Why Your 180 Looks Like a 220
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The episode, word for word
You ever look at your CGM and think, "I haven't eaten anything in three hours. Why is my blood sugar higher than it was an hour ago?"
You didn't sneak carbs. You didn't forget to bolus. You've been sitting at your desk doing absolutely nothing. And somehow your 180 turned into a 220.
What is happening? Did your pancreas decide to throw a surprise party without inviting you?
Nope. It's the concentration effect. And it's one of the most annoying things about T1D that nobody talks about.
Here's what's happening: when you're dehydrated, your blood volume drops. Same amount of glucose, less liquid. Higher reading. It's not new carbs, it's math. Your blood got thicker, and now your CGM's like, "Who are you?"
Today we're breaking down the concentration effect, and why drinking water can drop your blood sugar without insulin.
My name is Neil Greathouse, and this is Your Best T1D Year.
Alright, before we get into it: this is a New Girl episode.
That's right. Just like we did with the Seinfeld episode back in Week 2, I'm loading this thing up with as many New Girl references, quotes, and callbacks as I can possibly fit. Some are obvious. Some are sneaky. Some are so specific only true fans will catch them.
Here's the contest: Listen to the whole episode. Count how many New Girl references you can find. Then post your count to Instagram Stories, tag @thebetes, and use #RefillWhatT1DTakes.
I'll announce the winner on Friday's episode. If you get it right, or closest, I'll send you a signed copy of one of my books or some hydration swag.
Let's do this. True American style.
Alright, welcome to Week 7 of the Hydration Challenge: Refilling What T1D Drains. If you're just joining us, you're not behind. Jump in right now. Schmidt didn't give up on the douchebag jar, and you're not giving up on hydration.
So let's talk about the concentration effect.
Your blood is about 50, 60% water. The rest is red blood cells, white blood cells, platelets, proteins, glucose, electrolytes, all floating around in liquid.
When you're well-hydrated, everything's balanced. Your blood flows smoothly. Your glucose is diluted properly. Your CGM reads accurately.
But when you're dehydrated? Your blood volume drops. Same amount of glucose, less liquid. The concentration goes up. And your CGM goes, "Girl, that is a lot of sugar in here."
It's like making lemonade. If you use the right amount of water, it tastes good. If you use half the water, it's basically syrup. Same amount of lemon, less liquid, way stronger taste.
That's your blood when you're dehydrated. Thick. Concentrated. And your CGM's reading it like, "Damn, Schmidt, back at it again with the high numbers."
Here's where it gets worse: high blood sugar causes osmotic diuresis. Your kidneys flush out glucose, and glucose drags water with it. So you pee. A lot.
Every time you pee, you lose water. Your blood gets more concentrated. Your glucose reading goes up, not because you ate more, but because the solution's thicker.
And now your body's like, "We need more insulin to bring this down." So you correct. But your insulin's absorbing slower because you're dehydrated and your subcutaneous blood flow is reduced. So the correction takes longer. And meanwhile, you're still peeing out water. And the cycle continues.
It's a mess. Winston Bishop, level mess. The kind where you're like, "How did we get here? Who's in charge? Why is there a cat in the vents?"
Here's the good news: you can break the cycle by drinking water.
When you hydrate, your blood volume increases. The glucose gets diluted. Your CGM reading drops, not because the glucose disappeared, but because it's now floating in more liquid.
Studies show that drinking 16, 20 ounces of water can lower your blood sugar by 10, 30 mg/dL within 20, 30 minutes. Not because water magically burns glucose, but because it dilutes your blood back to normal concentration.
It's not a replacement for insulin. But it's an assist. Like Nick Miller trying to help move a couch, he's not doing the heavy lifting, but he's there, and that counts for something.
Next time you're stuck at 200+ and you can't figure out why, try this:
Drink 16 ounces of water.
Wait 20 minutes.
Check your CGM.
If it drops 10, 20 points without insulin, that's the concentration effect. You weren't high because you ate too much. You were high because your blood was too thick.
And now you know. Gave me cookie, got you hydrated.
Real quick, if you're sitting here thinking, "Neil, I don't understand half of what's happening with my blood sugars, and I definitely don't have time to decode the concentration effect," I feel you.
That's why Blue Circle Health exists. They offer free virtual care for adults with type 1 diabetes. Real endocrinologists who can explain this stuff without making you feel like you're taking an AP Biology exam.
They've helped over 650 people figure out their blood sugars, get access to insulin and supplies, and reduce diabetes distress. And it's all free.
Go to bluecirclehealth.org and sign up. Treat yourself, it's Blue Circle Health day.
Alright, here's your challenge: count the New Girl references.
Listen to this episode again. Write down every reference, quote, or callback you catch. Post your count to Instagram Stories. Tag @thebetes. Use #RefillWhatT1DTakes.
Closest count wins. I'll announce the winner Friday.
And while you're at it, drink 16 ounces of water. Test the concentration effect yourself. See what happens.
Go to yourbestt1dyear.com if you haven't signed up yet. Over 1,100 people are in. You're one of the good ones.
Look, T1D is confusing. Your blood sugar goes up for reasons you can't explain. Your insulin feels slow. Your corrections don't work the way they're supposed to. And you're sitting there wondering if you're doing something wrong.
But here's the thing: sometimes it's not you. Sometimes it's just dehydration. Sometimes your blood's too thick. Sometimes you just need water.
You can't control your pancreas. You can't reverse your autoimmune disease. But you can drink water. You can dilute your blood back to normal. You can give your body the hydration it's begging for.
Listen, I believe in you. I believe you're doing your best in a situation that's absurdly hard. And I believe that small changes, like drinking more water, add up to something powerful.
One glass. One test. One day at a time. You got this, you beautiful, talented, brilliant, powerful musk ox.
I'll see you Friday.
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: "Why is my blood sugar higher than it was an hour ago?" "Shouldn't/Won't" Placement: (Saved for Friday per calendar) BCH Ad Length: 30 seconds Challenge Name Mentioned: "Hydration Challenge: Refilling What T1D Drains" Contest Format: Count the New Girl references, post to Instagram, winner announced Friday New Girl References Included: Schmidt, douchebag jar, Winston Bishop, cat in the vents, Nick Miller, "gave me cookie got you biscuit" (adapted), "Who are you?", "one of the good ones", "beautiful talented brilliant powerful musk ox", "treat yourself" (borrowed from Parks & Rec but commonly misattributed), True American Jason Bateman Humor: Deadpan ("Did your pancreas throw a surprise party?") Tina Fey Humor: Absurd visuals ("cat in the vents," lemonade/syrup analogy) Ted Lasso Encouragement: Warm closer Key Science: Concentration effect, osmotic diuresis, blood volume, dilution
April 17 - 185
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.