 Hello everyone. This is Dr. Ahmed Ergin. I'm an endocrinologist and today we are going to talk about When to check the blood sugars. This is a very common question in my practice that I hear every day Now rightfully people ask how many times should I check because it hurts Especially if you're doing finger sticks that sucks. If you have a CGM like a dexcom G6 freestyle Whatever great, but even then you sometimes have to do finger checks and most of the time people don't even understand When to do finger checks when they're wearing a CGM if they are using a regular meter Then that's another story that you have to understand how many times because you don't want to check too many times And you don't want to check too many few too little two few times You don't want to check too few two few times so basically We are going to start with the easiest patient. So basic let's talk about a patient who just got diagnosed with diabetes They're super nervous. They're checking their blood sugar seven eight times a day Well, initially that may be exciting and you know, you're you're you're worked up You want to get this under control? Great, but eventually you are going to burn out So there are easier way to do this than just doing seven eight times a day Now if you are really wanting to you know, still have an understanding of where your blood sugars are without doing eight times a day Do the scattered matter so scatter your blood sugar checks, but make sure that it's organized So your doctor and yourself can actually look at it and have an understanding now For example, if you want to check your blood sugar twice a day, this is how you can organize You can do one day First thing in the morning at fasting, which is important and then the second blood sugar check could be an Hour or two after breakfast, but make sure you're consistent Let's say if you want to do one hour after breakfast keep doing that one hour after meals if you're gonna do after lunch or after dinner and Keep it make sure that it's one hour after So because if you're doing one hour one day and then two hours one day then then it becomes confusing so Let's say one day you do it for breakfast on Monday on Tuesday you can do a blood sugar check before lunch and After lunch one hour after on a Wednesday you can do the same thing before and after you just change the meal time But still stick to the two times a day That way you have an understanding of what your blood sugars are before and after breakfast before and after lunch Before and after dinner now what a lot of people do they start checking their blood sugar first in the morning and then before bedtime And they keep doing the same thing Now if your blood sugar is especially similar in the morning similarly high or similarly low Now some people say oh my blood sugar was 180 yesterday today is 160. Why is that? You know what another big deal is still highs Of course what you eat and what you do physical activity everything affects it but the bottom line you're running overall high So there's no point of rediscovering or trying to get hung up on 160 165 175 Don't worry about it. It's high It needs to be fixed to move on to see where the other problems are now what people think that the 160 for some people it's Okay, I can live with that, but then when they check their blood sugar after eating after breakfast They realize that they go sometimes up to 250 and and then they don't know that unless they check it now That is the scattered method and method and I think that's the best way to do it Especially if you have limited amount of strips if you cannot afford strips or just you just hate your pricking your fingers Then try to be wise and try this scattered method Especially if you're new now if you are not so new and you're on certain medications or your diet managed and you're doing well Now how many times do you really check your blood sugars? Well in this case you don't really have to do too many times if you just do if you if it's gonna make you comfortable Once a day in the morning just to keep a trap on it tap on it. You can do that But on the other hand if you want to you know occasionally you check after meals or let's say you think that you had too much carbs You want to check for it be my guest check for it So you understand how food affects you and so forth But if you're overall well controlled and you are waking up with you know say 100 You know 110 and then occasionally you check after meals and you never go more than 160 170 after meals Then you are pretty well controlled again for some people. It's not well controlled But I'm talking about the general purposes, you know because our goals for diabetes depends on the age Depends on the patient sometimes we are very strict with patients. Let's say a pregnant patient We want to keep him less than nine in the morning. There's a different beast I was on a bay beast in terms of the disease state. This is a different beast for a pregnant woman Then a 80 year old frail women So we don't tell them oh you have to wake up below 90 because we know that they're gonna be at risk of dropping their blood sugar And at date age it can be very hard on them and it can actually be very dangerous So what we try to do here? We are trying to manage risk based on the patient So