Signs of diabetes 2

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Hyperglycemia and Diabetic Ketoacidosis

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When blood glucose levels (also called blood sugar levels) are too high, it’s called hyperglycemia.

Glucose is a sugar that comes from foods, and is formed and stored inside the body. It’s the main source of energy for the body’s cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy.

Hyperglycemia is the hallmark of diabetes — it happens when the body either can’t make insulin (type 1 diabetes) or can’t respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia.

If it’s not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes.

These problems don’t usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven’t managed or controlled their diabetes properly.

Blood sugar levels are considered high when they’re above someone’s target range. The diabetes health care team will let you know what your child’s target blood sugar levels are, which will vary based on factors like your child’s age.

Causes of High Blood Sugar Levels

A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It’s a three-way balancing act of:

  1. diabetes medicines (such as insulin)
  2. food
  3. activity level

All of these need to be balanced to keep blood sugar levels under control. If any one is off, blood sugar levels can be, too.

In general, problems controlling blood sugar levels are due to one or more of the following:

  • not getting enough insulin or other diabetes medicine
  • not following the meal plan (like eating too much on a special occasion without adjusting medicines)
  • not getting enough exercise
  • illness or stress
  • use of certain medicines that can raise blood sugar, like steroids used to treat inflammation

Signs & Symptoms of Hyperglycemia

The symptoms of hyperglycemia are similar to those that happen when someone is diagnosed with diabetes, such as:

  • Frequent urination: The kidneys respond to high levels of glucose in the bloodstream by flushing out the extra glucose in urine (pee). A child with diabetes who has hyperglycemia may need to pee more often and in larger volumes.
  • Extreme thirst: Kids with hyperglycemia who lose a lot of fluid from urinating often become very thirsty and may drink a lot in an attempt to prevent dehydration.
  • Weight loss despite increased appetite: Without enough insulin to help the body use glucose, the body breaks down muscle and stored fat in an attempt to provide fuel to hungry cells.
  • Fatigue: Because the body can’t use glucose for energy properly, kids with hyperglycemia may be unusually tired.

Checking for High Blood Sugar Levels

As part of the diabetes management plan, you’ll need to check your child’s blood sugar levels multiple times a day with a blood glucose meter. This helps you identify when your child has high blood sugar levels, which don’t always cause symptoms. Someone who isn’t testing regularly might have blood sugar levels high enough to damage the body without even realizing it.

The HbA1c test can show if someone has been having significant hyperglycemia over time, even though the person may not have had obvious symptoms.

If you find that your child is having a lot of high blood sugar levels, the diabetes health care team may suggest changing the diabetes medicines or meal plan to bring the levels back into a healthy range.

In other cases, an equipment issue, like an insulin pump problem or expired insulin, may be the cause. Make sure you contact the diabetes team if your child’s blood sugar levels are often above the target range.

Treating High Blood Sugar Levels

Treating high blood sugar levels means correcting their cause. The diabetes health care team will give you specific advice on how to keep your child’s blood sugar levels in a healthy range. But here are some suggestions for managing some causes of hyperglycemia:

Cause What to Do
Not getting enough insulin or other diabetes medication
  • Make sure your child takes the right type of insulin and the correct dose at the right time.
  • Check that the insulin is not expired.
  • Make sure that all equipment (pumps, meters, etc.) works properly.
  • Diabetes medicines may need to be changed or adjusted — check with the diabetes health care team.
Not following the meal plan (like eating too much food on special occasions without adjusting medicines)
  • Work with a registered dietitian to change your child’s meal plan as needed.
  • Adjust insulin/pills whenever your child eats more or less than what’s on the meal plan (the care team can help you with this).
Not getting enough exercise
  • Help your child make time for exercise.
  • Adjust your child’s medicines based on the care team’s instructions.
Illness or stress
  • Contact the diabetes health care team.
  • Your child should continue to take insulin (the dose may need to change).
  • Check blood sugar levels often as per the diabetes management plan.
Use of medicines that increase blood sugar
  • Contact the diabetes health care team.
  • Insulin or pills may need to change while your child takes the medicine that’s causing high blood sugar levels.

A single high blood sugar reading usually isn’t cause for alarm — it happens to everyone with diabetes from time to time. However, consistently high blood sugar levels need to be addressed.

Diabetic Ketoacidosis (DKA)

Insulin lets glucose get into the body’s cells. Without enough insulin, the body can’t use glucose for energy and starts to use fat for fuel. This can happen, for example, when someone skips doses of insulin or when the need for insulin suddenly increases (for example, due to stress or illness) and the doses are not adjusted.

When the body uses fat for energy, chemicals called ketones are released into the blood, causing diabetic ketoacidosis (DKA). Some of the ketones, like extra glucose, exit the body through urine.

But high levels of ketones in the blood can be a problem because they cause the blood to become acidic. Too much acid in the blood throws off the body’s chemical balance.

Diabetic ketoacidosis is a very serious — but completely preventable — condition that can lead to coma or death if it’s not treated quickly. It happens more often in people with type 1 diabetes, but can sometimes happen in people with type 2 diabetes.

Signs & Symptoms of Diabetic Ketoacidosis

Symptoms of diabetic ketoacidosis usually don’t start all at once — they usually come on slowly over several hours. Signs and symptoms include:

  • fatigue (extreme tiredness)
  • excessive thirst/urination
  • dry mouth and dehydration

These symptoms are caused by the sustained hyperglycemia (usually lasting several hours) that typically happens before someone develops diabetic ketoacidosis.

