Is It Dehydration or My Diabetes?

Dehydration. We hear the word all the time. Sometimes I wonder if I have been chronically dehydrated for years. I am thirsty all the time. Is that diabetes-related thirst or is that dehydration?

What is dehydration?

My doctor says I’m not clinically dehydrated according to the lab results. Ok, I’m not ‘clinically’ dehydrated, so does that make it any less real? I’m still not sure. By definition: “Dehydration is a deficiency of water in the body.”¹

I rarely have a reason to question my family doctor, not because I’m blindly trusting him but because he presents his responses in a way I can accept, through evidence and best practices. But still, I’m not sure I believe that I’m not dehydrated. When I look at the symptoms it’s like my picture should be attached to the list of symptoms. I clearly have all, if not most, of them. Here’s how the Mayo Clinic defines the symptoms:²

• Extreme thirst
• Less frequent urination
• Dark-colored urine
• Fatigue
• Dizziness
• Confusion

Hydration dilemma because of type 2 diabetes

When I was exploring dehydration with him, he told me that a white tongue can also indicate dehydration. Hmmm. I hadn’t had much to drink that day; I was thirsty, my tongue was white and basically I hadn’t peed all day. As I thought even more about dehydration, I had to admit that I was constipated a lot over the years. Yes, years; but off and on. So now I’m starting to pull the picture together. I don’t drink enough. You know when you have to admit something, there is often a “Yes, but…”? Well here’s mine. I commute to work, 45 min in good weather; much longer if the weather is bad. My job involves driving even more after the commute to go from location to location pretty much all day. So here is my daily dilemma. Ever try to locate bathrooms? Yes... they’re in coffee shops. They’re in malls. Now that leads to two issues:

• Are they clean? About half are.
• Do they support my diabetes?

What do I mean by that? Coffee shops mean coffee, cream, sugar, and food I don’t need to be around because, well, depending on the day and my stress level, I’m weak. Not to mention, they frown on people coming in just to use the bathroom and not buying anything. So I try to avoid them. Malls can be the same. Ever walk into the mall to find the bathroom and realize it’s in the food court. Ugh!!!

So my solution has always been “drink less, drink none.” However, I’m thirsty all the time. How can I say it's diabetes when clearly I’m thirsty. In my mind, I’m dehydrated. I’m not taking in enough fluids. The amount of fluid I take in during the day is under my control. I can do better.

Dehydration and type 2 diabetes

That being said, what are the really serious issues for those of us with diabetes to be aware of to avoid true clinical dehydration?

Illness

If you’re diabetic, illness can quickly lead to dehydration. Diarrhea, vomiting, nausea all are issues. All three can cause water and electrolyte imbalances. The saying “What goes in must come out” can lead to big problems. However if it doesn’t go in, there’s either a decrease in what comes out or, worse yet, nothing comes out if the illness is prolonged. For some, this can lead to more serious issues with ketones. Even the common cold when we feel so lousy can lead to short term dehydration because we just don't feel like drinking or eating.³

Medications

The unfortunate truth for many people with type 2 diabetes is medication is needed. Some of the meds can cause a loss of fluids because of the nature of what the drug does. These drugs cause the body to eliminate the sugars by having the kidneys filter them out. In other words, peeing them out. This can lead to dehydration. Doctors usually make people aware of this as they are prescribing the drug. They often recommend making sure you are aware that you need to stay hydrated to maintain the balance. Pharmacists often reinforce that teaching when you pick up the prescription to avoid any issues with dehydration.

Kidney disease

“When you have diabetes, excess glucose builds up in your blood. Your kidneys are forced to work overtime to filter and absorb the excess glucose. When your kidneys can't keep up, the excess glucose is excreted into your urine, dragging along fluids from your tissues, which makes you dehydrated”.⁴ If the kidneys are damaged in the first place they cannot do their job. There are many restrictions that accompany kidney disease, one of which is fluids. There must be a balance maintained to ensure the kidneys can do their job without being overloaded especially if the kidneys have been damaged.⁵

How can you tell if you are getting dehydrated?

Simple. Look at your pee. The color of your pee will say a lot. Your pee when you're properly hydrated should be a straw color. Not orange or darker. Those colors tell you to see your doctor. But you can slowly drink fluids in the meantime. Try to avoid drinks that can lead to further dehydration such as alcohol. Best option: water. There seems to be some mixed thoughts on whether tea or coffee are good options for rehydration. I’d run that question by your health care team before assuming too much.

So is it dehydration or type 2 diabetes?

Since my diabetes is in a pretty good place, and I’m not clinically dehydrated, I’m going to say it’s neither. I’m “under-hydrated.” I think I’ll stay away from the term dehydration because that is a more serious situation often requiring medical intervention. I still have no answer as to how to get in more fluids during my workday since I have no access to clean bathrooms all the time. But at least I know I’m not dehydrated.