People with diabetes should not be unfamiliar with the tests associated with following up on their condition. Most are blood tests, but other tests are also included. Two simple tests for urine can help assess for kidney disease and severe hyperglycemia.
Kidney disease screening
About 1 in 3 people with diabetes have kidney problems. Early tight control of blood glucose and blood pressure combined with certain medications may allow the kidneys to maintain normal function.
To check for problems, your doctor may perform a urine test called a microalbuminuria test to measure the amount of protein in the urine. Microalbuminuria occurs when a small amount of albumin (the main protein in the blood) leaks into the urine. If protein leakage is not treated promptly, the kidneys may be damaged and eventually lead to kidney failure.
Once you are diagnosed with type 2 diabetes, you should get this test every year. This is because hyperglycemia is usually present for many years before the disease is detected.
In people with type 1 diabetes, this test may be needed 5 years after the diagnosis is made.
What a positive result means
A positive test result indicates that the kidneys are leaking protein into the urine. This is a sign of abnormal kidney function, even if you feel normal and have no symptoms. Your doctor may recommend medication or lifestyle changes to help control the following problems.
- Kidney damage. Medications may be started to prevent further kidney damage. If urine microalbumin levels are very high, your doctor may recommend another test that requires a specimen (urine) to be collected over a 24-hour period to better understand the extent of kidney damage and to see how it is functioning.
- Hyperglycemia. Studies have shown that tight control of blood sugar improves kidney damage, so your doctor may recommend more aggressive treatment.
- High blood pressure. Lowering blood pressure may reduce the risk of diabetes-related kidney injury. Blood pressure should be measured at each visit. The recommended blood pressure for the vast majority of people with diabetes is less than 130/80 mmHg.
- High cholesterol.
- High cholesterol. Over time, microalbuminuria may lead to an increased risk of heart disease, and the doctor will work with the patient to maintain both cholesterol and other lipid levels within a healthy range.
- Other. Other factors that may increase the risk of kidney disease include being overweight, obese, and smoking.
High blood sugar screening
For people with type 1 diabetes, your doctor may ask to check for the presence of ketone bodies in the urine. When there is a lack of enough insulin, the body breaks down fat to make ketone bodies, which provide energy for the cells. Ketone bodies are toxic if too many are produced. Too many ketone bodies can lead to a life-threatening emergency, ketoacidosis.
How do I get tested?
Physicians can check ketone levels, or patients can do so at home with an over-the-counter kit. Simply dip the test strip into the urine. The test strip changes color and can be compared to a chart to see what the color means in terms of the reading.
When should the test be done?
People with type 1 diabetes may need to be checked for ketone bodies in the urine if they have any of the following conditions.
- Feeling sick (from a cold, flu, or other illness) with nausea or vomiting.
- In pregnancy.
- In pregnancy.
- Being pregnant.
- Glucose levels above 300 mg/dl.
- Have symptoms of hyperglycemia, including extreme thirst or fatigue, hot flashes or confusion, or fruity-smelling breath.
- The doctor advises that testing is needed.
For people with type 2 diabetes, the risk of producing too many ketones remains low even if they are on insulin, but the risk is higher when they have severe disease. Your doctor may tell you to have a urine test if
- Have a cold, flu, or other illness, or unexplained nausea or vomiting.
- Glucose levels above 300 mg/dl that continue to rise throughout the day.
Timing of the visit
The results of a urine ketone body test should always be negative. If positive, a positive result should be reported to the physician immediately. If blood glucose continues to rise, or if there is stomach pain, nausea, vomiting, shortness of breath, sweet-smelling breath, or polyuria, the physician should also be informed immediately.
The physician may request:
- Increase water and fluid intake to lower ketone levels and keep the body hydrated.
- Continue to check blood glucose. If your blood glucose is at a high level, you may need to give yourself a small amount of rapid-acting insulin.
- Go to the emergency room at your local hospital, where you can receive IV fluids and insulin therapy.
How are test results recorded?
It is important to keep a detailed record of any urine or ketone test results you have received to help identify problems. You should bring a record of this to each visit.