When a patient is diagnosed with diabetes, urinalysis should be done to detect the presence of glucose, ketones, and protein in the urine. These tests help a physician diagnose certain diabetic complications, such as DKA and renal failure.A patient who has already been diagnosed with diabetes should periodically have urine ketone and urine protein tests to check for these complications. Routine urinalysis can be used for such monitoring, but patients typically perform the tests themselves using a kit with a dipstick or enzymatic tablet.

Urine Glucose Test

The urine glucose test, which detects the presence of glucose in the urine, is no longer used to diagnose diabetes because blood glucose tests provide more accurate results. If routine urinalysis reveals glucose in a patient’s urine, she should have a blood glucose test to confirm a diagnosis of diabetes.

The use of urine glucose tests to monitor diabetes treatment has diminished because blood glucose monitors are so convenient, inexpensive, and accurate. These monitors give the precise level of glucose in the blood, whereas urine glucose tests merely detect the presence of glucose in urine. Because glucose appears in the urine of adults with healthy kidneys only when blood glucose levels rise above 180 mg/dl, a normal result from a urine glucose test tells the patient little: She may be hypoglycemic, euglycemic, or mildly to moderately hyperglycemic.

Urine Ketone Test

The urine ketone test, which detects ketones in the urine, aids in the diagnosis of DKA. Ketones are the end products of fat metabolism, which occurs when glucose isn’t available for cell use. When blood cells use fat for energy in place of glucose, fat metabolism is incomplete, and ketones accumulate in the patient’s blood. Ketones eventually spill over into the patient’s urine and can be detected by urinalysis. Ketones usually appear in the urine when blood glucose levels are consistently above 240 mg/dl.

If your patient has Type 1 diabetes, she’s prone to develop DKA. When she experiences acute illness or stress, when her blood glucose levels are consistently above 240 mg/dl, or when she has signs or symptoms of DKA (nausea, vomiting, and abdominal pain), she should test her urine for ketones every 4 hours. A pregnant woman with diabetes should test her urine for ketones to monitor her diabetes control. If they’re present, her physician will change her treatment plan.

Urine Protein Test

The urine protein test detects the presence of protein (albumin) in the urine. Usually, small amounts of protein go undetected in routine urinalysis. When protein is detected, the cause may be renal impairment from diabetes. Or it may just be strenuous exercise, exposure to cold, or emotional stress.

When protein is detected in a patient with diabetes, urinalysis should be repeated. If the second test detects protein too, a 24-hour urine protein test should be done to determine the type of renal impairment. Protein levels of 150 mg in urine over 24 hours are normal. Levels higher than 150 mg indicate the need for further testing.

Diabetes can seriously impair kidney function and is one of the leading causes of end-stage renal disease. Even if your patient has no protein in her urine when she’s diagnosed with diabetes, encourage her to have her urine monitored periodically. All postpubertal patients who’ve had diabetes for 5 years or more and all patients with Type 2 diabetes should have their urine tested for protein once a year. inaccurate test results, send the urine sample to the laboratory immediately. If this isn’t possible, refrigerate the sample until it’s transported.

If you’re using a dipstick or enzymatic tablet to test urine, carefully follow the manufacturer’s instructions. Recheck abnormal results.

When preparing your patient for a 24-hour urine collection, tell her to save all urine in the special container provided. She should keep the container refrigerated throughout the collection period. Instruct the patient not to contaminate the urine with toilet tissue, vaginal secretions, mucus, or fecal material. She should maintain a normal fluid intake because diluted urine may cause false normal results.

Nursing Considerations

Collecting urine for urinalysis requires no preparation on the part of the patient. However, you should obtain a history of recent drug use. Many drugs can alter the results of a routine urinalysis, to prevent.