If the person isn’t treated, these symptoms can happen:

  • abdominal pain
  • nausea and/or vomiting
  • fruity (acetone) breath odor
  • rapid, deep breathing
  • confusion
  • unconsciousness (“diabetic coma”)

Checking for Diabetic Ketoacidosis

How do you know if your child has diabetic ketoacidosis? The signs and symptoms can mimic or be triggered by other illnesses, like the flu. So, it’s very important to check your child’s blood sugar levels and urine ketones during illness — especially if there are high blood sugar readings — or if your child has symptoms of diabetic ketoacidosis.

Because high levels of ketones in the blood cause ketones to appear in the urine, ketones can be checked at home by testing a sample of your child’s urine. If the urine test for ketones is negative, it generally means that symptoms are not due to diabetic ketoacidosis. If the urine test is positive, contact your child’s diabetes health care team.

Tests done by a lab or hospital can confirm whether a child has diabetic ketoacidosis, if necessary. Some newer blood glucose meters also offer the option of testing blood for ketones. Ask the diabetes health care team if such a meter is a good idea for your child.

Treating Diabetic Ketoacidosis

Diabetic ketoacidosis requires immediate medical treatment with intravenous (IV) insulin and fluids and close monitoring in a hospital. Contact the diabetes health care team immediately or seek emergency care if you think your child is having symptoms of diabetic ketoacidosis.

All adult family members and your child’s caregivers and school staff should know about the risk of diabetic ketoacidosis in a child with diabetes, and they should know when to call 911.

In addition, all kids and teens with diabetes should wear some sort of medical identification (like a bracelet or necklace) and/or carry medical identification (ID) information at all times. Besides identifying your child as having diabetes, these IDs can provide emergency contact information.

Avoiding Hyperglycemia & Preventing Diabetic Ketoacidosis

The best way to prevent diabetic ketoacidosis is to treat high blood sugar levels appropriately, which means following the diabetes management plan prescribed by the diabetes health care team.

Make sure your child:

  • takes insulin and diabetes medicines as prescribed
  • follows the meal plan and/or makes appropriate adjustments to diabetes medicines when changes to the meal plan are made
  • monitors his or her blood sugar levels regularly and ketone levels when indicated
  • follows the instructions and advice of the diabetes health care team and diabetes management plan, which should include instructions for sick days

By regularly monitoring blood sugar levels, you’ll know when your child’s blood sugar is high. If that happens, contact the diabetes health care team for more information and to learn how to help bring your child’s diabetes back under control.

Reviewed by: Mauri Carakushansky, MD and Jennifer L. Seekford, ARNP Date reviewed: October 2016

Dry mouth, clinically known as xerostomia, is the term used to describe a lack of saliva in the mouth.

Saliva helps to control levels of bacteria as well as balancing and washing away acid around teeth and gums.

Symptoms of dry mouth

An obvious symptom of dry mouth is having a lack of moisture in your mouth.

Other symptoms of dry mouth include:

  • Irritation at the corners of the mouth
  • Inflammation of the gums (gingivitis)
  • Oral thrush (yeast or fungal infections on the tongue and cheeks, sometimes following a course of antibiotics)

Symptoms of oral thrush include white patches in the mouth, redness of the tongue and cracking of the skin at the corner of the lips.

Causes of dry mouth

People with diabetes are more susceptible to dry mouth and yeast infections such as thrush because of high glucose levels in their blood and saliva.

Other causes include dehydration, smoking and some medication.

Ways to treat and reduce the effect of dry mouth

  • Keep your blood sugars within the recommended range
  • Brush braces or dentures after each meal – if relevant
  • Keep yourself hydrated and carry water with you
  • Use a non-alcoholic gel or mouthwash
  • Using lip balm is recommended if you have dry or irritated lips (particularly at the corners)

Dry Mouth and Diabetes: Four Tips for Prevention

Oral health care is important for everyone, but especially so for diabetics. Sufferers are often at higher risk of dental problems, and one common complaint is dry mouth. Thankfully, there are many ways to help fight off this condition, and most of them can be practiced easily every day.

According to the American Diabetes Association, dry mouth and diabetes are a common combination because of the medications diabetics take, and thanks to heightened blood sugar. Saliva serves as the mouth’s natural defense against cavity-causing bacteria and acid by washing away food particles and regulating the mouth’s pH levels. With a dry mouth, these bacteria and acids remain, increasing your risk of cavities.

Here are four tips to help diabetics (and everyone else!) prevent dry mouth.

Water and Sugarless Products

One easy, diabetic-friendly way to keep your mouth moist and increase your level of comfort is to drink plenty of water throughout the day. The water will help rinse away food particles, keep your mouth at a healthier pH level and keep you hydrated. The National Institute of Dental and Craniofacial Research also recommends sugar-free gum or candies to help alleviate the effects of dry mouth.

Humidifier

According to the American Academy of Oral Medicine, the ambient air of modern homes can contribute to the feeling of dry mouth. It suggests adding moisture to the air using a humidifier, especially during the night.

When using a humidifier, keep it clean by washing the inside often, and changing its water daily. The Mayo Clinic says that, if you use a humidifier for health reasons, you may also want to use distilled water to fill it. Distilled or demineralized water is recommended over tap water, which has minerals that can lead to bacterial growth and mold, potentially leading to respiratory problems and allergies.

