Sick Day Hydration Protocol
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The episode, word for word
Sick days with T1D are the worst.
You're already miserable. You've got a fever, or you're nauseous, or you're stuck in the bathroom wondering if your intestines are staging a mutiny. And then your CGM starts screaming at you because your blood sugar's climbing even though you haven't eaten anything since yesterday.
And here's where it gets dangerous: if you stop drinking water because you're too sick to care, dehydration can turn a bad day into a hospital trip. Fast.
Sick days are when dehydration turns into DKA. When high blood sugars become dangerous blood sugars. When "I'll drink water later" becomes "I can't keep anything down and now I'm in the ER."
Today we're breaking down the sick day hydration protocol, what to drink, when to drink it, and when to call for help.
My name is Neil Greathouse, and this is Your Best T1D Year.
Alright, welcome to Week 6 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.
But today, we're not talking about regular hydration. We're talking about sick day hydration, when your body's losing fluids faster than you can replace them.
So let's break down the protocol.
When you're sick, flu, stomach bug, COVID, whatever, your body releases stress hormones: cortisol, adrenaline, glucagon. Those hormones raise your blood sugar, even if you're not eating. Your liver dumps glucose into your bloodstream to give you energy to fight off whatever's attacking you.
So your blood sugar goes up. And when your blood sugar goes up, osmotic diuresis kicks in. You're peeing out glucose and water. You're dehydrated before you even start vomiting or sweating from a fever.
Now add nausea. You can't keep food down. You're barely sipping water. Your body's losing fluids through vomit, diarrhea, sweat, or just from high blood sugars, and you're not replacing them.
That's when dehydration spirals into DKA. Diabetic ketoacidosis. A medical emergency.
Here's the stat: sick days are one of the leading causes of DKA in people with T1D. Not because people stop taking insulin, though some do, but because they stop drinking water.
So here's the protocol.
This is non-negotiable. Even if you're nauseous. Even if you're not hungry. Even if water sounds disgusting.
Sip water every 15, 20 minutes. Small sips. A few ounces at a time. You don't have to chug a gallon. Just keep fluids moving in.
If plain water makes you nauseous, try ice chips. Popsicles. Gatorade Zero. Pedialyte. Whatever you can keep down.
But you have to keep drinking. Water is the baseline. Without it, everything else falls apart.
Water alone isn't enough on sick days. You're losing sodium, potassium, and magnesium through vomit, diarrhea, sweat, and osmotic diuresis. You need to replace them.
Use sugar-free electrolyte drinks:
Pedialyte Zero Sugar, The gold standard for rehydration. Designed for this exact situation.
Gatorade Zero, Easy to find. Works in a pinch.
Liquid IV Zero Sugar, Powder packets. Good if you can keep water down but need electrolytes.
LMNT, High sodium. Good if you're sweating from a fever.
Alternate between plain water and electrolytes. Don't just drink electrolytes all day, your kidneys need plain water to flush out glucose and ketones.
When you're sick, your blood sugar's going to be high. That's normal. Stress hormones do that.
But if your blood sugar's above 250 and you have moderate or large ketones, that's a red flag. That's the beginning of DKA.
Check your ketones with urine strips or a blood ketone meter. If you see moderate or large ketones, you need more insulin and more fluids. Call your endo or your diabetes educator. Don't wait.
If you can't reach anyone and your ketones are climbing, go to the ER. DKA doesn't wait for business hours.
This is critical: even if you're not eating, you still need basal insulin. Your body's still producing glucose from your liver. If you stop taking insulin, your blood sugar will skyrocket and ketones will build up fast.
If your blood sugar's high and you have ketones, you need more insulin, not less. Follow your sick day plan from your endo. If you don't have one, call them now, before you get sick, and get one.
If you're too sick to manage this alone, call someone. Your partner. A family member. A friend. Your endo. Blue Circle Health if you don't have regular access to care.
Don't try to tough it out. Sick days are dangerous. DKA can escalate fast. And if you can't keep fluids down for more than 6 hours, you need to go to the ER.
Signs you need the ER:
You can't keep fluids down for 6+ hours
Your ketones are large and climbing
You're vomiting repeatedly
You're confused, disoriented, or having trouble breathing
Your blood sugar's above 400 and won't come down
Don't wait. Go.
Real quick, if you're sitting here thinking, "Neil, I don't have an endo. I don't have a sick day plan. I don't even know where to start," I need you to hear this.
Blue Circle Health offers free virtual care for adults with type 1 diabetes. You can reach out to a real endocrinologist or diabetes educator when you're sick and need guidance. They help with sick day protocols, insulin adjustments, ketone management, and prescription access if you're running low.
They've helped over 650 people navigate this exact situation. And it's all free.
Go to bluecirclehealth.org and sign up. Before you get sick. Because when you're in the middle of it, you don't want to be Googling "what do I do when I have ketones."
Alright, here's your challenge: screenshot this episode and save it in your Notes app.
Seriously. Screenshot it. Title it "Sick Day Protocol." Put it where you can find it when you're too sick to remember what to do.
And if you have a sick day kit, Pedialyte, ketone strips, a thermometer, whatever, take a photo of it. Post it to your Story and tag @thebetes. Use #RefillWhatT1DTakes.
Go to yourbestt1dyear.com if you haven't signed up yet. Over 1,100 people are in.
Look, sick days are terrifying. You already feel like garbage. And then diabetes decides to make everything 10 times 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 don't have to be perfect. You just have to keep fluids in. Small sips. Electrolytes. Water. Ice chips. Whatever works.
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.
Listen, I believe in you. I believe you're stronger than you think. I believe that the effort you're putting in, the hydration, the insulin adjustments, the ketone checks, all of it matters.
One sip at a time. Even when it's hard. Especially when it's hard.
I'll see you Monday for Week 7.
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: "Sick days with T1D are the worst." "Shouldn't/Won't" Placement: (Saved for Monday per calendar) BCH Ad Length: 30 seconds (includes "Googling 'what do I do when I have ketones'") Challenge Name Mentioned: "Hydration Challenge: Refilling What T1D Drains" "You're Not Behind" Language: At the top Jason Bateman Humor: Deadpan ("intestines staging a mutiny") Tina Fey Humor: Self-aware observational ("Googling in the middle of DKA") Ted Lasso Encouragement: Warm closer ("One sip at a time. Even when it's hard.")
Key Science: DKA, cortisol, osmotic diuresis, ketone monitoring, sick day protocol
Week 61
April 13 - 183
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.