that's why your doctor should give you the goals, you know exactly what your goals should be or you should just Understand the guidelines well, so what does your personal goal should be between you and your physician? typically Although we'll make a video right after this about what your general guidelines are for blood sugars now in summary We recommend checking blood sugar a few times a week if you are very stable Just to keep an eye on it because sometimes people totally drop Checking blood sugars and the next thing they know that they're in the 200 again. You don't want to do that either. So don't be too obsessed Don't be too Lose just find a middle ground But I would suggest that break the habit, you know if you're checking it every morning and if it is every morning 120 Just stop it just because it's not changing. You're not really discovering anything new So and then your diet is not changing nothing, you know Then you can check it in different times a couple times a week just to have a general idea But overall that is what I would recommend now, of course if you're on insulin, that's a little different story So if somebody is on basal insulin, this could be Lantus. This could be levemir This could be terceba or to J. Oh, whatever you're on or MPH In this case, I would suggest checking the blood sugar before you go to bed and then before you wake up Now the reason for that and especially initially especially in the titration stage where we don't exactly know how much Insulin you need but we start you from somewhere and we titrate you to the goal In that stage you always have to want to check the blood sugar at night and in the morning Now what a lot of people don't understand with why we're doing this is that the Reason is the long-acting insulins guys are designed to keep your blood sugar stable now overnight And during the day as well your liver is constantly making blood sugar now that is regulated by insulin and insulin sensitivity When you're insulin resistant when you have diabetes, you know your liver does not realize that there's some insulin So it keeps making too much sugar. So to overcome the resistance, you know If you're not able to exercise and did good dieting etc. Or it may not be enough just simply that an exercise is just sometimes not enough In those cases we start a basal insulin just to keep the blood sugar stable That's why a lot of people wake up with a high blood sugar in the morning Just because their liver constantly makes sugar, especially after four o'clock at night or in the morning In the morning for four o'clock in the morning I would say, you know the growth hormone kicks in on all the other stuff kicks in and then you wake up With a very high blood sugar. That's very depressing for a lot of people So what we do is we just put a basal insulin and that way we really what we are trying to do is the bedtime blood sugar And the morning blood sugar should pretty much be similar now you will never wake up with the same blood sugar. So forget about You know keeping your blood sugar like on a flat line. That doesn't happen You don't see flat line in any human body. So everything constantly is changing Everything affects your blood sugar. So It's not like a heart rate even your heart rate when you get up a little bit your heart rate changes and so forth But with the blood sugars it constantly change Especially if you're not, you know, a normal person like, you know, normal people will wake up around 80 90 But when you're diabetic, you know, there's a lot of factors playing into it But if you are waking up with a blood sugar of let's say less than 120 That's great. But we don't want to start at 200 at night time So we want to make sure that your blood sugar is similar Now what a lot of people do wrong they try to give too much basal insulin to try to control morning numbers Well, that's a problem because we don't want you to go down Like this overnight. That's very dangerous. So we want to keep your blood sugar very stable when you are when you are sleeping We want to keep it like as straight as possible. Now if there is 20 30 plus minus difference, that's very acceptable Because that's not going to put you to danger zone. Let's say you go to bed with 120 You know, if you wake up with 90, that's not a big deal But if your blood sugars are typically dropping 100 points overnight Because of the insulin then you are putting yourself at significant risk Of going very low With the insulin so the goal of the basal insulin again is to keep the blood sugar stable overnight So that's why checking blood sugar at night time and in the morning is extremely important Now once you're stable and you know, you're a pretty regular person and nothing is really changing in your life You don't have to keep repeating that cycle You can maybe just check your blood sugar at night time to make sure it's not too low before you go to bed And people are really scared of insulin because most of the time they are prescribed too much insulin Or patients sometimes do their own thing Based on their own ideas and they just increase their insulin thinking that it's gonna They're gonna have a better blood sugar. Well, that's true But you don't want to have hazardly increase your blood sugar just to control your morning numbers