Healthy Diet

Dry mouth is sometimes a symptom of a spike in blood glucose levels, and meals that are high in refined sugars and fermentable carbohydrates make it much more difficult to regulate it. Instead, diabetics with dry mouth should aspire to a diet that is rich in vegetables and lean proteins. Choose vegetables low in carbohydrates, such as spinach, broccoli and tomatoes. These will provide essential nutrients without negatively affecting your blood sugar.

Regular Dental Checkups and Cleanings

Of course, people with diabetes should also commit to receiving regular dental cleanings and checkups, and maintain good oral hygiene habits. These should include thorough daily flossing and brushing your teeth after big meals. Consider a product such as the Colgate 360 Advanced 4 Zone toothbrush, which removes bacteria from teeth, tongue, cheeks and gums.

With these easy-to-follow tips, symptoms related to dry mouth and diabetes can be improved. If dry mouth persists, talk to your dentist and doctor to help you review your options.

Polyuria is a condition where the body urinates more than usual and passes excessive or abnormally large amounts of urine each time you urinate.

Polyuria is defined as the frequent passage of large volumes of urine – more than 3 litres a day compared to the normal daily urine output in adults of about 1 to 2 litres.

It is one of the main symptoms of diabetes (both type 1 and type 2 diabetes) and can lead to severe dehydration, which if left untreated can affect kidney function.

Causes of polyuria

Polyuria is usually the result of drinking excessive amounts of fluids (polydipsia), particularly water and fluids that contain caffeine or alcohol.

It is also one of the major signs of diabetes mellitus. When the kidneys filter blood to make urine, they reabsorb all of the sugar, returning it to the bloodstream.

In diabetes, the level of sugar in the blood is abnormally high. Not all of the sugar can be reabsorbed and some of this excess glucose from the blood ends up in the urine where it draws more water.

This results in unusually large volumes of urine.

Other causes of polyuria include:

  • Diabetes inspidus – a condition unrelated to diabetes mellitus that affects the kidneys and the hormones that interact with them, resulting in large quantities of urine being produced
  • Kidney disease
  • Liver failure
  • Medications that include diuretics (substances that increase the excretion of water from the body/urine)
  • Chronic diarrhoea
  • Cushing’s syndrome
  • Psychogenic polydipsia – excessive water drinking most often seen in anxious, middle-aged women and in patients with psychiatric illnesses
  • Hypercalcemia – elevated levels of calcium in the blood
  • Pregnancy

Polyuria as a symptom of diabetes

As well as being one of the symptoms of undiagnosed diabetes, polyuria can also occur in people with diagnosed diabetes if blood glucose levels have risen too high.

If blood glucose levels become too high, the body will try to remedy the situation by removing glucose from the blood through the kidneys. When this happens, the kidneys will also filter out more water and you will need to urinate more than usual as a result.

If you are frequently experiencing an increased need to urinate, it could be a sign that your sugar levels are too high. If you have access to blood glucose testing strips, you may wish to test your sugar levels if you are urinating more often than normal.

If you have diabetes but don’t have blood glucose testing supplies, you may wish to note down how often you are urinating and discuss this with your health team.

Your health team should be able to advise whether the problem may be related to diabetes and any remedial action you can take.

Recognising the symptoms of polyuria

The most common sign of polyuria is producing abnormally large volumes of urine at regular intervals throughout the day and at night.

If you are concerned about the amount you urinate and think you may have polyuria, you should make a note each day of how much you drink; how often you urinate and how much urine you produce every time you go to the toilet.

When to see your doctor about polyuria

You should consult your doctor if you have excessive urination over several days that cannot be explained by an increase in fluids or medications.

Paula’s story

Paula came to see mcomplaining that her urine smelt funny. She had been referred to through a friend who had diabetes, and who thought that I might be able to help Paula understand why her pee smelled funny.
“My friend told me my urine smells like diabetes,” said Paula. “She said she had that same fruity smell when she got diagnosed.”

Paula said her urine smelled like, “Sugar Smacks,” of all things. I suspected that Paula may have Type 2 Diabetes, but we needed to run some lab tests in order to confirm this suspicion

We tested her urine using a urinalysis. She had high levels of glucose in her urine. After the urinalysis, we ran a random blood sugar, which detected her levels at 798 mg/dL. With the results at hand, Paula was diagnosed with diabetes. She had to start on insulin seemingly right off the bat, as other oral medications wouldn’t control her diabetes. She had weight to lose, and goals to reach. While she’s a work in progress,her urine no longer smells like Sugar Smacks.

What exactly is urine made of ?

Urine is a clear, yellow liquid produced by the body to handle the wastes from normal body metabolism. When nitrogenous by-products build up in the blood from cellular metabolism, it must be cleared from the bloodstream.

In our bodies, some of our toxic waste from metabolism is excreted through perspiration as urea. The rest is handled by an intricate filter system that makes up the human urinary system.

The kidneys work through processes of filtering waste, reabsorption, and tubular secretion. They make urine through this complex filtration process, after which then the urine goes through the ureters, which are tubes to the bladder. Once urine reaches the bladder, it is then dispelled out of the body through a tube called the “urethra,” during a process called “urination.”

What is urine made of?

Being the liquid by-product of metabolism, urine is made from the toxins released from regular daily work of the cells. Nitrogen is one by-product, along with many other water-soluble toxins and chemicals. There are three main nitrogenous toxins that are produced by cellular metabolism.

