The Vicious Cycle of Low Potassium
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The episode, word for word
You ever have one of those days where your blood sugar's stuck at 250, you've corrected three times, you've drunk water, you've walked around the block, and nothing's working?
And you're sitting there thinking, "What am I doing wrong? Why won't this come down?"
Here's what nobody tells you: sometimes it's not about insulin. Sometimes it's about electrolytes.
Specifically, potassium.
When your potassium's low, your insulin doesn't work as well. Your cells can't absorb glucose efficiently. So your blood sugar stays high. And when your blood sugar stays high, you pee out more potassium through osmotic diuresis. Which makes your potassium even lower. Which makes your blood sugar even harder to control.
It's a vicious cycle. And most people with T1D have no idea it's happening.
Today we're breaking down the low potassium, high blood sugar loop, and how to break it.
My name is Neil Greathouse, and this is Your Best T1D Year.
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. Drink more water than you did last week.
So let's talk about potassium.
Potassium is one of those minerals you've heard of but probably don't think about. It's in bananas, spinach, avocados, potatoes. It helps your muscles contract, your nerves fire, and your heart beat. Pretty important stuff.
But here's what most people don't know: potassium is critical for insulin to work properly.
When your potassium's low, your pancreas can't secrete insulin as efficiently. And even if you're injecting insulin or pumping it, your cells can't absorb glucose as well. Your insulin resistance goes up. Your blood sugar stays elevated.
And here's where it gets worse: when your blood sugar's high, osmotic diuresis kicks in. You pee out glucose. And when you pee out glucose, you also pee out potassium.
So now you've got a loop:
Low potassium poor glucose control
Poor glucose control more osmotic diuresis
More osmotic diuresis more potassium loss
More potassium loss even worse glucose control
It's like trying to fill a bathtub with the drain open and someone standing there scooping water out with a bucket. You're never going to get ahead.
There's a ton of research on this, but here's the short version:
Studies show that low potassium impairs both insulin secretion and peripheral glucose utilization. Translation: your body makes less insulin, and your cells use glucose less efficiently.
One study found that potassium depletion reduced insulin secretion by up to 50%. Fifty percent. That's half your insulin function gone because of a mineral deficiency.
And it gets worse: low magnesium, another electrolyte people with T1D lose through osmotic diuresis, is linked to insulin resistance, neuropathy, retinopathy, nephropathy, and is a predictor of end-stage renal disease.
So it's not just potassium. It's the whole electrolyte system. And when you're running high blood sugars and losing fluids, you're draining all of them at once.
Good question. Most people don't know unless they get bloodwork done. But here are some signs:
Muscle cramps (especially at night)
Fatigue and weakness
Constipation
Heart palpitations or irregular heartbeat
Blood sugars that won't come down no matter how much insulin you take
If you're experiencing any of those, and your blood sugars have been running high for days, there's a good chance your potassium's tanked.
And here's the frustrating part: you can't just chug a Gatorade and fix it. Most sports drinks have barely any potassium. A bottle of Gatorade has about 80 mg of potassium. You need closer to 3,500, 4,700 mg per day.
So what do you do?
Here's the plan:
Eat Potassium-Rich Foods
These are your go-tos:
Spinach, 840 mg per cup (cooked)
Avocado, 975 mg per avocado
Sweet potato, 950 mg per medium potato
Banana, 420 mg per banana (not as high as people think, but still helpful)
White beans, 1,000 mg per cup
Salmon, 850 mg per 6 oz
You don't have to eat all of these every day. But if you're running high and you haven't had potassium-rich foods in a week, that's a problem.
Use Sugar-Free Electrolyte Drinks
LMNT, Liquid IV Zero Sugar, Nuun, these all have potassium. Not as much as food, but enough to help when you're losing fluids through osmotic diuresis.
LMNT has about 200 mg of potassium per packet. That's not enough to fix a deficiency, but it's enough to keep you from tanking when you're sweating, sick, or running high.
Hydrate
This should go without saying at this point, but: drink water. When you're hydrated, osmotic diuresis slows down. You stop peeing out as much potassium. And your body has a chance to recover.
Water won't add potassium. But it'll stop you from losing it as fast.
Get Bloodwork If You Can
If you have access to regular care, ask your doctor to check your potassium and magnesium levels. They're usually part of a basic metabolic panel. If they're low, your doctor can prescribe supplements or recommend dietary changes.
If you don't have access to regular care, that's where Blue Circle Health can help.
Speaking of which, if you're sitting here thinking, "Neil, I haven't had bloodwork in two years. I can't afford my endo. I don't even know where to start," I need you to know about Blue Circle Health.
They offer free virtual care for adults with type 1 diabetes. Real endocrinologists, real diabetes educators, real lab orders if you need them. They help with insulin access, prescription navigation, diabetes management, all the stuff that makes T1D feel less like juggling flaming chainsaws while riding a unicycle on a tightrope over a pit of angry alligators.
They've helped over 650 people. And it's all free.
Go to bluecirclehealth.org and sign up.
Alright, here's your challenge: eat one potassium-rich food today.
Spinach. Avocado. Sweet potato. Banana. Salmon. Whatever you like.
And drink water. Because hydration + potassium = breaking the cycle.
Snap a photo of your potassium-rich meal. Post it to your Story and tag @thebetes. Use #RefillWhatT1DTakes.
And if you guessed the New Girl reference count from Wednesday's episode, drop your answer in your Story too. I'm announcing the winner today.
Week 7 badge drops this Sunday. If you've been tracking your hydration, screenshot your progress and share it. I'm picking three winners this week to send prizes to.
Go to yourbestt1dyear.com if you haven't signed up yet. Over 1,100 people are in.
Look, I know this is overwhelming. You're already managing insulin, carbs, CGM alarms, and now I'm asking you to track electrolytes too?
But here's the thing: once you know the cycle exists, you can break it. You don't have to be perfect. You just have to eat some spinach. Drink some water. Replace what you're losing.
You can't control your pancreas. You can't reverse your autoimmune disease. But you can eat an avocado. You can drink water. You can give your body the tools it needs to use insulin properly.
Listen, I believe in you. I believe you're doing something most people couldn't handle for a single day. You're managing a relentless disease with grace, grit, and more strength than you probably give yourself credit for.
You shouldn't have to fix electrolytes AND blood sugars separately. By Week 8, you won't, you'll know how they work together.
One meal. One glass. One day at a time.
I'll see you Monday for the final week.
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: "Sometimes it's not about insulin. Sometimes it's about electrolytes." "Shouldn't/Won't" Placement: In encouragement closer (as per calendar) BCH Ad Length: 30 seconds (includes "juggling flaming chainsaws while riding a unicycle on a tightrope over a pit of angry alligators") Badge/Prize Language: Week 7 badge drops Sunday, picking 3 winners New Girl Winner Announcement: Mentioned in CTA Challenge Name Mentioned: "Hydration Challenge: Refilling What T1D Drains" Jason Bateman Humor: Deadpan ("bathtub with drain open + bucket") Tina Fey Humor: Absurd visual ("juggling flaming chainsaws...angry alligators") Ted Lasso Encouragement: Warm closer ("grace, grit, and more strength than you give yourself credit for")
Key Science: Potassium depletion, insulin resistance, osmotic diuresis, magnesium, electrolyte loop
Week 62
April 20 - 186
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.