I kind of have to see that but it's not going to give a conclusive result because again, you're looking for variability Now if your A1C is 5.7 percent That is just saying that your average blood sugar is 110 115 So here's what's happening if your blood if you're checking your blood sugar You're saying rarely below 120 if you're checking your blood sugar at say 8 o'clock in the morning You may be looking for a dawn phenomenon So you may be going down to 90 80 overnight and you may be 120 by 8 o'clock When I say overnight like 3 o'clock in the morning, you may be down to 80 And then you may rise to 120 between 4 a.m. And 8 a.m So that's called dawn phenomenon that happens a lot now the Glucose monitor, especially librae, especially the older librae does not really Tell you Exactly what's happening. They're giving you a ballpark. So again since librae is not gold standard in blood sugars It is not going to give you the exact answer So here's your problems. The A1C is not gold standard in understanding exact blood sugars It's just an estimation even with let's say 6 A1C it it corresponds to on average 120 blood sugar, but But A1c also is not exact science Even your blood sugar is perfect. Even your red blood cells are perfect. You're not anemic none of that You're a perfectly healthy guy. Otherwise 6 A1c with the variability again, remember every test has variability in it So 6 A1c can suggest although we we say oh your blood sugar should be on average 120 But it can be as low as 100 it can be as high as 140 in reality so So if your A1c is 5.7 percent Let's say your average blood sugar is supposed to be 115 In reality In reality, you're maybe real average blood sugars if I hooked you to a vein like I hooked you to a machine and I'm monitoring your blood sugar like in an ICU setting Intensive care unit setting in that case You know You will see the exactly what's going on but with A1c again, you're looking for an Estimation a variability your blood sugar finger sticks has variability So there's so many Variability that you will never match Exactly like an exact science Of A1c and the blood sugars and the liberate they all give you estimations Now, why is your doctor not concerned? I'll tell you why because he knows your blood sugar is overall in a good range Okay So he would be concerned if your A1c was 5.7 percent, but your blood sugars are going to 180 200 he will like that doesn't make sense Even with the variability that doesn't make sense, right? So your doctor is not concerned because he knows overall you're doing a good job Now what your doctor should be concerned about you eating whatever you want So yeah, you're taking medications and all that but eating whatever you want will eventually catch up with you And you will need either more medications or your weight loss will stop And you will end up having problems now when you say eating whatever you want Maybe you mean good not necessarily bad and you know eating good or bad is a very subjective term You know, some people may say that. Oh, I'm just eating a pint of ice cream every day That's whatever they want and some people may think that just eating a cracker Or a little cookie every day Is considered whatever they want. So if that's whatever you want and it's not excessive That's okay But as I said your doctor should be concerned about your diet Because if you're not eating right not just because your blood sugar will be affected But you're still looking for a lot of problems not eating right can lead to Cancer not eating right can lead to autoimmune diseases and an overall well-being and your overall health So but I hope that answers your question around the a1c the continuous glucose monitoring systems and finger sticks Like I said, it's it's it's a science, but it's estimation It's not none of these tests are gold standard. So I have that help you guys and we'll see you in the next video All right. Thank you for watching and I want you to be more informed and more educated So to do that go ahead and watch this next video right here