They are:

  • Urea
  • Uric acid
  • creatinine

Other things, like extra fluid, blood sugar, and other compounds, find their way out the body through the process of urination. About 95% of the content of urine is water. There are also different kinds of salts found in urine, and protein, metabolites, hormones. Solids found in urine are half urea, and the other half contains urine dry solids, volatile solids, and small amounts of carbon, nitrogen, oxygen, and hydrogen.

What is contained in your urine varies greatly related to your diet, and what kind of toxins you are introduced to. Health can play a factor. For example, large amounts of protein in the urine is indicative of illness. People who are healthy have very little protein found in their urine.2

The color of your urine

Different medications, foods, illnesses (bacteria), and other factors can affect the color of your urine. The color of your urine can give you important clues as to what’s going on inside your body. There are other properties of urine that can make it easier for doctors and medical providers to determine what’s going on inside. Our urine is the end result of all the metabolic processes that go on in our bodies, so it provides a valuable diagnostic source.

The amount of fluid in the body affects the color of urine. The more dehydrated the person is, the darker the urine can look. The more hydrated that the person is, the lighter in color that it may appear.

What does normal urine look like?

The normal look of urine ranges from pale yellow and clear, to a darker yellow. When red blood cells are destroyed, they breakdown into urobilin, which is a waste product from these cells. These waste products form a pigment, “urochrome,” which gives normal urine the characteristic yellowish color.

Hydration vs. dehydration

When urine barely has a yellow color, a person may be too hydrated. Urine that is basically colorless during a urine drug screen indicates an attempt to overhydrate, and cover up the presence of illegal drugs. Conversely, when urine has a dark yellow, or amber color, the person is likely dehydrated. In a person who takes diuretics, such as Lasix, the urine may also be pale in color.

Why is the color of my urine telling me?

  • Orange urine

When an excess amount of B vitamins is removed from the blood, and excreted through urine, the resultant urine is a light orange in color. Medications, such as Rifampin and Phenazopyridine can change the color of urine, and make it turn orange. Liver or bile duct problems can also cause orange urine.

  • Dark brown, or amber urine

When blood gets in the urine, it’s termed, “hematuria.” This can be a sign of many different medical problems, and should be evaluated by your provider. Dark brown urine can indicate rhabdomyolysis, Gilbert’s Syndrome, or jaundice (yellowing of skin and eyes) from liver problems.

  • “Black” or dark brown urine

If a person notices black or very dark colored urine, this is called, “melanuria.” This can be caused by a condition called, “acute intermittent porphyria,” or from a skin cancer called melanoma.

  • Pink or red urine

When eating certain foods, it can change the color of your urine. Beets and carrots, blackberries and rhubarbs, for example, can turn urine pink or reddish. Asparagus and foods with green food dyes may give urine a green color. It could be that your urine is pink or reddish due to blood in your urine, so unless you are sure the color is a result of the food you atge, see your doctor. If there is blood in your urine, it can be from kidney problems, a urinary tract infection, prostate problems, or even from cancer (ie: bladder cancer).

  • Blue/green urine

Methylene blue, found in some medications, or foods and drinks that use blue food coloring can cause blue urine. Blue urine is also caused by “blue diaper syndrome.” This rare syndrome is also called Drummond’s syndrome, or hypercalcemia (high levels of calcium). It’s an autosomal recessive disorder of metabolism that is characterized by blue stained diapers.

  • Purple urine

Urine that is purplish in color can be due to a condition called, “purple urine bag syndrome.” Medically, this means that bacteria get into urine in catheter bags of persons with indwelling catheters. The bacteria produce enzymes that convert a compound in urine into indirubin (red), and “indigo,” (blue). There are several bacteria that are responsible for this, including Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Morganella morganii, Proteus mirabilis, Providencia stuartii, and Providencia rettgeri.

  • White urine, milky

White or urine that looks milky in consistency, is usually caused by an infection in the urinary tract. White, milky urine may have a foul odor. It can also be caused by fats in the urine, white or red blood cells in urine, or pus in the urine from bacteria. The color is telling you to see your doctor, and have them check to see if your have a UTI, or another problem that is causing fats, blood cells, or pus to get into your urine.

The color of your urine can give you important clues about your health. It can give you indication onhow hydrated you are, if you may need to be checked for liver problems, acute intermittent porphyria, or even cancer of the bladder (which can cause blood in the urine). If it’s not clear, think infection. Strange colors such as purple or green may be from the foods you ate, so recall your diet intake. There are many things that the color of your urine may be telling you, so the best thing may be to see your doctor for a urinalysis, or other tests, when you don’t understand why your urine is a certain color or if the color has been persistent in showing up for more than a few times

For people without diabetes vs for people with diabetes

People with diabetes, mainly women, get more urinary tract infections, yeast infections, and bacterial vaginosis. In fact, many women may see these symptoms as the first signs of diabetes that clue their healthcare provider to test for diabetes. Uncontrolled diabetes can result in more infections.

For infections, it’s not so much the color of the urine, but the clarity of the urine. If your urine is cloudy (or has a foul) odor, you may have an infection. If your urine is dark, you could be dehydrated, and if your urine is light you could be hydrated. Dehydration can happen during episodes of high blood sugar.

Is there a difference?