without having an idea about night time numbers So definitely consult with your doctor at sugar md's, you know, we basically monitor you all the time So we have the cellular systems where if we are sending you a A meter that actually transfers data electronically to us So if you are going to bed with 200 and waking up with the 70 We immediately realize then we call you and you know, see what's going on And of course, most of our patients don't get to that stage because we never over-insulinize our patients But we have a system where we can remotely Monitor you without even you having to call us We will call you to make sure everything is staying stable and straight now If you are on one time insulin that is the way to go and you can still check your blood sugars Occasionally after meals based, you know, and it doesn't have to be all the time Let's say your doctor may say, okay, we now controlled your blood sugars You are waking up less than 120 110 And you're consistent your nighttime blood sugars are not horrible But if you're if you are waking up at 120 and your blood sugar starts climbing up to 180 200 by the by the time you go to bed, you know What we need to address is the blood sugar spikes after you eat So what we typically ask patients if they're fasting blood sugars are not bad But then they their blood sugars are high during the day Then we ask them about their blood sugars after they eat So I tell them, okay Check your blood sugar one day after breakfast one day after lunch one day after dinner Again, we try not to do too many finger sticks. We try to keep it to minimum So I tell them that and then they bring it And if I see blood sugar spiking more than 180 200 after certain meals, that's a red flag We try to adjust their diets Of course reduce the carbs or exercise more etc If they can't great if they cannot then we have to do something about this We have a lot of great medications as well That help control the blood sugar spikes after meals Again, not everybody is the same some people do great with diet and exercise But depending on the disease status, you know some type one diabetics for example They have to take insulin with meals some patients with type one and a half diabetes They have to take insulin now some people think that if you stop eating sugar Your diabetes will be fixed. Well, that's not the case That's that's the case for I will say, you know quite a bit of people maybe 50% of people But that's generally true at the beginning stages of type 2 diabetes And even like if you have been diabetic for 20 plus years of type 2 diabetes It becomes hard to control your diabetes just with diet and exercise guys So in my practice, I see a lot of complicated cases Those cases that people discuss on the youtube and other places They're simple new diabetics, you know, they just stop eating carbs and they think they're fixed But diabetes is not a disease like that It's a very philosophical disease. Most people don't understand What it is really entails everybody thinks it's just a sugar problem It's not and we'll talk about that in other videos But the bottom line is if you're checking your blood sugars Twice a day you can stagger it And if you're on insulin one time a day at night and in the morning to kind of make sure they're stable And then once you're fasting blood sugars are stable We look at your blood sugars after meals again by checking your blood sugars, you know after certain meals Now who needs to check their blood sugar four or more times? Those are the people who really take insulin For three times a day with their meals and four times actually the one basal insulin and three meal time You know for type one and a half diabetics sometimes or type one diabetics or some two of course advanced type two diabetics Do that some multiple injections a day And the reason they have to do multiple injections a day multiple testing a day actually Is the fact that they only need to know their blood sugars before they take insulin Because the fast acting insulins actually drop your blood sugars very rapidly So there are two ways of taking the rapid acting insulin one is for correction And the second is for the food for the carbohydrates now Of course, you know if you're going to Be like 200 before you eat you need to know that so that actually you can take a little bit of extra insulin to correct the 200 number so And then the same thing applies if your blood sugars are down to 70 You may want to take a couple units off of your regular schedules those so that you avoid a low blood sugar So monitoring also helps you understand overall how you're doing Let's say you check your blood sugar before breakfast one day and then Second day, you know After you check it Before lunch, right? So you check it before breakfast and before lunch If you're on insulin before meals. So let's say your blood sugar goes up quite a bit every time After you eat so you have a breakfast but by the lunch time it should be down But you're still at the 160 170 range by the lunch time Then you know that you actually need to take more insulin So that's very important to be able to adjust your insulin to be able to give your doctor some data To have him or her understand what's going on with your blood sugars If your blood sugars, for example, are