 Hello everyone, this is Dr. Ahmet Ergin from Sugar MDs. Today the topic is what is my blood sugar goal? Again, this is a common question we get and we are going to address it today. Now before we jump into the video, please subscribe to us, please like us. If you want to test us, definitely watch more videos, understand more about diabetes and then subscribe. And once we get to 30,000 subscribers, we are going to start making patient cases from real life, then it's going to be really really interesting. So we really need to get to 30,000 subscribers, get us there and let's move on for the real deal now. So what is my blood sugar goal? Common question. Now you're gonna find stuff on the internet, you know, your blood sugar goal should be this, should be that. The problem with that, when you say my, when you say mine, then everything changes. The general guidelines are there and I'll talk to you about general guidelines and I'll tell you how your situation can be different and I will divide patient groups according to certain characteristics. Now you can decide what characteristics you have and what goal you should have for you as a person because I'm not going to give one single number that can fit everyone that never happens, right? So let's get started. Now the general guideline is 7% A1C. So if you do not know what an A1C is, please click above so that you can actually understand what an A1C is and come back to this video. Now A1C less than 7% is the goal. In this case, you know, majority of the people think that they have to go below 7, but your goal may be different. And then to get to 7% A1C, let's talk about this. How do you really get to 7% A1C, that magic number that everybody wants? Although as I said, your goal could be 6% or even 8%, depending on what type of person or patient you are, but for 7%, this is the rule of thumb. If you are less than 130 before meals consistently and you are less than 180, one to two hours after meals, then you are going to be at 7%. Why do I say that? Because 7%, like we discussed in the A1C video, that percentage, 7% equals to an average blood sugar number. So 7% in this case is 150 milligram per deciliter. And to achieve 150 milligram per deciliter, without having severe fluctuations, less than 130 before eating, less than 180 after eating, you can get to 7%. So or below. Now A1C is not the greatest tool because it doesn't really tell you highs and lows. It just tells you the average. So you can still get to 7%. If your blood sugars are 50 and 250 every time and you're a roller coaster, you can still get down to 7%. That doesn't mean that you're doing really well. But the bottom line is 7% is a common goal. Less than 130 before meals, less than 180 is a common goal for most patients. Now, of course, another thing you have to pay attention to is the patient characteristics. What we look at is how young is a patient and how healthy is a patient. The younger and healthier you are, and the more strict we can be with you. So and then how willing are you to actually bring your A1C down? How willing are you to do diet and exercise? How willing do you to take medications? And so forth. A lot of factors play into it. Medications costs are there and this and that. But the bottom line is for a motivated patient, a young individual, you can easily go below 6%. I have a lot of patients down to 5.5 or even down to 5%. With or without medications, depending on the individual. But that's very achievable. So I always say as low as reasonably achievable. So why do I say reasonably? Because you don't want to go there by causing a lot of low blood sugars, like blood sugars down to 50, 40. You don't want to do that. You don't want to go below 70. You want to stay above 70. But you want to stay less than 130 as well. So if your blood sugars are ranging from 90 to 130, some days you're behaving. You're good. Your blood sugar is 90 to 100 before meals. Next day, it's a weekend. You're doing stuff and you're eating out, whatever. And then you go to 120, that's okay. You're a human being. As long as you keep that upper threshold below 180 and you keep most numbers down to 90-100 range, you can still get your A1C down to 6.5 or less than 6.5. So again, it's all about the average numbers. And then your blood sugar, how much you spike, also determines it. So I generally recommend checking blood sugars after meals sometimes as well to make sure that you are staying below 180. Now, if you want to really go down to 6.5 or 6 percent or below, you want to go below 160 or 150 after meals, then you are really going to be able to achieve that A1C level. So like, for example, another question is what should my blood sugar be at bedtime? Now, that depends on what medication you're on, typically. But I would suggest being below 150 is a general rule of thumb, because bedtime is not necessarily after dinner. So even if after dinner you're let's say 170 or so, you should be able to go down to 150 before bedtime. So what ends up happening is a lot of people start eating snacks and fruits and stuff like that while watching TV, God knows. And then their blood sugar starts climbing. So although they didn't have a big dinner, but these snacks carry them up to 200 at night. And then sometimes if they're having fatty snacks, that may affect the morning blood sugars as well. And then that becomes a constant problem. So that's why people will say why my blood sugar is in the morning fluctuating so much, because those snacks, those, you know, the dinners that you're eating, the fat content in them can be a big major factor. Let's talk about older individuals or individuals with more problems, such as people with chronic kidney disease, people with liver disease. We are more careful with them just because they tend to have more susceptibility to low blood sugars. And these people are typically have been diabetic for 15, 20 or more years. And then they are, you