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An Accurate, Immediate Test for Dangerous Ketone Levels
Urine testing strips can tell you what your blood glucose levels are and detect the presence of ketones in your urine. For blood glucose monitoring, blood testing is definitely superior, since urine can only tell you what your blood glucose levels were a few hours ago, while blood tests report current levels. You should never make insulin therapy decisions based on a urine test strip. However, when it comes to ketones -- a byproduct of lipid fat and protein metabolism -- urine testing is best. Ketone presence in your urine is a sign that you may be in a state of ketoacidosis, a life-threatening condition that requires immediate medical attention.
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Urine Glucose Levels Are Not Very Accurate
- Because urine is gathered slowly, the urine glucose levels reflect your blood sugar level from a couple hours ago.
- The concentration of your urine varies according to the amount of fluid you intake, so excessive amounts of water will dilute your glucose levels.
- There are a number of things that can interfere with urine glucose readings, especially certain drugs and conditions.
- Urine testing is not precise. It can only tell you if your glucose is high. In addition, the "proper level" of glucose in urine varies from person to person, from time to time, and from condition to condition.
- Urine glucose testing strips are sensitive to humidity, so they must be stored properly.
- To achieve the greatest accuracy possible, get some training from your pharmacist or doctor.
- Be sure to use more than one method of glucose monitoring.
Choosing and Using Urine Tests
- Urine glucose test strips are available at pharmacies.
- There are two types of tests (copper reduction and glucose oxidase) and they differ in method, price, and accuracy.
- Urine glucose test strips vary in range and sensitivity. Choose the one that best suits your needs.
- Try to gauge the availability of your particular brand of urine glucose test strips. This information will be helpful.
- Many of the solutions and test materials included in urine glucose test kits are hazardous. Take care in handling them.
What Are Ketones?
In the absence of insulin, your body will begin to oxidize (break down) fat. Ketones are a toxic byproduct of this process. Ketones that are produced are acetoacetic acid, acetone, and betahydroxybutric acid. Ketones in your urine can signal the onset of a very dangerous condition called ketoacidosis. While the presence of ketones in your urine does not automatically signal ketoacidosis, if you are experiencing extreme stress, pregnancy, and/or symptoms such as diarrhea, vomiting, fruity-smelling breath or high fever, ketones in your urine are most likely a sign of ketoacidosis.
What Should You Know About Ketone Tests?
- Type I diabetics are more likely to go into ketoacidosis.
- Urine ketone test strips do not give a specific number but rather a general range of the level of ketones in your urine. Some ketone test strips require that you read by color and others by plus signs. Make sure you are capable of reading the test strip.
- Some urine ketone test strips test for ketones and glucose level.
- Some only test for acetoacetic acid. Others test for acetone and acetoacetic acid (nail polish remover can be used to check for these tests' effectiveness). There are no tests for beta-hydroxybutric acid.
- The length of wait time required for a result ranges from 15 seconds to 2 minutes. Choose which one is better for you and remember that ketones in your urine can be an indication of a medical emergency. You may not want to have to wait the 2 minutes!
- Urine ketone test strips need to be stored properly.
- Always check the expiration date.
- Individually foil-wrapped ketone test strips last longer, but they have a higher initial cost. The higher initial cost is offset by the length of time they can be used.
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What Urine Glucose Testing Strips Do
- Urine glucose strips measure the amount of glucose that has spilled over from the blood into the urine.
- Strips can be used as a supplement or alternative to self blood glucose monitoring.
- We recommend, if other methods are available, that you not rely solely on urine glucose strips in order to monitor your blood sugar level.
How Copper Reduction and Glucose Oxidase Urine Tests Work
- There are two types of urine glucose strips.
- In copper reduction tests, a chemical on the strip reacts with glucose in the urine and changes color.
- It should be noted that copper reduction tests also react with other substances in the blood because it is unable to differentiate between glucose and a number of other substances.
- In glucose oxidase tests, glucose oxidase on the strip reacts with glucose in the urine and changes color.
What Ketone (Urine Testing) Strips Do
- Urine ketone test strips help you determine whether or not you are in a state of emergency.
How Ketone Strips Work
- The strips are treated with a substance that reacts with ketones (waste chemicals). If your urine contains ketones, the strip will either change color or reveal markings that indicate ketone level in your urine.
How do ketone strips differ from a urinalysis obtained at the doctor's office?
- They do not. The importance of ketone strips is that they give you immediate response. You should never wait until you see your doctor to test your ketones!
Pre-Test Precautions
- Try not to drink excessive amounts of fluid a few hours prior to your urine glucose test.
- Keep in mind that the urine glucose test gives you a range of your sugar levels from a few hours before.
- A number of drugs and conditions can interfere with either the copper reduction test or the glucose oxidase test. Check with your doctor or pharmacist for more information and choose an alternate glucose testing method.
