 Hi guys, this is Dr. Ahmed Ergen. I'm an endocrinologist, and today I'm going to talk to you about up and down blood sugars. Why is my blood sugar is up and down? Up and down. So when I ask my patients, okay, how's your blood sugar running? They'll be like, up and down. It always perplexes me because I'm like, what do you mean by up and down? I don't know, up and down, up and down. Well, okay, so, just to tell you something, something that's really secret that you will need to really know. Your blood sugars will always be up and down. So nobody's blood sugar is really a flat line. You will not have a blood sugar like this. If you're expecting a blood sugar like this, then you should not be alive, okay? So that's number one. Now, even if you're non-diabetic, let's say I'm non-diabetic and I check my blood sugars because I want to and I use continuous glucose monitoring system, et cetera, et cetera. Now, what happens is every time you eat, your blood sugar is going to blip a little bit, okay? It's going to go up and down, up and down. Now, what these diabetics refer to, though, that everybody's, of course, understanding of up and down is different, but they may mean that their blood sugar is going up to 200 and it may be going down to 60. Now, the question is, then my next question is, what sugars are you talking about? Are you talking about the fasting blood sugars in the morning? Are you talking about after meals? Are you talking about bedtime? These are blood sugars will be totally different depending on what time you check it, right? So if you're checking it after an hour after a meal, that's a different story than checking it right before a meal. So if you're telling me, for example, if your blood sugar is, like, let's say before breakfast one day is like 70 and then you check it after breakfast one hour after and it goes to 170, you say like, hmm, my blood sugar is up and down. Well, of course, because you just ate, right? So it is not uncommon for your blood sugars to spike a little bit. Of course, in this situation it's a little bit extra higher spike, but that is kind of unexpected. Now, of course, it's going to be up and down, but the question is how up and how down? So if you're going more than 180 at any time, after a meal typically, that's not good. And if you are going below 70 at any time, it could be when you're sleeping at night or it could be in the early in the morning or maybe an hour after a meal. So let's say you take a short acting insulin and your blood sugar is, let's say, 160, which is not good. But you took insulin because you're an insulin mealtime, et cetera, or you just wanted to correct it. You're on a sliding scale, you wanted to correct this and you ate food, but if you did something wrong, you ate too much insulin, right? So you're 160 and you ate food and then one hour after, you went down to 50. You're like, oh, my sugar is down. Now, of course, you don't realize that you maybe did something wrong with the insulin, right? Although you ate, you still went down. So how do you really manage that problem? So you really need to understand the patterns, the pattern of recognition, and you have to have a lot of data. So you have to really analyze your numbers. So the best thing to do, keep checking your blood sugar, right? So 120-year blood sugar, let's say you took five units of noble log, you put that down and let's say you ate 60 grams of carbs, you put that down as well. Now the next thing is you check it again, let's say two hours after breakfast if you're going to do that or before lunch, but be consistent with that so that you can analyze, you can create a pattern of recognition. So let's say you're 120, you did five units, you ate 60 grams and then you ended up being, let's say, before the next meal, 150. And that's, let's say, before lunch, okay, before lunch. Now, let's say, second day, you woke up with a blood sugar of a similar, 110, and again you took five units of noble log, but you ate, for example, 30 grams of carbs this time. And then your blood sugar ended up being 70, right? So do you see, of course, it's hard to see a pattern just from these two numbers, but you can tell by the data provided, you can tell the problem here. So that's the problem. Blood sugars are very similar, 110 to 120. You took the similar amount of insulin, but you ate 60 grams here versus you ate 30 grams the next day. Now, your blood sugar ended up being 150 and a little bit higher than where you started, which means that maybe you should have taken a little bit more insulin here, or maybe you had a misunderstanding of misconception of how much carbs you eat. But here you ate 30 grams and you took, still took the five units and you ended up 70. So why? Because basically you took insulin more than you needed because you only ate 30 grams, right? So if you knew that, for example, yesterday you took five units for 60 grams, you ended up a little bit higher sugar, maybe if you have taken a 60 units, that would have done it, right? If you ate, if you took 60 units of noble log and you ate 60 grams, that could have been just 120 just like you started, that tells you that one unit basically would have taken care of 10 grams. So if you're taking six units for 60 grams, that means that your insulin carburetor is one unit for 10 grams. Now here you should have taken based on this, if this was a successful story, if you need one unit for 10 grams, here for 30 grams you should have taken three units, three units