Resource Guide 2004

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FOR TYPE 1/TYPE 2

Urine Testing

by Kathleen Stanley, CDE, CN, RD, LD, MSEd

In the past, before the advent of blood glucose monitors, urine testing was the only method for gauging blood glucose levels in one's system. But it is, and always has been, a very imprecise method and does not provide a complete picture of diabetes management.

In most cases, for example, glucose is not detectable in the urine unless the blood glucose levels have been above 180 mg/dl, which means that urine tests are virtually useless at detecting hypoglycemia (low blood glucose levels).

For this reason, and others, health care providers recommend that those interested in attaining good blood glucose control use blood glucose meters, not urine test strips or tablets.

Urine, however, contains many other substances and is still very important in diabetes care. For example, if the body burns fat for fuel in the absence of insulin, poisonous ketones are produced, and these substances find their way into the urine. Also, when the kidneys' filtering processes begin to become impaired, microscopic amounts of protein (microalbuminuria) begin to spill into the urine, which is an early sign of kidney disease.

Three different kinds of urine testing kits are available for testing three different substances in the urine: glucose, ketones, and microscopic amounts of protein (microalbuminuria).

(There are dual-function meters that measure both blood glucose levels and ketones. Some health care providers prefer these meters for ketone measurement in certain patient populations, but others prefer the traditional urine test strip or tablet method. It is important to discuss the testing method that is best for you with your diabetes health care professional, as well as to report all test results to that provider.)

Glucose Kits

Home urine glucose tests are available in strip form. They may or may not be less expensive than blood glucose test strips. Insurance companies may not pay for urine test strips, however, because blood glucose meters are now held as the standard.

Strips are either foil-wrapped or in vials, and are marked with shelf-life dates. Strips should be stored according to manufacturer's recommendations, because the chemicals on the strip will react to light, temperature, and changes in humidity. Foil-wrapped strips may be a better choice if strips are infrequently used, to preserve the integrity of the strips.

Urine specimens must either be collected in a clean, dry container (one would then dip the test pad into the collected specimen), or by passing the test pad through the urine stream to saturate it. Timing for the result varies.

Results are obtained by noting the presence of a visible color change on the test pad of the strip. A color scale will indicate the result, either in an estimated quantitative value (example: 250 mg/dl, 300 mg/dl), as a percentage (1/10 percent, ¼ percent, etc.), or a descriptive term (for example, trace, small, or large). People who have problems with color perception or poor visual discrimination are not candidates for using color charts and should use other methods.

Improper handling or storage could skew the readings. There are also certain medications and vitamins that potentially could alter the urine color, causing false results. Check with your health care professional about interfering agents if you plan to use home urine testing products.

Ketone Kits

Ketone bodies (acetone, acetoacetic acid, and beta-hydroxybutyric acid) are byproducts of burning fat, rather than glucose, to fuel the body.

Ketones are a waste product. If they build up, they can lead to very serious energy problems in the body, resulting in diabetic ketoacidosis. The body tries to dispose of ketones as quickly as possible when they are present in the system. Urine test strips can detect ketones as the body tries to rid itself of these poisons.

Ketone testing should be performed by people with type 1 diabetes when their blood glucose is high (usually greater than 240 mg/dl), or as directed by their physician. All people with diabetes who are sick, under stress, or who have blood glucose over 300 mg/dl should also test for ketones, as should pregnant women with any type of diabetes (type 1, type 2, or gestational). And, of course, anyone who suspects onset of ketoacidosis should test for ketones immediately. Check with your diabetes health care professional about the ketone-testing guidelines and record-keeping methods he or she recommend.

Some urine ketone strips may detect only ketones. Others test for both glucose and ketone levels. Please note: Urine ketone strips will detect only some of the ketone bodies produced by the body, not all of them.

Strip storage, handling, and testing procedures are similar to those used for glucose test strips. Strips are available in foil-wrapped packets or vials. Follow all manufacturer's guidelines and procedures.

Test results are indicated by presence of color changes, indicating presence of ketones, either quantitatively (for example, 5 mg/dl, 15 mg/dl, etc.) or by descriptive terms (for example, negative, trace, small, or large). False positives may occur if you are also using certain medications or vitamins, or if the strips have been handled or stored improperly.

New blood ketone testing meters more accurately detect some ketone bodies and may be preferred by some providers, as previously noted, or they may be used in combination with urine strips.

Microalbuminuria Kits

Microalbuminuria tests measure microscopic amounts of protein in the urine. The presence of microalbuminuria in the urine is an early sign of kidney disease.

People with diabetes are at risk for kidney damage. Therefore, the American Diabetes Association recommends everyone with diabetes be tested for microalbuminuria annually. Some people, however, will require more frequent testing, in order to detect progression of kidney disease or adverse effects of certain medications on the kidneys.

This test has only been available through your health care professional in the past but is now available in home-test kits. The test kits, which measure microalbuminuria and creatinine products in the urine, can be ordered through the mail. A urine sample is applied to a specially packaged test kit, which is returned to the company. While the results cannot be interpreted at home—a physician must evaluate the results—this method does allow for more convenient access to the test.

View the Urine Testing Products for Ketones and Glucose chart in PDF format (link will open a new window).
Please Note: Due to the size and layout of this chart, it has been saved in PDF format for easier on-line viewing. This document requires the Adobe® Reader® in order to be viewed. If you do not have this application already on your computer, you can download it for free from Adobe's Web site.

Microalbuminuria Testing Kits
Product (Manufacturer)	Features
AccuBase µAlb (Diabetes Technologies, Inc.)	Easy-to-use, accurate, mail-in urinary microalbumin screening test kit for early detection of kidney disease, which is commonly associated with diabetes and/or hypertension. Three-minute urine dip test with positive patient ID, HIPPA compliant. Specimens are mailed directly to a CLIA, CAP lab for analysis and reporting. Each lab report contains recommendations for testing as well as confounding factors that can affect the validity of the test. Test results can be mailed, faxed, e-mailed, or posted on the company's confidential Web site. For more information, visit www.diabetestechnologies.com.
Appraise Microalbumin Diabetes Monitoring System (Matria Laboratories, Inc.)	Test kit enables patients to self-collect a spot urine specimen in the privacy and convenience of their own home. Provides patients and physicians with an early assessment of kidney damage, a common complication associated with diabetes. Test results are reported within 24 hours of receipt of the specimen and are sent by mail, fax, or electronically. Matria Laboratories is a CLIA-licensed laboratory and a Medicare provider. May be purchased directly or obtained through a physician and is available in all states. For more information, go to www.matria.com.
KidneyScreen At Home (FlexSite Diagnostics, Inc.)	Sample collection kit for mail-in microalbumin testing. Proprietary urine collection paddle allows sample to be mailed in a dried state to FlexSite's CLIA-licensed laboratory. Results reported as microalbumin/creatinine ratio and sent to patient and authorizing physician by mail, fax, or electronically. FDA-approved for over-the-counter sales. For more information, go to www.flexsite.com.

Kathleen Stanley, CDE, CN, RD, LD, MSEd, is a member of the Diabetes Forecast editorial board and a diabetes education program coordinator in Lexington, Ky.