 Hello everyone this is Dr. Ahmed Ergin from Sugar MDs. Today we are going to talk about how many carbs should I eat per meal. Extremely common question and we are going to try to reply to this question. It's not gonna be one single answer but I think at the end of the video you will have an idea about how much carb you should eat. So before we move on to the video please subscribe and give a thumbs up if you like the video and when we get down to or up to actually 30,000 subscribers we are going to start making patient cases that's going to be real patients real life situations and how we treat our patients and that's going to be extremely useful. Now when it comes to this topic today we are going to talk about is how many carbs you can eat based on actually is based on your gender, your age, your activity status and your diabetes duration and severity. Now in this case I'm going to give you an example. Let's say you have been a diabetic for 20 years and you are 65 year old and you are a woman and you are on three oral medications and you're on one long time or long term or basal insulin whatever you call it or slow acting insulin you're on three oral agents and one insulin you're 65 you're inactive you have problems you've joined problems you are generally sitting at home you're really not doing anything much and your own medications and you are around 230 pounds. I would consider that an obese so in this case how many carbs should you eat right? My answer to that is very little very little because you're gonna be I can imagine you as being very insulin resistant and anytime you eat very little carbs you are going to skyrocket. Now when I say very little what I mean by that I mean like maybe like 20 to 30 grams of carbs per meal and that's very generous and the reason I say it's very generous is because you know you're really not burning anything. Yes I know you know if you you may want to eat more you know that's the only thing you enjoy nowadays and I understand that but if you want to eat more carbs you're gonna need more medications and sometimes more medications may mean more side effects but we have a lot of ways especially at sugar MDs we have different ways to help our patients but if you want to use medications in addition to what you're already on then I would suggest you know you can go up to maximum and that's maximum 45 grams of carbs for a woman at that stage and you may end up needing insulin as well. Of course we have a lot of non-insulin medications we can use but depending on your activity level again we have an exercise video check it out you know it's it's there basically even for very inactive people or people with disabilities or joint problems you know we have ways to get them to exercise one way or the other but if you're really not at your sizing you know you're really looking for 20 to 30 grams of carbs and if you want to force it 45 grams max so it is very hard to tell these patients not to eat any carbs that just not gonna listen I'm sure there are some people right now watching this video and saying that all these doctors are coming and eating much of carbs listen you may be very very savvy very dedicated very strong willed person but a lot of people are not like that and they are just not gonna listen to you unless you give them a reasonable goal so that's my job to get my patients so I may start with them 45 grams I may get them to go get them some motivation and then we can try to cut their carbs even more again that depends on the individual but you know we sometimes get patients to find them different recipes find them different ways to eat and they they enjoy it and they do it I think it takes a lot of motivation a lot of coaching that's why it's sugar MD's what we do is we just coach a lot we stay in touch be directionally texting voicemail phone call video call whatever you name it so we kind of stay on top of them all the time we see their numbers remotely all the time that's another thing without having them to do anything just that they do a finger stick or use a CGM and we can see their number like all the time so that's what our patients do really well now yeah I call this accountability you know when people feel accountable they feel supported motivated then they do well but anyway so next thing is I'm giving up I'm gonna give you another example and men who has a very active job a very physical job and he is 35 he has type one-and-a-half diabetes he is on one long insulin and two oral agents so type one-and-a-half diabetics do not end up on insulin right away so though this individual is doing well and he also goes to gym five times a week and he works out one hour on those five days so I tell the individual that you know my conservative goal for you could be as low as 30 grams of carbs if you want to go really low carb and reduce the number of medications but if you are very active and you're working out you must have carbohydrates this what your muscles are burning if you do not eat any carbs you're gonna have significant fatigue with with exercise and exercise has many benefits I know there are a lot of keto people out there and they think that the carbs are poison for you that's not true you know you have to have some healthy carbs in your body to make sure that you have you know fuel source for your exercise because exercise will help your cholesterol etc those people who eat fat all the time and not exercise I think they're looking for a very great heart outcome or the great cholesterol so but the bottom line is you know you want to have some healthy carbs minimum 30 grams if you are very active and exercising five times a week and so forth but if you are really athletic and you know you're you're early diabetic and you are physically active and you can try eating 45 up to 60 grams for a man like that and you can still be very fit you can still be controlling your blood sugars very well even if you have diabetes just because you are physically very active so my limit for a man who is active it will be 60 grams to 75 tops for a women my maximum carbohydrate recommendation is 45 grams again it depends on again you know you're looking for from a carbohydrate eating standpoint you're looking for a percentage of total calorie intake so if you want to be on the low carb side you may you may go down to 30% of your total calories if you want to be on the more you know more generous side because you're physically active you may go up to 35 40% of your total calories as carbs again the basic thing here basic thing to understand if you want to keep your blusher under control is eating healthy carbs and being physically active so if you're not physically active then your goals are down to 15 20 grams for women and less than I will say 45 grams for sure for men and 60 to 75 is the for men who are very very active so again like let's say you're a 60 year old man retired you're mostly at home especially with this virus going on you're not doing anything you don't want to go outside etc only can exercise at home but this is a good excuse not to exercise right so if you're not exercising if you're not doing much and and you're already overweight or obese then you should really not eat more than 45 grams at all and if you want to really control your diabetes with less medications then you should go 30 grams or below per meal again you can find a lot of carbohydrate alternatives for eating so you can definitely avoid things with flour and high carb actually if you avoid refined sugars and carbohydrates that are in the market today you will have much limited options from natural sources so it's gonna be much less effect you know effect on your blood sugars but that is my rule of thumb as I described and sometimes you know for people who are like a really frail they're already losing weight and they're very advanced age as we discussed in the previous video I'm not super super strict with their blood sugars I let them go to 1.15 in the morning up to 200 after meals for those older individuals and I don't restrict them too much because they don't have a good appetite to begin with cancer patients for example we limit their carbohydrate because you know sugar really drives your cancer cells but if you are like you're really losing too much weight and you really are not looking to cure this cancer you're on you're only in it to have another you know a couple months really there's no point of torturing these people with low carbs I just tell them hey you know if if your cancer doctor said that the chances of recovery from this cancer is nothing then maybe just just enjoy your life if you have metastasis all over your body and you're already on chemo you don't even have an appetite I'm not gonna give you a diet that's just stupid to begin with so we don't want to really do anything like that but the majority of the time most diabetics fall into the previous category that we discussed I hope that video is helpful and we'll see in the next video make sure you give a thumbs up make sure you subscribe and make sure you get us to 30,000 subscribers so we can start doing real-life patient cases have a wonderful day