of noble log. Now what happens is you took five units, that's why you're down to 70. So when you're seeing your blood sugar is up and down, I get it, but the problem is you should actually keep a good record of what's going on for your doctor to understand why your blood sugars are up and down, right? So that's why people get surprised that my blood sugar was 120 yesterday before lunch and today it's 70, so what's going on? They just do not understand all the variables that go into it. There are actually more variables than just this. So the problem, there are a lot of problems. So other variables that you need to be aware of is when you take an insulin shot, right? When you take an insulin shot, the absorption is not always 100%. So there is 20% variability in your absorption and then 20% will create a significant variability if your insulin amount is high. Think about this. If you are taking only 10 units of insulin and you have 20% variability, you took 10 units, your body absorbed eight units, right? So you're off two units. You thought that you took 10 units, but you actually ended up absorbing eight units because of the 20% variability. And the next time you may have, you may absorb 12, not 12 units, I'm sorry, you may absorb nine units. Of course, you know, when there's a one unit difference, that may not be a big deal. But think about this. If you're taking not 10 units, but let's say 50 units before the meal, then based on this 20% variability, you may have up to 10 units difference in the absorption. If you have a 10 unit of difference in absorption, that's going to throw you off like significantly. Even if you do everything right, if you are taking a lot of insulin, the variability factor will be a big determining factor. So when you're thinking that you're taking 50 units, but you're only absorbing 40 units sometimes, sometimes you're absorbing 44 units, sometimes you're absorbing the entire 50 units, of course there's going to change your blood sugars and that's going to cause the up and down. So for example, people who take long-acting insulin, right? So they will take, for example, you know, 60 units of lontas and their blood sugar in the morning sometimes is 120, sometimes it's 80, sometimes it's 160. And they say, you know, the only thing I take is a one-time insulin 60 units and my blood sugar is sometimes 120, sometimes 80, sometimes 160. Now as we said, one of the factors is the variability. That's 60 units guys that you're taking is not always the 60 units. Your body may absorb sometimes 52 units, sometimes 55 units, sometimes the entire 60 units. And that's not in your control. So it will happen no matter what you do. Another variability is, what did you have at dinner? So if you had a little bit extra fatty food, that fat can create immediate insulin resistance in your system. So as a result, your blood sugar, although you're absorbing exactly the same amount of insulin, that's a nothing change in terms of variability in the insulin absorption, but you will still make up the higher blood sugar, even if you have done everything exactly the same, except you put extra butter on your bread or you fried that food that night, then you're going to have a higher blood sugar in the morning. Or that day you decided that the weather was nice, you wanted to go out and take a three mile walk. You have a 120 blood sugar the day before, you will end up with an 80 or even maybe down to 60 blood sugar because of the exercise factor, which makes the insulin sensitive immediately overnight and your blood sugar may go down. So there's a lot of variability guys, so your diet, your exercise, even the smallest changes that you make, but I say smallest changes of frying the food is not necessarily a smallest change, but it makes on, it makes on, obviously it's just one time, but it can make a difference. The pizza that you ate, for example, last night can make a huge difference. The exercise that you did, the gardening that you did that day can make a huge difference in your blood sugar in the next 12 to 24 hours. So do not underestimate these facts. Remember, the more insulin you take, the more variability you will have. And the diet and exercise, the fried food or eating excessive food or having a nighttime snack, all these things will increase your blood sugar. Exercise may reduce your blood sugar. And again, as I said, sometimes you may absorb the insulin more, sometimes less, that also will change your blood sugars. So, I hope that helps. Again, short-acting insulin is the same way. The absorption factor, how much carbs you're eating will definitely affect your blood sugars. So make sure that you try to keep a consistency. You try to make sure that you collect enough information so that you can create this analysis. If you are using continued school-class monitoring systems, it's gonna give you a lot of data points. You're gonna be able to see your blood sugars much better because it's continuous. And you will be able to go back and see what happened. So these are the good things about continued school-class monitoring systems. You can prefer Freestyle Libre. There's a Freestyle Libre II now. There's Dexcom out there. There's Guardian out there. There's a lot of good continued school-class monitoring systems that I love because they basically help you to monitor and get you a lot of data on a day-to-day basis. So anyways, so that was today's topic. Make sure you subscribe, guys, and we will see you in the next video.