know, on multiple medications, multiple insulins. And they're more on the older age, you know, especially if somebody is like 75 plus 80 plus, you know, they do not respond well to low blood sugar problem. And they may be alone. They may not fix it themselves. So they're more at risk. So for those people, we relax the blood sugar goals. And we tell them, look, you know, basically, yes, you have a chronic kidney disease. But you have a lot of other problems. We actually look at the patient, you know, what do we, what are we looking here, how many years this patient may have, you know, let's say five, 10 years, all those chronic problems. And we don't foresee any major problems from a slightly high blood sugars. But we see more harm from a very strict blood sugar control. And there have been a lot of studies about this, you know, when they try to bring as older frail patients down to a very tight blood sugar control, they actually end up dying more typically. So that's why we are easy on them. We tell them, okay, your blood sugar goal is not let's say 8% A1c. We can live with that. If your blood sugar is less than 115 in the morning, I can live with that. You can live with that. Especially if they didn't have, you know, major complications so far. Some people are resistant to complications of diabetes for an unknown reason. You know, they have been let's say 7%, 8% in their entire life for 20 years. And now they don't really have much of anything going on. They have a good kidney function, you know, that's another factor, you know, when we look at people. So they haven't died for 20 years. And they don't have any eye disease, no kidney disease, no heart disease. Obviously, some people are reacting differently to high blood sugars. And I look at them, look, you're already 75, you don't have any complications, you haven't died for 20 years. Well, let's just relax because this is, you don't really have to kill yourself to go down to 6% because going down to 6% sometimes can kill you fast, way faster than if you were up to 7.5 or 8% A1c. So it is an art. We look at our patient, we look at, you know, what's the best thing for them? What is best thing for a patient can be different from the patient standpoint because the doctors go to school for that. So the same thing when I take my car to a mechanic, what I think best for my car is totally different than what a mechanic thinks is best for my car, you know. So as a result, you sometimes, you know, try to trust a professional opinion to save yourself some time and harm. So as I said, older people less stringent, 8% A1c, less than 150 in the morning is fine, less than I would say 200 at bad time is okay for those older people. But for younger people who have been newly diagnosed, go as low as you can, 4.5% A1c, go for it. It's just that you have to be careful about what you're doing to get there. You know, if you're doing this with diet and lifestyle, great. But sometimes people will come to me and they say, oh, my blood sugar is 120, that's horrible, what am I going to do? I'm like, look, 120 is not bad, you know, and you're dieting and exercising, you're doing everything. You know, the next thing we have to do is put you on a medication. And they say, yeah, that's the medication, no worries. I'm like, well, that's okay. But the thing is with the medications, you know, everything has a possible side effect. So the thing is sometimes you have to really understand what side effect you're looking for in the short term and long term and what your goals are in the short term and long term and what's the benefits in the short term and long term. These are the things that a lot of patients don't understand, they just get stuck on their number, whatever they think is best in their mind. But I think you should really provide good sorts of information and have a good discussion with your doctor. Now at SugarMDs, you provide you all that, we're always staying in touch with you with texting, emailing, so you don't have to make a decision on the spot. We do virtual appointments, so we can see on the video, we can talk to you, we can text with you. That's a different way of managing diabetes. We have cellular communication where basically we can even get your meter, send us data through a cellular towers. We are using AT&T to collect blood sugar data without having the patient to enter blood sugar anywhere, or keep logs or anything like that. So all this data comes to us and we manage our patients that way. So we become very proactive instead of reactive. Most of the time, you know, the traditional doctors, you know, you will go to the office, they'll say something, you go, you don't see them for another three months. Good luck if you can reach out to them. And then next thing you know, your blood sugars are either too low or too high, but you have to wait for your appointment. It's a bunch of craziness. And then by the time you get to the doctor, the doctor will say, okay, where's your blood sugars? Are they going to start screaming at you because you're too high or too low? None of that we want to do. So in our practice, things are very modern, very simple, even for older patients. So let's say you're a 75-year-old, it may sound intimidating, but it's very simple. We send you a meter, you start checking your blood sugar and we call you, if you don't like texting, we call you, that's fine, whatever you want to do. If you're from a Florida or New York resident, make sure you give us a call and learn more about our services. And before the end of this video, make sure you give a thumbs up and subscribe so we can get you more videos. Very soon, we are going to start making patient cases, real patient cases without giving names, of course. And we are going to make these presentations of patients and their outcomes, etc., which will be a lot of fun. We will do that once we achieve the 30,000 subscribers and have a wonderful day.