As far as the color goes, certain infections and problems can lead to changes in color of urine regardless of diabetes. Some of these infections can be more common in people with diabetes, but they don’t happen only in people with diabetes. The characteristic factor is the fruity smell, which we shall discuss.

I suggest reading the following articles:

  • Exercise Activities That Every Person with Diabetes Should Do
  • Beta Cells and Diabetes
  • Author Voice: Eric O’Grey
  • Can An Exercise Physiologist Help With Your Diabetes?
  • What are Basal Rates of Insulin?

The smell of your urine

The smell of urine, like the color, can also change. It can change with medications, bacteria in urine, foods we eat, and illness, such as diabetes or kidney disease.

Some of the foods that may cause a funky smell to your urine include:

  • Asparagus – not only a green color, but an “asparagusy,” sulfar smell – from asparagusic acid, in the vegetable plant
  • Saffron spice
  • Alcohol
  • Coffee
  • Tuna fish
  • Onion
  • Spicy foods
  • Garlic

Other things that can cause your pee to stink

  • Passage through the urethra, bacteria
  • Ammonia released from breakdown of urea
  • Vitamin supplements (B12)
  • Medications of all types
  • Disease processes (diabetes, infection, metabolic disease)
  • Strong ammonia odor when concentrated

What is a normal urine smell?

Urine doesn’t normally have a strong odor, except in the case of dehydration, where it can have a strong ammonia odor. Otherwise, it’s clear, not cloudy, yellow to straw in color, with a light ammonia smell. As urine dries, it gets stronger, which may be why a peed-on carpet may smell strong long after the pee has dried on it

What is the smell of my urine telling me?

If your urine smells like anything other than a light ammonia smell, it could mean that any one of the above factors is affecting the smell of your urine. Some of these things that make your urine smell differently are not a problem, such as if you are taking a prescribed medication, or a vitamin supplement, or you have been eating strong and spicy foods.

If it’s not any of those things, then the smell of your urine is telling you to make a trip to your doctor, for a health and urinary tract check-up.

Is urine sterile?

Most people believe that urine is sterile, but lately research has shown that bacteria can be picked up in the urethra, and bladder neck, which make urine not sterile after all. The breakdown of the chemical bi-product, urea, is what causes a slight ammonia smell in a hydrated person, or a strong ammonia smell in the dehydrated person’s urine.

Is there a difference in the smell of urine for people without diabetes vs for people with diabetes?

As with Paula, and for other people who suspect they may have diabetes, fruity smelling or sweet-smelling urine could signify that you need to be tested for diabetes, especially when accompanied by frequent and excessive urination. High blood sugars will cause excessive urination, and a fruity odor to the urine. For people with diabetes who have a fruity odor to their urine, it probably means that your blood sugars are not in your target range, and are too high. High blood sugars in people with diabetes have to go somewhere, in which case they head out the body via the kidneys.

This accumulation of high blood sugars, that must go somewhere, causes the build-up of ketone bodies, when the body burns fat for energy. This occurs in Type 1 and Type 2 Diabetes where insulin is required, due to there not enough insulin to carry blood sugar into cells.

Not only does a fruity smelling urine clue us in to the likelihood that we may have diabetes, but diabetes, if not well controlled, can be extremely tough on the kidneys, eventually causing them to fail.

What does the consistency of urine mean?

There are other properties of urine that are of importance as well when determining the health of a person. The consistency and clarity of urine can help to determine if there are issues with urine that need to be attended to by your healthcare provider.

Foamy-looking urine

If your urine is frothy-looking, or has a foamy consistency, this could be a sign that you have protein in your urine. This usually indicates issues with your kidneys, that may include trying to deal with high blood sugars, such as in diabetes. You should see your doctor if you see foam or froth in your urine, and have it evaluated to determine the cause.

Cloudy, murky-looking urine

Urine that is cloudy may be due to a bacteria infection in the urinary tract, or it could also be due to kidney stones.3,4

Old urine dip stick test for diabetes

Doctors used to test for diabetes before the days of home glucometers, by a urine dip for sugar. When blood sugar levels are too high, the blood sugar has nowhere to go but to be excreted as urine. This produces the symptom of “polyuria,” or excessive urination, that people with diabetes have when their symptoms are out of control. Often at first, when diagnosed, they will have excessive urination, due to severely high blood sugars.

Urine ketone testing strips

As their diabetes is more controlled, and A1C and blood sugars are brought into their target range, they will not have fruity smelling urine anymore. People with Type 1 Diabetes, and some with Type 2 Diabetes, can check for ketones by using ketone testing strips that are available at any local pharmacy. These are good to have around for sick days, when blood sugars may run extra high. People with Type 1 Diabetes use ketone strips more often than people with Type 2 Diabetes, due to their complete lack of endogenous insulin, or insulin that they make themselves.

How often should I be going to the restroom?

The average adult will generate about 1.4 liters of urine per day. You generally go to the bathroom for urination anywhere from six to eight times in one day, depending on how much fluids you have been drinking, how much exercise you are doing, your weight, and how well your kidneys are functioning. If you think that you are not going to the bathroom enough times, or you are going too many times, talk with your doctor about your symptoms. These can be signs and symptoms of serious illness.

Everyone’s restroom habits are a little different, and things like caffeine consumption, and alcohol intake can affect how many times you go to the bathroom. As we age, our bladder loses elasticity, and we may need to go to the bathroom more frequently. The bladder can’t hold as much urine as it used to when we are younger.

