Urine Tests and Diabetes

Urine Tests and Diabetes

Summary

A urine test, also called urinalysis, uses a urine sample to diagnose or monitor diseases. In patients with diabetes, urine tests may be used to assess kidney function, estimate glucose levels and detect complications such as kidney disease, infections, diabetic ketoacidosis and cardiovascular conditions. The early detection of complications may prevent or delay the onset of more serious conditions.

Urine tests involve normal urination, and patients usually experience no discomfort. Most tests require one urine sample. Other tests collect urine over a 24-hour period, overnight or during a specific period, such as four hours. For most urine tests, there is little or no preparation and people can immediately return to their usual daily activities afterward.

Different urine tests may require different methods of analysis. Urinalysis may include:

  • Visual examination
  • Test strip examination
  • Microscopic examination
  • Culture

About urine tests

A urine test (urinalysis) uses a sample of urine to diagnose diseases of the urinary system and other body systems. Urinalysis may be ordered to check for early signs of a disease or disorder, or it may be used to monitor conditions such as diabetes or kidney diseases.

For individuals with diabetes, urinalysis serves a number of purposes. It can be used to:

  • Estimate glucose (blood sugar) readings when blood testing is impossible
  • Monitor or detect the presence of substances in urine that indicate a potentially life-threatening complication of diabetes, including:

    • Ketones to diagnose ketoacidosis
    • Proteins (microalbuminuria or proteinuria) to diagnose or monitor diabetic nephropathy and indicate cardiovascular disease
    • Creatinine to diagnose kidney damage

  • Help diagnose urinary tract infections, musculoskeletal conditions such as gout and osteomalacia (weakened bones), and autoimmune diseases such as lupus and scleroderma

Urinalysis is also used with many other conditions, including certain cancers (e.g., bladder, prostate, kidney, pancreas), sexually transmitted diseases and prostatitis. Urine tests can also detect pregnancy.

Urine testing is a simple and easy method of detecting potentially serious conditions early. This allows for treatments that may delay or prevent the onset of more serious complications.

Samples of urine may be taken in several ways:

  • Spot sample (also called dipstick method). A single urine sample.
  • 24-hour urine sample. A collection of all urine for a 24-hour period.
  • Overnight urine sample. A collection of all urine formed between going to sleep at night and waking up in the morning.
  • Timed urine sample. A collection of all urine voided in a specific period, such as four hours.

Spot samples provided in a physician’s office should be tested within 15 minutes of collection. Immediately after the sample is taken, the cup is labeled with the date and the patient’s name. Timed and 24-hour samples need to be refrigerated throughout the day and are tested once turned over to the physician’s office or lab. The 24-hour sample is the most accurate way of testing conditions such as microalbuminuria, but because of its inconvenience, a physician may recommend an overnight or timed sample instead.

Different urine tests may require different methods of analysis. Urinalysis may include:

  • Visual examination. Tester visually examines the color and clearness of the urine sample. Blood may make the urine appear red or brown. An infection may cause the sample to appear cloudy.
  • Test strip examination. Tester uses a chemically coated test strip to measure the amount of certain substances in the urine including blood, glucose, creatinine, protein, pH, nitrite, ketones and bilirubin. The test strip is dipped into the urine sample. A chemically coated test pad on the strip will react with the urine and change color accordingly. The test pad is then compared to a color chart of possible results. Test times vary, but most test strips provide results in less than a minute.
  • Microscopic examination. The tester examines a small amount of urine under a microscope. Cells, bacteria, casts (protein substances that can indicate kidney disorders), crystals and other matter are counted and reported as either the number observed or as estimates (e.g., few, moderate or many).
  • Culture. When the presence of bacteria is suspected in the urine, a urine culture may be ordered. A sample of urine is streaked across the surface of one or more lab dishes (Petri dish). The sample is then placed in an incubator that keeps the urine at body temperature. Bacteria will be allowed to grow in the dish so the type of bacteria can be determined. If there is no growth on the dish at the end of 24 hours, the test is considered negative for infection. If yeast or bacteria are present, the organisms are identified and counted. Further testing is then done to determine what antibiotics are likely to be effective in treating the infection.

Although urine tests often measure or detect the same substances as blood tests, they do not always provide similar information. For instance, a blood glucose test indicates the level of glucose circulating in the body at the moment of the test. Glucose found in urine (glucosuria) is an average value of what glucose levels were several hours ago. Blood glucose monitoring with a glucose meter is thus more accurate and appropriate for the daily evaluation of glucose levels.

Before, during and after the urine test

Patients need to take few or no preparatory steps prior to most urine tests. The patient may need to reduce or stop taking certain medications or vitamins at some point beforehand. Additionally, exercise may be temporarily restricted or suspended.

Infection, fever, dehydration and other physical stress can cause inaccurate results. Patients should notify their physician of these conditions when scheduled for a urine test. People conducting urinalysis at home should refer to package instructions about factors that can alter test results. Menstruation, overhydration (consumption of too much fluid) and failure to empty the bladder on the previous trip to the bathroom can also interfere with test results.

The test requires only normal urination and takes just minutes to complete. Performed in a physician’s office, the test will require a 1- to 2-ounce (30 to 60 milliliters) urine sample to be collected in a cup. The urine sample should not be brought from home because the urine needs to be as fresh as possible. The sample should be a midstream, or clean-catch, sample. To collect a clean-catch sample, the patient should:

  1. Clean the exit area. Men should wipe the head of the penis. Women should wash the area between the lips of the vagina with soap and water and rinse well. Cleansing wipes may be provided.
  2. Allow a small amount of urine to fall into the toilet bowl. This will clear the urethra of contaminants.
  3. Catch the required amount of urine in the provided collection cup.
  4. Remove the cup from the urine stream and place the provided lid firmly on the cup.
  5. Return the sample to the physician or physician assistant.

Some tests will require a 24-hour urine sample. To collect a 24-hour urine sample the patient should:

  1. Get up in the morning of the first day of the test and empty the bladder. The urine should then be discarded in the toilet.
  2. Collect all subsequent urine in the provided container for the next 24 hours.
  3. Cap the container and keep it in a refrigerator or cool place during the collection period.
  4. Get up in the morning of the second day of the test and urinate in the container.
  5. Return the container to the physician’s office or a laboratory for analysis.

Following the release of urine for the test, patients may resume exercise and medication and vitamin intake according to their physician’s orders.

Questions for your doctor

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about urine tests:

  1. Do I have or I am at risk of any conditions, such as diabetic kidney disease, that require me to have urine testing more often than most patients?
  2. How often should I have a urine test for microalbuminuria?
  3. How often should I have a urine test for ketones?
  4. What other urine tests might I need to have at a doctor’s office?
  5. Which type of urine test do I need: spot sample, overnight, 24 hour or timed sample?
  6. Do I need to suspend medication, halt exercise or do anything to prepare for my urine test?
  7. How do I take a clean-catch sample?
  8. When will my test results become available, and who will explain them to me?
  9. May I have a copy of my test results for my records?
  10. What do my test results show? If I need treatment, what are my options?
  11. Should I perform ketone tests or other urine tests at home? How often? Do you recommend a particular brand or company?
  12. Under what circumstances would I have a urine test rather than blood test for glucose?
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