 Hello everyone, welcome to another episode of SugarMD. Today we are going to talk about glucose management while fasting. Especially now the Ramadan is kicking. There are a lot of Muslim audience we have that are watching and they have questions. What am I gonna do when I am fasting? And when they fast, believe me, they fast. They fast from dawn to dusk. So it can be up to 18 hours of no eating and no drinking, not even water. Not even water. Yeah, you heard me right. So I'm telling you, it's tough, tough, tough. Especially if you're not used to it, you're diabetic. That may be a little tough situation unless you know what you're doing. And today what I'm gonna talk about is not a medical advice, but the general idea to you to make sure you do not make a mistake on your own and always consult with your doctor before you attempt anything. So let's get started. Okay guys, so you want to go into a fasting regimen to lose weight or religiously during Ramadan, whatever it may be for you right now. When you're fasting, a lot of things happen in your body. Now number one, your body goes into stress reaction. What is stress reaction? So your body makes catecholamines, adrenaline, noradrenaline, stress hormones like cortisol. So all these things actually initially can give you a little boost of glucose, right? But then after a prolonged fasting, after eight hours or so, your body starts running out of glucose. Now when that happens, you have to burn fat. You have to burn fatty acids to turn them into ketones so that you can use these ketones to spare the glucose or to make a little glucose at least keep going to your brain because you have to have a certain amount of glucose in your body. Even when you're on a keto diet or when you're fasting, you have to maintain your blood sugars at a certain level. So you are fasting. After a while, you're in a keto mode. The problem is for a lot of you is the medications. So if you are a diabetic who is not taking any medication, trying to do anything with the lifestyle changes and is working for you, in this case, it's really not a big deal. When you're fasting, you will do well. Your blood sugars will improve. Everything will be good, except you're going to feel a little ozzy, woozy, a little lightheaded, whatever. If you have not practiced fasting and if you're jumping to an 18 hour fast, that can be really striking. So having said that, for people who are on, say, metformin, that may not be a big, huge deal. I know some of you hate metformin. I'm not trying to say it's good or bad for you in this video. We have videos about metformin. You can check that out. But if you're on metformin or agents that do not necessarily cause low blood sugar, even when you don't eat. So actually, there are some rare cases of metformin causing low blood sugar, but at large, it does not necessarily do that to majority of the people. So let's say you're on metformin or you are on a medication like Genuvia or Tragenta, or you're on a GLP-1 agonist, say, for example, Osempic, Trilocid, Victosa, Bayata, Biterian, all these things. They do not necessarily cause low blood sugar. I know they can, but it's not really common. So if you're on these drugs, you may still be safe to fast for a long time without causing a low blood sugar. And why I keep talking about a low blood sugar? Because it's a big deal. If you have a low blood sugar, you're breaking your fast, you may end up in the hospital, not a fun situation. It doesn't feel good, believe me. I have tried on myself before. It does not feel good. And most of you probably had experience at least once if you're on medication. So if you are on a medication group such as Sulfonylurea, and these are like Glypozide, Glymopride, Glyboride, the problem with those agents, they raise your blood insulin level and it stays up. And if you're eating only once or twice a day, and if you're not having anything in between, or like, say, you know, you're having one meal at, you know, 7, 38 o'clock in the evening, another one and very early in the morning, then you are looking for 16, 18 hours of fasting, you know, once the sugar carbohydrates, whatever you ate runs out of your system, then you are at the mercy of these drugs that are still in your system, and they will not really show mercy to you. They'll keep your insulin up. And if it is too much of a medicine, you can definitely go down. So I definitely do not recommend using Sulfonylurea for that purpose. Now, what is an alternative to Sulfonylureas? Now, of course, the GLP1 drugs we talked about, like here, are alternatives, or the DPP4 inhibitors like the genivia and trigenta, like here. So these are good ones to try when you're fasting, especially during Ramadan month. But on the other hand, if you cannot get your hands on these because they're expensive, you may not like the side effects or whatever the reason may be. There is a cheap alternative. They're called megalithonides, but you can call it short acting Sulfonylureas. So they raise your insulin level, but not too long at a time. So you have to take them before every meal. So my favorite is Repagilionide. There's another one called Natagilionide. But the Repagilionide, the brand name is Prondin, and the Natagilionide is Starlix. When you take these drugs before the meal, they increase your insulin a little and then they fade away, they disappear, they're eliminated, provided that you do not have major kidney problems. There's another factor for a lot of diabetics. If you have kidney problems, things tend to stay in your system longer. So you have to be extra careful with that. Of course, when we are talking about all these drugs and so forth, the most important thing for you to do, especially the first few days of fasting, is checking your blood sugar so many times to understand what's going on. Because if you don't really check your blood sugar, it may hit you. It may go from like 120 blood sugar down to 50, like so quick that you may not really realize what's going on. When I say so quick, it may go within a couple of hours, say three, four hours. But if you are really checking your blood sugar every two to three hours, at least you will see a trend. If your blood sugar is dropping from like 180, now 150, 120, 190, you're like, wait a minute, maybe you should cut that fast. You don't want to kill yourself just to be able to fast religiously. So if you are really not able to do that, just don't do it. Especially if you feel like sweaty, shaky, you don't feel right, check your blood sugar low, fix it, eat something, do not try to save your fast. Important fact, this is very important. Now this DEXCOM and Freestyle Liberate, those glucose monitoring systems, they are not perfect by any means, but they are great to understand your trends. So most people get hung up, hey, my blood