Diabetes: Urine Tests

Urine tests are often given to people with diabetes to check for diabetes-related kidney disease and severe hyperglycemia.

Testing for Diabetic Kidney Disease

Diabetic kidney problems occur in about 20%-40% of all people with diabetes. However, with early and intensive control of blood sugars, blood pressure and the use of certain medications, the development and the progression of kidney problems can be slowed.

To check for kidney problems, your health care provider can perform a urine test that measures the amount of protein in your urine, called microalbuminuria. Microalbuminuria occurs when small amounts of albumin (the main protein in your blood) leak into your urine. Without treatment to slow the leakage of protein, the kidneys may continue to be damaged and eventually fail.

This test should be performed every year, starting when you are diagnosed with type 2 diabetes. This is because diabetes is actually present many years before the diagnosis.

If you have type 1 diabetes, this test often isn't performed until you've had the diagnosis for five years.

What Happens If the Microalbuminuria Test Is Positive?

If the test is positive, it indicates that the blood vessels to your kidneys are damaged. It also reflects more widespread blood vessel disease that can increase your risk of heart problems. Therefore your doctor will take the following steps:

• Give medications to slow kidney damage. Your health care provider may recommend starting specific medicines to prevent further damage to your blood vessels and kidneys. If the microalbumin level is very high, your doctor may recommend that you have another type of urine test that involves you collecting your urine for 24 hours to more accurately determine the extent of damage to your kidneys and see how well they are working.
• Offer more aggressive diabetes treatment. In addition, studies show that tight control of your blood sugar can significantly decrease kidney damage, so your health care provider may recommend more aggressive treatment of your diabetes.
• Better blood pressure control. Controlling your blood pressure has also been shown to reduce the risk of kidney damage related to diabetes. It is important that your blood pressure be checked each time you have an office visit. The recommended goal for blood pressure control in people with diabetes is less than 130/80.
• Better cholesterol control. Since the microalbuminuria suggests that you are at greater risk of heart disease, your physician may try to get your cholesterol and other fats into a healthier range.

Urine Testing For Severe Hyperglycemia

Sometimes, your health care provider may perform a urine test to determine if your blood glucose is dangerously high and if you are producing substances called ketones. Ketones are the by-product of the fat burning process that occurs in the absence of insulin. When a person with diabetes develops hyperglycemia, or high blood glucose, if there is not enough insulin around (type 1 diabetes) or if their body is unable to utilize the insulin properly (type 2 diabetes) and break down glucose, the body turns to fat stores to create energy for the cells. While ketones can be a source of energy for many cells, they can be toxic in large amounts and cause a life-threatening emergency condition called ketoacidosis.

Ketone levels can be measured in the urine by your doctor or by using an over-the-counter kit at home.