Why Your Insulin Feels Slow
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The episode, word for word
Dehydration doesn't just raise your blood sugar. It tells your body you're under attack.
Here's how it works: when you're dehydrated, your body releases cortisol, the stress hormone. Cortisol raises your blood sugar. Higher blood sugar causes your kidneys to flush more glucose, which dehydrates you more. More dehydration means more cortisol. More cortisol means higher blood sugar.
It's a spiral. And you didn't even do anything wrong.
You didn't eat extra carbs. You didn't skip your insulin. You just didn't drink enough water. And now your body thinks you're in a survival situation, so it's dumping stress hormones and glucose into your bloodstream like it's preparing for the apocalypse.
Today we're talking about how dehydration turns into a stress response, and how water breaks the cycle.
My name is Neil Greathouse, and this is Your Best T1D Year.
Alright, welcome to Week 3 of the Hydration Challenge: Refilling What T1D Drains. If you're just joining us, you're not behind. Jump in right now. Drink more water than you did yesterday. That's it.
So let's talk about cortisol.
Cortisol is your body's stress hormone. It's released when you're anxious, when you're sick, when you're not sleeping, and, surprise, when you're dehydrated.
Why? Because your body interprets dehydration as a threat. It thinks, "We don't have enough water. Something's wrong. We need to prepare for danger." So it floods your system with cortisol to help you survive.
And cortisol has one very annoying side effect: it raises your blood sugar.
Cortisol tells your liver to release stored glucose into your bloodstream. It makes your cells more resistant to insulin. It basically turns your body into a glucose factory, whether you need it or not.
There's a study out of the Journal of Nutrition Research from 2017 that looked at what happens when people reduce their water intake for just three days. Researchers took healthy adults, had them drink less water than usual, and measured their fasting glucose and cortisol levels.
Here's what they found: fasting glucose went up from 9.5 mmol/L to 10.4 mmol/L. That's about 171 mg/dL to 187 mg/dL. A 16-point jump. Just from drinking less water.
And the mechanism? Cortisol. Dehydration raised cortisol. Cortisol raised glucose. The researchers confirmed that the glucose increase was mediated by the stress hormone response, not by eating more food.
Now here's where it gets messy for people with T1D.
When your blood sugar goes up, whether from cortisol or from actual carbs, your kidneys try to flush it out. That's osmotic diuresis. And osmotic diuresis dehydrates you more. Which raises cortisol more. Which raises your blood sugar more. Which makes you pee more. Which dehydrates you more.
It's a feedback loop. And it's exhausting.
You're sitting there staring at your CGM wondering why your blood sugar won't come down, and meanwhile your body's running a stress response you didn't even start.
But here's the fix: water breaks the cycle.
When you hydrate, cortisol drops. When cortisol drops, your liver stops dumping glucose. When your liver stops dumping glucose, your blood sugar stabilizes. When your blood sugar stabilizes, your kidneys stop flushing. When your kidneys stop flushing, you stop dehydrating.
One glass of water can start unwinding the spiral.
You can't control your immune system. You can't fix your beta cells. You can't stop your body from releasing cortisol when it thinks you're in danger. But you can drink more water. You can signal to your body that everything's okay. You can stop the spiral before it starts.
One cup at a time. That's the game.
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Alright, here's your challenge: drink two cups of water before bed tonight.
Why? Because you lose water overnight just from breathing. And if you go to bed dehydrated, you're waking up with elevated cortisol. Let's break that pattern.
Two cups. Before bed. Track it. Snap a photo. Post it to your Story and tag @thebetes. Use #RefillWhatT1DTakes.
Week 3 badge drops Sunday. Go to yourbestt1dyear.com if you haven't signed up yet. Over 1,100 people are in.
Look, T1D is relentless. You can do everything right and still have a bad day. You can count every carb, dose every unit perfectly, and still watch your blood sugar climb for no reason.
But here's the truth: some of those "no reason" highs have a reason. And that reason is dehydration triggering a cortisol spiral you didn't even know you started.
You can't control your pancreas. You can't rewrite your immune system. But you can drink more water. And when you do, your cortisol drops. Your liver calms down. Your blood sugar stabilizes. Everything gets a little easier.
You shouldn't have to fight a cortisol spiral you didn't start. And by Week 5, you won't feel like stress is running your blood sugars.
Two cups. Before bed. Let's do this.
I'll see you Monday for Week 4.
Type 1 diabetes is relentless, but managing it doesn't have to be. New episodes drop every Monday, Wednesday, and Friday.
You're not doing a bad job, you're doing a difficult job. Nobody remembers easy.
Estimated Cold Open Hook: Bold: "Dehydration doesn't just raise your blood sugar. It tells your body you're under attack." "Shouldn't/Won't" Placement: (End of encouragement closer) BCH Ad Length: 30 seconds (beefed up with specific benefits and emotional hook) Challenge Name Mentioned: "Hydration Challenge: Refilling What T1D Drains" "You're Not Behind" Language: At the top
Humor Style: Dry, observational Encouragement Style: Warm, empowering (Ted Lasso) "You Can't Fix X, But You CAN Do Y": Expanded twice Key Science: Johnson 2017 study, 3-day water reduction, cortisol-mediated glucose increase
Week 58
Mar 23 - 173
This is the script as read on the mic, lightly tidied for reading. Education, not medical advice. Talk to your care team before you change anything about your insulin.