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Urine and blood testing

As was emphasized above, diabetic dietary care is a matter of balance; carbohydrate is needed for energy and must be taken appropriately. Whether the right amount is being taken or not will be demonstrated by the third objective in treatment the urine test. Too much carbohydrate and up goes the blood sugar; the urine demonstrates this by the presence of sugar in it. Thus urine testing has to become a standard part of a diabetics life, in particular in the early years of treatment and essentially in the daily control of a child's diabetes.

At first it is necessary to test the urine four times a day on waking, mid-morning, mid-afternoon and in the evening before bed. For the first and last test it is sensible to empty the bladder half an hour before the test and then to collect a fresh sample at the end of the half hour and test that one. For the mid-morning and afternoon tests, the straight sample can be used. The reason for the double emptying, morning and evening, is quite simple: the bladder collects urine over several hours and the urine will always react to give the highest level of sugar that has existed at any time over that period of hours. If you want to know how your blood sugar is at any one given time, then double emptying has to be done.

The test is simple. By using dipsticks, only a small amount of urine need be collected, or the stick can be simply passed through the stream of urine itself and then looked at for the colour change. The stick has really only three grades of reaction: no change, meaning that there is no sugar there; a faint blue discoloration meaning there is a trace; or a rapid change to dark blue meaning there is a lot of sugar present. (These sticks are prescribable by the doctor, and diabetics in Britain can, as with all their medical needs, obtain a certificate to avoid having to pay a prescription charge. In the United States the sticks can be purchased at any drug store and they are also available in a reel form so that a piece of the 'Tes-Tape', as it is called, can be torn off and used to perform the test.)

The urine test can be undertaken more accurately with tablets added to a test-tube that has a precise quantity of urine (5 drops) and water (10 drops) in it. The kit comprising tube, dropper and bottle of tablets comes complete, again on prescription.

Urine and blood testing

The advantage of doing it this way is that a more precise measurement of the urine sugar is given, for the tablet fizzes in the tube and then settles down to one colour: blue for no sugar; green for a trace; brown for a moderate quantity; and orange for a lot. The diabetic should record these results on a chart (the testing kit includes one) as follows: none = '0'; trace = 'tr'; brown = '+'; orange = '++'. The physician will want to see the chart to see how the patient's needs with regard to diet, tablets or insulin are being met.

Ketone testing is also done by drops of urine on a special tablet but, except in circumstances where the doctor has asked the patient to do it, ketone testing is not necessary for determining daily diabetic control the sugar tests are the best guide. If the sugar tests are always high, so will the ketones tests be (indicating body fat breakdown), so there is little need (except perhaps in hospital) for this test to be a routine.

Self-administered blood tests are also a 'skill' that diabetic can learn if they feel they can cope with them. The blood from a finger prick is mixed with a special fluid and then tested in a portable electronic device, or smeared on to a special type of dipstick similar to that used for urine testing.

It could be assumed that, if every test was sugar free, the diabetes would be perfectly controlled, but unfortunately this is not always the case. The kidney only spills out its excess sugar when the blood levels are high, and when they are low the urine test will obviously be sugar free but in diabetics on treatment, particularly with insulin, the blood sugar may be too low. Too low a blood sugar means that the brain, the heart, the muscles and all the body cells are deprived of their essential fuel, and insulin given by injection can cause this to happen. Tablets can do it, too, but less dramatically, and so also can exercise. Remember that the blood sugar is the energy source for the body's cells. If they need to burn up a lot of energy for example, children running and playing, adults doing housework, playing golf, gardening, walking, etc. - then, with dietary restriction being followed and treatment imposed, the blood sugar may drop alarmingly. A hypoglycaemic reaction (hypo = low, glyc = sugar, aemic = in the blood) may occur (see later) and the patient may collapse.

As ever, diabetic control is a matter of balance and the best urine test result that could be achieved would be the regular appearance of a trace of sugar each day in some of the tests (say the mid-afternoon, evening and, occasionally, the morning one) to show that the dietary restrictions and the treatment are not so rigorous so as to be able to meet the individual's needs for energy.

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