Burning, urgency and frequency of urination

If you have a burning feeling when you urinate, or an urgency and a frequency, and suddenly you need to run to the restroom, this can be an UTI, from female vaginal infections, or from a condition known as overactive bladder. There are treatments, so talk to your doctor about medications and procedures to correct any of these problems.

If you are going to the bathroom much more frequently, you should see a healthcare provider to get checked for a UTI, for enlarged prostate, Bacterial Vaginosis (BV) and yeast infection in women, or a condition of the bladder wall called “interstitial cystitis.” Similarly, too little urine could mean that you are dehydrated.

There are terms to describe the increase, decrease, or cessation of urine production in the body.

They are:

  • Anuria – less than 100 mL of urine produced per day
  • Oliguria – less than 400 mL of urine produced per day
  • Polyuria – excessive urine production of greater than 2.5 Liters per day

What laboratory tests should people with diabetes have on their kidneys?

Your doctor will perform a blood renal panel to obtain laboratory results for electrolytes (sodium, potassium, bicarbonate, chloride), and minerals (phosphorus and calcium), and albumin, urea, creatinine and glucose. People with diabetes should have their kidneys tested by their doctor each year. Some of the kidney tests that may need to be done to make sure that a person with diabetes kidneys are healthy are:

  • Urinalysis

A urinalysis will detect the presence of many abnormalities in urine, including protein, blood sugar, blood, and pus due to bacterial infections. It only requires that you urinate in a container, which is then sent to the laboratory for testing.

  • Microalbumin

A microalbumin test is done five years after the diagnosis of Type 1 Diabetes, and on diagnosis, and at yearly check-ups, for those with Type 2 Diabetes. This simple laboratory test, which checks for the spillage of protein in the urine, can detect early kidney damage. When blood sugar remains high over a period of time, and it has to go through the kidneys, it tends to cut little tiny slits in the filtration system of the kidneys.

These tiny slits or holes make way for larger particles of protein to slip though, which is why you will find protein in the urine on a urinalysis test related to diabetes.

  • Glomerular filtration rate (GFR)

A glomerular filtration rate is a test your doctor does from blood creatinine tests, looking at factors such as your body size, gender, and your age. This number tells the doctor the stage of your kidney disease when you have diabetes. You will only get this test if your kidneys have had damage shown on a microalbumin test previously. If your GFR is low, your kidneys are not working well, and prevention of severe kidney disease by slowing or halting it is much better than options of dialysis and transplant.

What is Diabetic Kidney Disease (DKA)

Diabetic Kidney Disease, or DKA, is the type of kidney disease that is caused by diabetes mellitus. You may hear DKA referred to by other names, such as Chronic Kidney Disease, or Diabetic Nephropathy. It’s all the same thing. Check out our article here to learn more about Diabetes and Renal Failure.

As the leading cause of kidney disease, one fourth of people with diabetes have kidney or renal disease. Years of high blood sugars damage the kidneys, and the filtration system doesn’t work properly. As the blood vessels in the kidneys become damaged, blood flow to the kidneys is compromised. Kidney damage puts a strain on the heart, and other organs.

Will you see changes in your urine with DKA?

This is when you can see changes in your urine, related to the state of your kidneys. You could see a marked decrease in the amount of urine that is made, dark amber urine, and other symptoms.

Kidney disease with diabetes is not inevitable, and there are ways that people with diabetes can protect their kidneys from damage, and prevent DKA.

Preventing DKA by controlling blood pressure

Preventing high blood pressure, which often goes together with diabetes and also with kidney disease; should be controlled with diet, activity, a low salt diet, and medications if needed. You want to keep your blood pressure under 140 systolic/90 diastolic, but some providers will want you to keep it below 130/80.

Preventing DKA by controlling cholesterol

High cholesterol, which also goes together with diabetes and kidney disease, can also be controlled with a heart healthy diet, activity, and medications if needed. If left unchecked, high cholesterol can cause plaques to be deposited in the arteries and veins near and in the kidneys. This can cause problems in the functioning of the kidneys. You will want to keep your total cholesterol below 200 mg/dL, your LDL under 100 mg/dL, your HDL greater than 50 mg/dL, and triglycerides less than 150 mg/dL.

Preventing your DKA by keeping your A1C and blood sugar in target

Of course, the main way to prevent DKA is to self-manage your diabetes well. Keep your A1C below 7 percent, and your blood sugars in their target ranges. If you are not sure what your target ranges are, read our article here. This will help to protect your kidneys, along with controlling your blood pressure, cholesterol, and keeping check-up appointments with your doctor for needed renal function tests.

Also, don’t smoke! This further compromises the circulation to your kidneys. Keep your diabetes in check, and your heart in shape, as heart issues affect the health of your kidneys. In some cases, you may not see any changes in your urine, or any symptoms to tip you off that you have kidney problems. That’s another good reason to keep up the check-ups with your doctor.5

When should you see your doctor?

If you run though our check-list of foods and medications above, and you haven’t had anything to turn your pee a funky color, or if you have an odor, fever, nausea and vomiting, low flank, or pubic pain – then it’s time to see your doctor or healthcare provider about your urine. Generally, if you don’t know what’s causing it, and it’s a change from your usual, then get your urine checked!

Your doctor can perform a variety of tests to determine what’s going on with your urine. It may be that you need an antibiotic for an infection in the urinary tract, (UTI), or you could need an antispasmodic for your bladder if you have an overactive bladder.