sugar is 120, DEXCOM says it's 130. Okay, well, it's the same thing, you know, is your finger stick even is not always very 100% accurate. These are all estimations. These are devices are created around the estimations, but they are good at understanding the trend analysis. And then all alerting you like Liberate 2 system, for example, alerts you to DEXCOM, alerts you. So if your insurance covers or if you have the ability to pay self-pay, I think there are very good investments for any diabetic. So you don't have to prick yourself like 20 times a day, and you can still see what's going on, at least on a ball part, you know. So, but then, you know, let me talk about the repegulonide, or the repegulonide as other solutions, compared to cell phone ureas, if you have to do some sort of cell phone urea because they're cheap, et cetera, but if you're an insulin, that's a whole different ball game. Because if you're an insulin, the question is, are you really taking insulin correctly? How controlled your diabetes is? We don't really know all of this. So you may be taking insulin like 300 units, and your blood sugar may still be 300. That doesn't mean that you're in control. You know, you're some somebody else may be taking only 20 units of insulin, and your blood sugars may be perfect. So there is a difference there. So if your blood sugars are uncontrolled with a lot of insulin, especially taking multiple shots a day, and you're trying to fast, you have to really sit down with your doctor and try to find out what you can do. I wouldn't really experiment myself because a lot of people go with either all or nothing type of thing. And like they will say, oh, I'm fasting, I don't need insulin. If you do that, if you say, especially if you're type one diabetic, we always kind of try to focus on the type two. But if you're type one diabetes, you have to have long acting insulin in your system. Now, when you're fasting, you may need less long acting insulin, and you may need very little to none short acting insulin just maybe for corrections and so forth. But it's going to be a very delicate balance if you have been diabetic, like type one diabetic for 15, 20 years, because you really don't have the defense mechanism that the type two diabetics have. Like your body doesn't really make enough gulcogon, you're not really making enough epinephrine and so forth. Type one diabetes is very tricky. I would not recommend playing with your insulin at all, especially if you're not controlled when you're fasting. You have to consult with an endocrinologist, make sure you know what's going on, and stay in touch with them. Type two diabetes a little bit easier, but when you are on multiple shots of insulin a day, I'll give you an example. I mean, if you are controlled, let's say you're taking 30 units of lontas and 10 units of hemolog, and your blood sugars are really good, you don't have any problem with it. If you were my patient, I would probably tell you, okay, well, since you're not eating, when you don't eat, you don't really take the hemolog or novelog. When you eat, you take the insulin, you take the short acting insulin. Of course, when you're fasting, at some point, you eat, right? So at that time, if you're going to have a bigger meal than usual, I may say, hey, okay, so you normally take 10 units per meal, but if you're going to have a bigger meal, and you're going to have only one meal a day, I would say take 15 units, still have a reasonable meal, not too much, not too little. Check your blood sugar two hours after you eat, after you take, you know, of course, you take your insulin, you eat, and you check your blood sugar two hours, and then see how you're responding, and make sure you keep track of your carbohydrates if you're having carbohydrates a lot in your dinner. Now, of course, if the long acting insulin, you still need long acting insulin, but if your overall calories are going down, more than likely, you will need less long acting insulin, unless you stop exercising, you know, that also another contributing factor. If somebody, you know, stops exercising when they were normally exercising every day, but then fasting, that kind of balance it out each other, right? So you don't have to really change your insulin too much for the long acting. But if you are not really a, you know, person who exercises and you decide to take on this whole Ramadan month, and you want to fast every day, well, in that case, you may need less, you're more than likely will need less. If you're my patient, I will say, you know, if you're taking long to 30 units, go down to 20 units, and then monitor your blood sugar very closely. But again, that's in a perfect world and a perfect patient, you know, the problem with diabetes, it is such, it's a disease that is so individualized, like when God forbid, when you have a cancer, they have protocols. Well, if you have stage three disease, this is the chemotherapy you get, this is the radiotherapy you get, you know, this is very kind of standard and whatever. Sometimes they put you on experimental treatments, but diabetes is not like that. Everybody is so unique. I tell my patients, sometimes they come into the door and they say, I want to be on this medication. I'm like, no, you're not. No, you know, I'm trying to be on this medication. You know, and I explained, I'm like, the person just left before you got on that medication, but you're not going on that medication because of this. You know, we have so many medications and we have so many comorbidities, so many conditions that I have to choose the right, the best medication for you. So just because you want this medication doesn't mean that you're going on that medication, right? So otherwise, everybody can read about medications and can be their own doctor. But diabetes is a very unique disease where everybody's so different. Some people will control their diabetes with just, well, just eating, stop eating carbs or eating less carbs or just walking a mile or two every day. Boom, their diabetes is gone. There's some people, no matter what they do, their blood sugars will be in 200, 300. Or some patients may need five medications to control their diabetes. Some patients may need only one single medication. So it's a disease where you really have to understand what's going on with your doctor, constantly with your doctor. But as I said, if you're on pills, not insulin, it's a little bit easier. Like we discussed before, I would say, you know, you can make your own mind what to do, but always confirm with your physician. And they'll appreciate that you're thinking about it, definitely. You can tell them that I heard from a young, handsome YouTube doctor. That's okay. They want mine. Guys, we'll see you next time. And guess what? I want you to watch this video now.