 We will discuss the questions you should ask before intermittent fasting, especially if you have type 2 diabetes. We are going to talk about number one, what are the benefits of intermittent fasting for patients with diabetes? What are the risks of intermittent fasting, especially for diabetics who are on insulin or south venaluria, such as gliposide, gliboride, glimopride, or even the class of megalithonides such as rapaculonide, denatoglonide, or even the SGL2 twin emitter, such as Jarnians and Farsia. The third, how many carbs you should be eating during the day when you are in intermittent fasting? Number four is what type of intermittent fasting would be really the best for you when you have diabetes? Hi, I am Dr. Ahmet Ergen, I am an endocrinologist and a certified diabetes education specialist. I am here to help you to understand everything about the intermittent fasting so you can have a smooth sale while controlling your diabetes. Before I jump into the topic, I highly encourage you to share your experience in the comments below so we all can learn from each other. If this is your first time watching sugar empty channel, please remember to subscribe for hundreds of other awesome diabetes and health related videos. Let's start with the benefits of intermittent fasting. Number one. First of all, intermittent fasting will lower insulin levels. Blood insulin levels drop dramatically with the intermittent fasting which helps also the fat burning and the weight loss process. Not only you will become more insulin sensitive, but also medications will work better. Even the supplements will work better. In addition to diabetes, your cholesterol and your blood pressure will also see benefit from intermittent fasting as a result of changes in the insulin levels. And yes, insulin plays a major role in your blood pressure and cholesterol as well. The lower the insulin levels, the better the blood pressure and the better the cholesterol. As most of my audience know by now that the insulin resistance induces inflammatory state by inducing high C-reactive protein, by decreasing the adiponectin which is a good fat hormone and creating a lower LDL particle size which is not good at all because a low particle LDL is way more dangerous than the large LDL particles. And all that will contribute to heart attacks, the strokes and so forth, which what we are primarily trying to prevent by lowering the insulin resistance. Also since insulin causes water retention, you are looking to benefit from a relief from heart failure or just simply the leg swelling if you are already suffering from these conditions. Now number two. You will see a rise in human growth hormone levels. Why is growth hormone so important? Well, because the higher levels of growth hormone help with fat burning and the muscle gain and have numerous other health benefits. On the other hand, trying to take growth hormone as a medicine may have significant side effects unless you are growth hormone deficient. So there is a difference there that I want you to understand. You need to be monitored by an anachronologist and you have to have an indication for growth hormone replacement. But intermittent fasting can give you the growth hormone boost that you are looking for. Number three. Intermittent fasting is a fixer. It has a major role in cell repair. Our cells need repair due to oxidative damage that happens during the energy production process. Unfortunately, when body is busy trying to digest the food that the fixing process does not take place. What else? Autophagy. Most of you may have heard this term and the term autophagy literally means self-eating. Autophagy is a natural mechanism of the body. So the cells in your body have to destroy the redundant or the injured components within the cell. The autophagy process helps maintain the normal function, which is also called homeostasis, within the cells. Although autophagy sounds like a self-destruction process, the process actually helps clean up the bad stuff inside the cells and revives them. Now autophagy may completely destroy the damaged molecules sometimes and recycle them into the new parts, which can be used for cell repair. So in times of stress such as the hunger, fasting in this case, when cells are deprived of nutrients, autophagy can provide the alternate source of the energy from the recycled cellular material to help them survive. The autophagy can also help the immune system by cleaning up the toxins and the infections. Number 4. Improved gene expression. So what's that? There are beneficial changes in several genes and the molecules related to longevity and protections against the disease. The intermittent fasting will induce those genes that are the longevity genes. So what about the risks of intermittent fasting, especially when you are on insulin or sulfonylurea? If you are taking any of these insulins or sulfonylureas like glupazide, galiparide or galiparide, etc., you will see that your blood sugars will start improving dramatically once you start fasting. As a result, you may end up with very, very low blood sugars if you do not adjust your insulin or the sulfonylurea medications. Well, the problem with adjusting the insulin or the pills is that most patients are not educated enough to be able to adjust their own insulin or sulfonylurea medications. I would suggest that if you are on these medications, it would be wise to discuss with your doctor prior to even attempting the intermittent fasting. Also, your insulin sensitivity will be different on the days that you are fasting compared to those days that you are not fasting, which kind of makes things even more complicated. So you may have to take less insulin on the days that you are fasting and again, that is kind of a discussion between you and your doctor. Another important caveat is that when you are in intermittent fasting, even if you think you adjusted your insulin or the sulfonylurea