- Drugs commonly interact with glucose oxidase tests, producing false negative results (meaning a lower glucose level will be indicated than actually exists) or false positive results.
- Drugs commonly interact with copper reduction tests, producing false positive results, meaning a higher glucose level will be indicated than actually exists.
Abbreviated List of Drugs and Supplements That May Interfere with a Glucose Oxidase Test
- Ascorbic Acid (Vitamin C)
- Aspirin
- Epinephrine
- Ferrous sulfate/Feosol (Iron)
- L-Dopamine
- Levodopa
- Methyldopa (Aldomet)
- Sodium Fluoride
- Tetracycline with Vitamin C
Abbreviated List of Drugs and Supplements That May Interfere with a Copper Reduction Test
- Ascorbic Acid (Vitamin C)
- Aspirin
- Cephalosporins
- Isoniazid
- Levodopa
- Metaxalone (Skelaxin) metabolite
- Penicillin
- Probenecid (Benemide)
- Salicylates
- Streptomycin
Using a Urine Glucose Test
- Follow the instructions provided by the manufacturer.
- Dip the test strip in a urine sample.
- Wait the allotted amount of time.
- Read your strip immediately. The passage of time may affect the color and thus your reading.
- Always watch your test! Copper reduction tests can change from green to orange to brown in a matter of seconds. You may misinterpret such a result as a less than 2% glucose reading when in fact it is really a more than 2% glucose reading.
- If you suspect that you have missed a rapid color change, perform the test again and watch carefully.
- Record your test results immediately.
- DO NOT make drug treatment decisions based on your urine glucose test, as the ranges provided reflect your sugar levels from a few hours before, not the present.
- Urine glucose test strips need to be stored carefully.
- Always tighten the cap immediately after removing a strip. Glucose oxidase strips are humidity sensitive.
- If you suspect that a strip is defective, do not assume that the rest of the strips from that batch are okay. Often, whole batches are defective. Contact the manufacturer.
Testing for Ketones
- Follow the instructions provided by the manufacturer.
- Dip the test strip in a urine sample. Or place the tablets (or other reagents) into your urine specimen.
- Wait the allotted amount of time. If you are adding tablets or other reagents to urine, make sure you watch the urine sample carefully for any color changes.
- Read your strip. Or observe the color change in your urine.
- If your strip (or color change) indicates anything over zero or trace amounts of ketones in your urine, seek medical help immediately.
- But remember: Ketones are a byproduct of fat metabolism, and you metabolize fat if you have not consumed any source of carbohydrates for 12 to 16 hours (i.e. have not eaten for 12 to 16 hours). Low levels of ketones in your urine could simply be a consequence of skipping a meal. However, moderate to high levels of ketones, or ketones with the presence of elevated blood sugars or sugar in the urine, is a danger sign.
When Should You Perform Urine Ketone Testing?
You should test your urine ketone level if any of the following apply:- Your blood glucose level is above 240 mg/dl. Note: In a clinical setting, ketone level is usually tested when the blood glucose level is 350-500 mg/dl. You should consult your physician.
- You are sick (e.g. have a fever, are vomiting, have diarrhea).
- You are pregnant. Check your ketone levels when you wake up and before you eat.
- You are experience extreme stress: physical or emotional.
- You have a strange fruity taste or odor in your breath.
- You are breathing deeply and rapidly.
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Drug Interference With Urine Glucose Tests
There are a number of drugs and conditions that can interfere with urine glucose tests. The following is an abbreviated list of drugs and supplements that may interfere with a glucose oxidase test. They are likely to produce a false negative result -- they will give a lower glucose level than actually exists.- Ascorbic acid (vitamin C)
- Aspirin
- Epinephrine
- Ferrous sulfate/feosol (iron)
- L-dopamine
- Levodopa
- Methyldopa (Aldomet)
- Sodium fluoride
- Tetracycline with vitamin C
The following is an abbreviated list of drugs and supplements that may interfere with a copper reduction test. They are likely to produce a false positive result -- they will indicate a glucose level that is higher than actually exists.- Ascorbic acid (vitamin C)
- Aspirin
- Cephalosporins
- Isoniazid
- Levodopa
- Metaxalone (Skelaxin) metabolite
- Penicillin
- Probenecid (Benemide)
- Salicylates
- Streptomycin
The above lists of drug interactions are not comprehensive, so check with your doctor or pharmacist for more information. If you have consumed any of the above drugs or supplements they may remain in your urine and interfere with your glucose test. Choose an alternate method of glucose testing.
Take the Results Seriously
- DO NOT make drug treatment decisions based on your urine glucose test, as the ranges provided reflect your sugar levels from a few hours ago, not the present.