If your urine indicates an illness of some kind, such as diabetes, then your doctor can test you for them. Kidneys are important organs that we can’t live without, at least not without kidney dialysis or a kidney transplant.

Over to you

I bet you didn’t know that there was so much to know about urine. Now maybe when you smell a funny odor, see a funny color, or can’t quit running to the bathroom and peeing a thimble full each time, you will have an idea as to what might be going on with your pee, and what you need to do about it. Please share with us your thoughts or any comments you may have in the comment box below.

TheDiabetesCouncil Article | Reviewed by Dr. Jerry Ramos MD on September 11, 2018

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Last Updated: Saturday, September 15, 2018 Last Reviewed: Saturday, September 15, 2018

Urine test for diabetes: What you need to know

A urine test can detect various substances, including glucose, ketones, protein, bacteria, and bilirubin.

Glucose

Share on PinterestA urine test is an noninvasive way of testing for glucose, ketones, and other substances.

Typically, glucose is not present in urine. However, when a person has diabetes, glucose can pass from the kidneys into the urine.

Other conditions, such as pregnancy and kidney disorders, can also lead to glucose in the urine.

Pregnancy: Around half of women have glucose in their urine during pregnancy, even if they do not have diabetes.

A person who has high levels of glucose in the urine during pregnancy may need monitoring for gestational diabetes.

This is a type of diabetes that occurs in some people during pregnancy. It usually resolves after delivery, but it can affect the fetus, lead to complications during labor, and may put the individual at a higher risk of developing type 2 diabetes later in life.

Glycosuria: This is a rare kidney condition in which a person does not have high blood glucose levels, but their kidneys excrete high levels of glucose into the urine. There are often no symptoms, but some people may experience thirst, urination, and other symptoms. In rare cases, dehydration or ketoacidosis can occur.

Ketones

When a person has diabetes, the glucose in their blood cannot enter the body’s cells, and it remains in the blood. When this happens, the cells do not have enough glucose for energy.

As a result, the body starts to break down fat to use for energy instead. This produces toxic ketones. If ketone levels rise too far, they can cause the blood to become too acidic. In a person with diabetes, this can lead to diabetic ketoacidosis (DKA), a potentially fatal condition that needs emergency treatment.

Ketones can also enter the urine, so a doctor can use a urine test to detect DKA. People with diabetes can do a urine test at home if they start to experience the signs and symptoms of DKA.

According to the American Diabetes Association, symptoms of DKA include:

  • a “fruity” or acetone smell on the breath
  • frequent urination
  • thirst
  • dry or flushed skin
  • difficulty breathing
  • confusion
  • abdominal pain
  • nausea and vomiting
  • high blood sugar levels
  • In severe cases, a person may experience:
  • a loss of consciousness
  • a coma

Anyone who thinks they might have DKA should first check their blood sugar levels. If these are over 240 milligrams per deciliter (mg/dl), the ADA recommend testing for ketones.

If ketone levels are high, seek medical help at once to prevent further problems developing.

DKA often takes time to develop, but if a person experiences vomiting, it can quickly become severe. It can affect people with both type 1 and type 2 diabetes.

The risk of DKA is also higher when a person with diabetes has a cold or flu. During these times, they should test their ketone levels every 4–6 hours, according to the ADA.

Knowing about self-testing for both glucose and ketones can enable a person with diabetes to have more control over their condition.

Protein

A doctor may test for protein in the urine to monitor for kidney problems. This is because diabetes increases the risk of chronic kidney disease (CKD) and specifically diabetic nephropathy. An early sign of diabetic nephropathy is protein in the urine.

If a person receives an early diagnosis of kidney disease, they may be better able to control it through diet and possibly medications.

Learn more here about diabetic kidney disease.

Bacteria

A doctor may use a urine test to check for a urinary tract infection (UTI).

People with diabetes have a higher risk of infections, including a UTI. Without treatment, this can lead to complications, such as a kidney infection.

The doctor will send the sample to a laboratory for culturing if a person has diabetes. If an infection is present, they may prescribe antibiotics.

Bilirubin

Sometimes a urine test can detect bilirubin, a substance which can indicate liver damage and certain other health conditions.

A study published in 2017 found a link between high levels of bilirubin in people with diabetes and kidney disease, retinopathy, and diabetic neuropathy, all common complications of diabetes.

Dry Mouth and Excessive Thirst

Published: May, 2016

Welcome to the symptom guide regarding dry mouth and/or excessive thirst. We’re sorry to hear you’re having this problem!

This symptom guide is designed for persons who have noticed dryness of the mouth and/or unexplained thirst and would like to find out more about this condition. Please keep in mind that this guide cannot replace a face-to-face evaluation with your own doctor. It is meant to provide helpful information while you are awaiting further evaluation or to supplement what you may have already learned after evaluation with your doctor.

This guide will focus on dry mouth that has been persistent over time. Temporary dryness of the mouth may accompany nervousness, anxiety, and breathing through the mouth (as many people do when they sleep). Eating a salty or spicy meal can be a cause of temporary (though intense) thirst.

It’s also worth mentioning that many people drink frequently out of habit. They may feel thirsty if unable to drink as often as they’re used to even though there is no real disease causing the thirst. It can be hard to tell whether this is the cause of a person’s thirst or dry mouth without first ruling out other possibilities.