all over the place Then maybe maybe you need to pay attention to your diet a little bit more to try to fix your, you know A consistency problem or a carbohydrate counting problem You know because if you're taking say 10 years of insulin for every breakfast and then your blood sugar one day Drops down to 90 by lunch time and another day goes to 190 That means that what you're eating probably is very different. So you have to understand the consistency of your Your of your eating etc. So this is a different topic we discussed earlier But that's why checking blood sugar four times a day at least is important Sometimes we tell patients to check it after meals as well if we are suspecting certain high blood sugars And in a necronology practice in diabetes practices, we sometimes Perform a professional glucose monitoring, which is a short term cgm short term continues glucose monitoring to see where they're spiking That kind of helps us a little bit more than just relying on patients now Now also in my practice what I really love about is is those cellular meters So because every time they check their blood sugar comes to me, so I don't have to really bag for the numbers I find myself you can you can call my second name as a beggar because I really bag for these numbers like hey Did you bring your blood sugars? Oh, I forgot at home. It's on the desk. It's on the canopy. It's on somewhere It's in the car, uh, or I didn't write it. I forgot I checked. I didn't write it, you know Etc. So all these excuses just used to drive me crazy But now we make patients with diabetes life easy, you know, either we give them a cgm You know, they carry the cgm now Since we jump to cgms, let's talk about when to check your blood sugars when you're using a cgm now the cgm Companies like dexcom or freestyle libero or metronic. They advertise no finger sticks no finger sticks just use no finger sticks Well, that is true to a point But they don't really tell you the downsides of the product they sell Now here's what happens if you're in a cgm like dexcom or freestyle libero Since dexcom or any cgm is somewhat delayed After you know when the blood sugars are changing rapidly and and if you look at the fine print You will see that they actually warn you about that If your blood sugars are changing rapidly your dexcom is not going to be true Like one typical example that a lot of people do wrong The dexcom will show that their blood sugar is low and it's true. It's typically low. It's generally correct Although freestyle libero has not been the most correct cgm when it comes to low blood sugar alerts and stuff But um, and they don't even have alerts, but you know, sometimes they tell us low, but it's not low with the freestyle now with the dexcom Let's say you have a low and then you eat something and then the dexcom keeps showing it slow And they keep eating more and more and the next dexcom shows like your blood sugar is 300 now Well, the reason for that is There is a delay as we discussed on our previous video on the dexcom d6 versus libero video or dexcom or cgms are explained video In that video We tell you guys that there is a delay so you cannot really rely on a cgm when you have a low blood sugar So what you do you eat something 15 20 grams of carbohydrates like simple carbs candy, etc And then you check it in 15 20 minutes with a finger stick Then your finger stick may tell you your blood sugar is 120 and your dexcom may still say your blood sugar is 75 So so as a result guys So this is the point where I want to make if your blood sugar shows that your dexcom shows that your blood sugar is 300 You decide to take some insulin. Okay, so half an hour you check it one hour after you check it You want to check your blood sugar with a finger stick? Yes, dexcom will show the trend, you know, that's always A good thing to know that your blood sugar is now rising or going down Based on what you have done But the exact numbers is not going to be true when your blood sugar is going really high or really low based on what you have Done in this case when you have a low you ate something your blood sugar is going up Dexcom is going to be way behind when you took insulin your blood sugar is coming down fast Your dexcom is going to be behind So as a result in those cases where the things are extreme or not right not not normal You want to do your finger sticks? And then rely on that a little bit more If you catch your low blood sugar like when dexcom tells you your blood sugar is going to be low and you catch it before it's low Then then you're much better luck But when you're bottoming out or you're already down to 50 Or you already 300 You may want to go with the finger sticks at that stage Now I hope that video was helpful guys and make sure you give us a thumbs up And make sure you subscribe now We are going to move on to a stage where we discuss patient cases like real patients real treatments real outcomes And although I may not be able to reply to you in person To your case Because I have to take a lot of information and that requires time and energy You can be our patient, you know if you're watching us from florida and new york sign up to our services in florida We accept insurance in new york. 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