- The test strip is not the final word. If your test does not register excessive ketone levels in your urine yet you still feel ill, consult a doctor immediately.
- Please remember that this test is designed to let you know whether or not your health is at immediate risk. Take the results seriously and seek medical attention if you are registering any ketones in your urine.
Treat Test Strips Carefully
- Urine glucose test strips need to be stored carefully.
- Always tighten the cap immediately after removing a strip. Glucose oxidase strips are sensitive to humidity.
- If you suspect that a strip is defective, do not assume that the rest of the strips from that batch are okay. Often, whole batches are defective. Contact the manufacturer.
- Urine ketone test strips expire and can be defective. Take proper care of your strips and make sure you always have fresh ones on hand in the event of an emergency.
Ketones Are a Warning for Diabetic Ketoacidosis
Diabetic ketoacidosis is always due to insufficient insulin and/or an increase in the relative amount of glucagon (due to drop in insulin) or absolute amount of glucagon (due to increased glucagon production). It is entirely preventable by proper and adequate use of insulin, monitoring of blood sugars, and monitoring of ketone levels. Symptoms include:- Loss of appetite
- Nausea
- Vomiting
- Increased urine production, which can lead to dehydration
- Kussmal-Kien respiration: rapid, deep breathing as if thirsty for air
- Impaired mental function possible leading to coma
- Fruity breath
Ketoacidosis treatment requires medical attention. It involves the following:- Insulin therapy to stop the production of ketones and control hyperglycemia
- Fluid replacement to offset blood volume loss from dehydration
- Potassium and other electrolyte replacement
- Bicarbonate administration might also be used depending on the severity of the acidosis.
Hyperosmolar Coma: Danger without Ketoacidosis
Hyperosmolar coma can lead to death with a mortality rate over 50%. It is more deadly than ketoacidosis. It is mainly seen in type II diabetes (or noninsulin dependent diabetes). It can be seen in type I diabetes (or insulin dependent diabetes) if enough insulin is used to control ketosis, but not enough is given to control hyperglycemia. Hyperosmolar coma is caused by extremely high levels of blood glucose leading to dehydration, which makes blood glucose levels rise higher, leading to further dehydration. The cycle of rising blood glucose levels and further dehydration eventually lead to a dangerous drop in blood pressure and coma. Before any dehydration occurs, it is preventable by properly monitoring glucose levels and consuming enough fluids.
Ketoacidosis is not a complication. This makes hyperosmolar coma more insidious than ketoacidosis, because ketoacidosis produces symptoms that will cause you to seek medical attention before the conditon progresses too far. With hyperosmolar coma, there is not acidosis, and consequently, no early symptoms. By the time other symptoms appear you are at real danger of going into a coma. Here are some symptoms:- Extreme hyperglycemia which can be greater than 1000 mg/dl
- Hyperosmolality: increased concentration of body fluids measured in molals
- Decrease in the total amount of water in the body
Impaired mental function possibly leading to coma- Dehydration with its associated symptoms (i.e. dry mouth, cold extremities, confusion, loss of skin firmness, sunken eyes)
Treatment of hyperosmolar coma is similar to treatment of ketoacidosis, involving:- Fluid and electrolyte replacement to offset blood volume loss from dehydration
- Potassium replacement
- Insulin therapy to control hyperglycemia
- But bicarbonate administration is not necessary because acidosis is not present.
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Websites, Organizations & Manufacturers
Sources & Further Reading
Books
- 1. American Diabetes Assocation.American Diabetes Association: Complete Guide to Diabetes. New York: Bantam Books 1996.
- 2. American Pharmaceutical Association. Handbook of Nonprescription Drugs. 11th ed. Washington., D.C.: American Pharmaceutical Assocation 1996.
- 3. Fauci, Anthony S. et al. Eds. Harrison's Principles of Internal Medicine, 14th ed. New York: MacGraw Hill 1998.
- 4. Saudek, Christopher D. et al. (Baltimore: JHU Press, 1997.The Johns Hopkins Guide to Diabetes for Today and Tomorrow. Baltimore: JHU Press 1997.
- 5. American Diabetes Assocation.American Diabetes Association: Complete Guide to Diabetes. New York: Bantam Books 1996.
- 6. American Pharmaceutical Association. Handbook of Nonprescription Drugs. 11th ed. Washington., D.C.: American Pharmaceutical Assocation 1996.
- 7. Fauci, Anthony S. et al. Eds. Harrison's Principles of Internal Medicine, 14th ed. New York: MacGraw Hill 1998.
- 8. Saudek, Christopher D. et al. (Baltimore: JHU Press, 1997.The Johns Hopkins Guide to Diabetes for Today and Tomorrow. Baltimore: JHU Press 1997.
Find more books on health and wellness at  barnesandnoble.com.
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