You’ll be asked a series of questions that will walk you through some of the most common causes that may explain your symptoms. The guide will cover the most common reasons for dry mouth; however, it won’t cover every cause.

Okay, let’s get started.

Symptoms & Causes of Bladder Control Problems & Bedwetting in Children

What are the signs and symptoms of bladder control problems in children?

Losing urine by accident is the main sign of a bladder control problem. Your child may often have wet or stained underwear—or a wet bed.

Squatting, leg crossing, and heel sitting can be signs of an overactive bladder.

Daytime Wetting

Signs that your child may have a condition that causes daytime wetting include

  • the urgent need to urinate, often with urine leaks
  • urinating 8 or more times a day, called frequency
  • infrequent urination—emptying the bladder only 2 to 3 times a day, rather the usual 4 to 7 times a day
  • incomplete urination—not fully emptying the bladder during bathroom visits
  • squatting, squirming, leg crossing, or heel sitting to avoid leaking urine

Bedwetting

Nighttime wetting is normal for many children—and is often not considered a health problem at all—especially when it runs in the family.

At ages 5 and older, signs that your child may have a nighttime bladder control problem—whether due to slow physical development, an illness, or any cause—can include

  • never being dry at night
  • wetting the bed 2 to 3 times a week over 3 months or more
  • wetting the bed again after 6 months of dry nights

Your child’s doctor can suggest when treatments may help control bedwetting.

When should my child see a doctor about bladder control problems?

If you or your child are worried about accidental wetting, talk with a health care professional. He or she can check for medical problems and offer treatment, or reassure you that your child is developing normally.

Take your child to a health care professional if there are signs of a medical problem, including

  • symptoms of bladder infection such as
    • pain or burning when urinating
    • cloudy, dark, bloody, or foul-smelling urine
    • urinating more often than usual
    • strong urges to urinate, but passing only a small amount of urine
    • pain in the lower belly area or back
    • crying while urinating
    • fever
    • restlessness
  • your child dribbles urine or has a weak urine stream, which can be signs of a birth defect in the urinary tract
  • your child was dry, but started wetting again

Although each child is unique, providers often use a child’s age to decide when to look for a bladder control problem. In general,

  • by age 4, most children are dry during the day
  • by ages 5 or 6, most children are dry at night

Seek care right away

If your child has symptoms of a bladder or kidney infection, or has a fever without a clear cause, see a health care professional within 24 hours. Quick treatment is important to prevent a urinary tract infection from causing more serious health problems.

What causes bladder control problems in children?

Bathroom habits, such as holding urine too long, and slow physical development cause many of the bladder control problems seen in children. Less often, a medical condition can cause wetting. Learn which children are more likely to have bladder control problems.

What causes daytime wetting in children?

Daytime wetting in children is commonly caused by holding urine too long, constipation, or bladder systems that don’t work together smoothly. Health problems can sometimes cause daytime wetting, too, such as bladder or kidney infections (UTIs), structural problems in the urinary tract, or nerve problems.

When children hold their urine too long, it can trigger problems in how the bladder works or make existing problems worse. These bladder problems include:

Overactive bladder or urge incontinence

Bladder muscles squeeze at the wrong time, without warning, causing a loss of urine. Your child may have strong, sudden urges to urinate. She may urinate frequently—8 or more times a day.

Underactive bladder

Children only empty the bladder a few times a day, with little urge to urinate. Bladder contractions can be weak, and your child may strain when urinating, have a weak stream, or stop-and-go urine flow.

Disordered urination

Muscles and nerves of the bladder may not work together smoothly. As the bladder empties, sphincter or pelvic floor muscles may cut off urine flow too soon, before the bladder empties all the way. Urine left in the bladder may leak.

What causes bedwetting in children?

Nighttime wetting is often related to slow physical development, a family history of bedwetting, or making too much urine at night. In many cases, there is more than one cause. Children almost never wet the bed on purpose—and most children who wet the bed are physically and emotionally normal.

Sometimes a health condition can lead to bedwetting, such as diabetes or constipation.

Bedwetting often runs in families, where it is usually a normal growth pattern, not an illness.

Slow physical development

Between ages 5 and 10, slow physical development can cause your child to wet the bed. Your child may have a small bladder, deep sleep cycles, or a nervous system that’s still growing and developing. The nervous system handles the body’s alarms—sending signals about a full or emptying bladder—and the need to wake up.

Family history

Bedwetting often runs in families. Researchers have found genes that are linked to bedwetting. Genes are parts of the master code that children inherit from each parent for hair color and many other features and traits.

Making too much urine

Your child’s kidneys may make too much urine overnight, leading to an overfull bladder. If your child doesn’t wake up in time, a wet bed is likely. Often this excess urine at night is due to low levels of a natural substance called antidiuretic hormone (ADH). ADH tells the kidneys to release less water at night.

Sleep disorders

Sleepwalking and obstructive sleep apnea (OSA) can lead to bedwetting. With OSA, children breathe poorly and get less oxygen, which triggers the kidneys to make extra urine at night. Bedwetting can be a sign that your child has OSA. Other symptoms include snoring, mouth breathing, ear and sinus infections, a dry mouth in the morning, and daytime sleepiness.

Stress

Stress can sometimes lead to bedwetting, and worry about daytime or nighttime wetting can make the problem worse. Stresses that may affect your child include a new baby in the family, sleeping alone, moving or starting a new school, abuse, or a family crisis.

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