intake, you may still have to monitor your blood sugar more often than not. I believe the Freestyle Libre and the Dexcom will come in very handy in this situation because it will be challenging to monitor blood sugars two to three times more often than the average on those days that you are actually fasting. Also, if you are on an SGLT-2 inhibitor, such as Jordans and Farsiga or even in Makana, talk to your doctor if it is okay not to take them on those days when you fast. Another potential problem with prolonged intermittent fasting is that sometimes we are concerned about the protein malnutrition if patients are not conscious of maintaining the adequate protein intake on those days when they are not fasting. However, the vitamin and mineral malnutrition can also occur. Also as a result, depending on how often and how long you have fasted, you may need to take some vitamin and mineral supplements to compensate for the deficiencies you may experience due to fasting. On the philip side, intermittent fasting can make you overeat because your appetite, hormones and the hunger center in your brain go into overdrive when you are completely deprived of food during that fasting period. The word occasion there, you better have a plan to prevent overeating, especially if you are breaking your fast later in the evening. I always recommend planning the food you will be having and even your portion size and sticking to it. Other risks include a few other potential harms related to dehydration. With or without low blood sugars, you may experience mild or moderate or sometimes even severe symptoms such as dizziness, nausea, insomnia, blackouts, the falls, the migraines, the weakness that may be actually even limiting your daily activities and excessive hunger packs too. If you have a chronic disease including heart disease or lung disease or kidney disease, you will definitely increase the chances of side effects from intermittent fasting. So be careful. For those who are new to intermittent fasting, I highly recommend starting at 6-8 hour fasting and gradually prolonging the time as tolerated. If you begin fasting from eating every 3 hours to not eating up to 16 hours, you will have significant and severe side effects and problems. If you have conditions that I have just mentioned and you are an insulin, you may want to think twice before intermittent fasting due to the potential significant complications we just talked about. Also, I strongly recommend not to fast if you are pregnant like dating women that may not be good and the young children should not attempt that yet if they are very young and they are not even a teenager. Advanced age and frail older adults should probably refrain that as well. People with immunodeficiencies including those who have had like solid organ transplants or people who are on immunosuppressive drugs and so forth should refrain from fasting. So how much carb should you be eating a day during those days of intermittent fasting? Well I do not recommend eating more than 45-60 grams of carbs per meal for a reason. Even a healthy individual may start having problems in controlling the blood sugar within the normal range if you load enough carbs to that individual. So I would say stick with your routine amount of carbs that you normally have per meal when you are not fasting. So I would suggest increasing the healthy fats in your main meal on the days of fasting such as the olive oil, the avocado, the nuts in your salad and so forth to keep you full longer to prevent snacking too much. And stick to your meats like your beef, lamb, chicken etc. and even fish or seafood in that regard even better. Eggs are okay unless consumed excessively but never ever. Forget your vegetables and your plant based diet is the most important. Your cabbage, your kale, eggplant, spinach, leafy greens and so forth. You will have a temptation for a dessert as well after a long day of fasting. If that is the case try to stick to a dark chocolate or fruits after the dinner. What type of intermittent fasting is best for diabetic then? Well there are methods such as 18-6, 20-4 meaning like fast 16 hours and eat 8 hours or fast for 20 hours and eat for 4 hours. You can do it alternate day, you can do it like 2 days out of a week etc. But where do you really begin? Well like anything else in life. You should start something new gradually and ease into it. Introduce yourself to intermittent fasting in the form of time restricted feeding. How do we do that? For example you can start by restricting the food intake to a daily 12 hour period, typically an overnight fast like a 7 p.m. to 7 a.m. a lot easier to do as you become more comfortable with this pattern of eating. The feeding window can be restricted even further such as 16 hour fast or even 18 hour fast or even 20 hour fast as you create a fitness to the fast. This gives you some also flexibility in choosing when to consume the calories if you just set a time of the day to fast because our schedules may change and new things can come up and you don't want to just cancel your fasting entirely and you cancel execute and be flexible without giving exact hours. Lastly to avoid the adaptation to the time restricted feeding you may want to choose to switch to alternate days or periodic fasting with this provision and the guidance of possibly a registered dietitian which we readily have it on our website if you go to sugarmds.com or if your physician is available or knowledgeable enough then you can get their support as well. Thank you for watching everyone I hope this video was helpful and if it was please write a comment, like, share and subscribe. We will see you in the next video. Remember to watch the hundreds of other videos we have in this channel. Hey guys I hope you're enjoying this channel so far and I hope you subscribed already. If you didn't do it and if you did watch this video right there I think that will help you too.