When some critical function goes haywire in your body, the kidneys are often the first to know. These organs act like toxic-waste sites, filtering bad stuff from the blood and eliminating it through the urinary tract. If you run low on insulin and can't use glucose for energy your body has to burn other sources of fuel. This alternative strategy produces high levels of waste products, so the fastest way to find out if your insulin has dropped perilously low is to test your urine for metabolic garbage known as ketones.

Two-for-One Ketone TestingSince ketones float around in the blood before the kidneys filter them, and since people with diabetes become experts at poking their skin with needles, it's worth asking: Why not just measure ketone levels in the blood at the same time you check blood-sugar levels? A company called Abbott Diabetes Care wondered the same thing and produced a meter called the Precision Xtra, which measures both glucose and ketone levels with just a drop of blood. Whichever method you choose, if a test result shows that your ketone levels are too high, call your doctor right away.

Don't worry: It's not a taste test, though in the old days physicians often made their assistants sample patients' urine to see if it was sweet. (Doctors who treated a lot of people with diabetes must have had a heck of a time hanging on to good help.) In fact, while you can tell whether your body isn't burning blood sugar by measuring glucose in the urine with special kits, the tests aren't terribly accurate. Instead, your doctor may ask you to test your urine periodically for the presence of ketones, harmful substances that your body produces in the absence of insulin.

Remember, when insulin levels drop and your cells can't get the glucose needed for fuel, they resort to burning fat for energy. Sounds like a swell slimming strategy, but relying on this fallback energy source for too long can be bad news for the body. Burning fat makes ketones, which spill into the blood and urine. When ketone levels rise too high, you can become sick and possibly slip into a coma.

That's why you may need to disappear into the bathroom now and then to find out whether your urine is brimming with ketones. If the idea of obtaining a urine sample from yourself sounds unappealing at first, don't worry: It will soon seem routine. Besides, it could save your life. Doctors typically recommend testing your urine for ketones if

• you have type 1 diabetes and your blood sugar rises above 240 mg/dl.
  
  
• you have any form of diabetes and your blood sugar rises above 300 mg/dl.
  
  
• you have any form of diabetes and you become seriously ill or are under severe psychological stress.
  
  
• you have any form of diabetes and become pregnant. (Your doctor will advise how often you should test yourself.)
  
  
• you are experiencing ketoacidosis for any reason.

You can buy ketone strips for urine testing at any pharmacy. Follow label instructions and discuss how to use the test with your doctor or diabetes educator. In general, you will use a clean, dry container to "catch" a small amount of urine (and if you "drop" it, you better clean it up or you risk becoming very unpopular with other members of the household). Then you dip the strip into the urine and wait a few moments. Ketones in your urine will cause a chemical reaction on the test strip, prompting a color change. The degree of color change will indicate your ketone levels when you compare the strip to the chart provided by the manufacturer.

For more information on diabetes and kidney disease, and their complications, try the following links:

• Diabetic Kidney Disease gives an overview of these two conditions and how they are linked.
• Read Blood Sugar for valuable information about blood glucose and its link to diabetes.
• To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
• For a decsription of the symptoms diabetics may experience, read Diabetes Symptoms.
• To get the facts on ketoacidosis, including symptoms and treatment options, see Diabetic Ketoacidosis.

ABOUT THE AUTHORS

Timothy Gower is a freelance writer and the author of several books. His work has appeared in many magazines and newspapers, including Prevention, Health, Reader's Digest, Better Homes and Gardens, Men's Health, Esquire, Fortune, The New York Times, and The Los Angeles Times.

ABOUT THE CONSULTANTS

Dana Armstrong, R.D., C.D.E., received her degree in nutrition and dietetics from the University of California, Davis, and completed her dietetic internship at the University of Nebraska Medical Center in Omaha. She has developed educational programs that have benefited more than 5,000 patients with diabetes. She specializes in and speaks nationally on approaches to disease treatment, specifically diabetes.

Allen Bennett King, M.D., F.A.C.P., F.A.C.E., C.D.E. is the author of more than 50 papers in medical science and speaks nationally on new advances in diabetes. He is an associate clinical professor at the University of California Natividad Medical Center and cofounder and medical director of the Diabetes Care Center in Salinas, California.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.