Protect Your Kidneys
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The episode, word for word
Dehydration doesn't just make you feel bad. It can send you to the hospital.
When you're sick, flu, stomach bug, COVID, whatever, your blood sugar goes up even if you're not eating. That's cortisol and stress hormones doing their job. But if you stop drinking water because you're nauseous or too tired to care, dehydration accelerates everything.
High blood sugar causes osmotic diuresis. Osmotic diuresis dehydrates you more. Dehydration makes your blood more acidic. And if you're not drinking and not eating, your body starts burning fat for fuel, which produces ketones. Too many ketones plus dehydration equals diabetic ketoacidosis, DKA.
And DKA can kill you.
Today we're talking about sick days, dehydration, and the one thing you can control when everything else is falling apart.
My name is Neil Greathouse, and this is Your Best T1D Year.
Alright, welcome to Week 4 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 last week.
So let's talk about sick days.
When you're sick, your body releases stress hormones, cortisol, adrenaline, glucagon, to help you fight off whatever's attacking you. Those hormones raise your blood sugar, even if you're not eating. Your liver dumps glucose into your bloodstream. Your cells become more insulin-resistant. Your blood sugar climbs.
And here's where it gets dangerous: if you're too sick to drink water, dehydration kicks in fast.
High blood sugar makes you pee more through osmotic diuresis. You're losing water and electrolytes. Your blood volume drops. Your blood becomes more concentrated. And now your kidneys can't flush out ketones as effectively.
Ketones are acidic byproducts your body makes when it burns fat for energy. If you're sick and not eating much, your body shifts to burning fat. If you're also dehydrated and your kidneys can't clear the ketones, they build up in your blood. Your blood becomes acidic. That's DKA, diabetic ketoacidosis.
DKA is a medical emergency. It causes nausea, vomiting, abdominal pain, confusion, and rapid breathing. If untreated, it can lead to coma or death.
And dehydration accelerates the whole process.
There's a study published in Diabetes Care that looked at predictors of DKA in people with type 1 diabetes. One of the biggest risk factors? Delayed or inadequate fluid replacement during illness.
People who didn't drink enough water when they got sick were significantly more likely to develop DKA. And the ones who ended up in the hospital? They were often severely dehydrated by the time they got there.
Another study found that dehydration worsens the metabolic acidosis of DKA. Translation: the less water you drink, the more acidic your blood gets, and the harder it is to recover.
Here's the protocol:
Keep drinking water. Even if you're nauseous. Even if you're not hungry. Sip water every 15 minutes. Small sips are fine. Just keep fluids coming in.
Check your blood sugar and ketones every 2, 4 hours. If your blood sugar's above 250 and you have moderate or large ketones, call your doctor. Don't wait.
Don't stop taking insulin. Even if you're not eating. Your body still needs basal insulin. If your blood sugar's high and you have ketones, you need more insulin, not less.
Add electrolytes. Gatorade Zero, Pedialyte, LMNT, whatever you can keep down. You're losing sodium, potassium, and magnesium through osmotic diuresis. Replace them.
Ask for help. If you're too sick to manage this alone, call someone. Your endo. Your partner. A friend. Don't try to tough it out.
You shouldn't have to fear DKA every time you get the flu. And if you won't let dehydration send you to the ER, you've got to stay on top of fluids even when you feel like garbage.
Real quick, if you're worried about managing sick days alone because you don't have regular access to an endo, let me tell you about Blue Circle Health.
They offer free virtual care for adults with type 1 diabetes. You can reach out to a real diabetes educator or endocrinologist when you're sick and need guidance. They help with sick day protocols, insulin adjustments, and even prescription access if you're running low.
It's all free. No insurance required. They're helping people in 10 states right now.
Go to bluecirclehealth.org and sign up.
Alright, here's your challenge: take a photo of your sick day hydration stash.
What do you keep on hand for when you get sick? Water bottles? Electrolyte packets? Gatorade Zero? Pedialyte? Post it to your Story and tag @thebetes. Use #RefillWhatT1DTakes.
And here's the fun part: Week 4 badge drops this Sunday. If you've been tracking your hydration this week, screenshot your progress and share it on Instagram. I'm picking three winners this week to send a prize to, either a signed copy of one of my books or some hydration swag.
Go to yourbestt1dyear.com to download your tracker and grab your badge when it drops. Over 1,100 people are in. You're not behind. Jump in now.
Look, sick days are the worst. You already feel terrible. And then diabetes decides to make everything harder. Your blood sugar's high. You're nauseous. You're exhausted. And now you're supposed to check ketones and drink water and keep taking insulin.
It's overwhelming. I get it.
But here's the thing: you can't control when you get sick. You can't stop your body from releasing stress hormones. But you can keep drinking water. You can check your ketones. You can ask for help when you need it.
Dehydration doesn't have to send you to the ER. DKA doesn't have to be inevitable. You've got more control than you think.
One sip at a time. Even when it's hard. Especially when it's hard.
I'll see you Monday for Week 5.
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 make you feel bad. It can send you to the hospital." "Shouldn't/Won't" Placement: In core content (mid-episode) BCH Ad Length: 30 seconds Challenge Name Mentioned: "Hydration Challenge: Refilling What T1D Drains" Badge/Prize Language: Week 4 badge drops Sunday, picking 3 winners for prizes "You're Not Behind" Language: In CTA
Humor Style: Minimal (serious topic) Encouragement Style: Grounded, empowering (Ted Lasso) "You Can't Fix X, But You CAN Do Y": Expanded in closer Key Science: DKA predictors, fluid replacement, metabolic acidosis
Week 59
Mar 30 - 176
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.