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Orinase (Tolbutamide)

What about urine tests? These tests have been the mainstay of self-monitoring for many years. The kidneys help to maintain the normal blood glucose concentration by saving glucose from being excreted. However, the kidneys do not conserve glucose indefinitely and when the blood glucose level rises above the kidney, or renal, threshold (which is slightly different in each person) glucose starts to appear in the urine. This threshold lies at about 10 mmol/1 (180 mg/dl) but may occasionally be very different from this. Someone with a very high renal threshold (for example, 15 mmol/1 or 270 mg/dl) would have negative urine tests until his blood glucose level rose above 15 mmol/1 (270 mg/dl). Someone with a low renal threshold (for example, 4 mmol/1 or 72 mg/dl) would sometimes show glucose in the urine even it he were not diabetic. The higher the blood glucose level rises above the renal threshold, the more glucose appears in the urine. High urine glucose concentrations draw water out of the body while the urine is being made, fluid is then lost and you become thirsty. This urine gradually collects in the bladder until it is emptied. The glucose concentration in a urine sample, therefore, represents how much above the renal threshold the blood glucose was during the time it took for the urine to collect in the bladder. Urine tests are therefore:
1. Not as accurate as blood glucose tests because they depend on each person’s renal threshold
2. An average, depending on how long the urine has been collecting in the bladder.
Even so, urine tests can be a useful indicator of general glucose control, especially if you know your approximate renal threshold. (You can work this out yourself by comparing blood and urine tests over the same time period.) Many diabetics use both blood and urine tests to monitor their glucose control. For example, if you test the first urine that you pass in the morning, that is, the urine that has been accumulating in your bladder while you are asleep at night, and it shows glucose, you know that for part of the night your blood glucose has been above the renal threshold even if your pre-breakfast glucose is normal. If you find that your fingers are getting sore from finger prick tests, try doing some urine tests instead (but check on your finger prick technique as well; perhaps you are going too deep).
Urine can be tested using strips such as Clinistix, Diastix, Tes-tape and Diabur 5000; in the United States, also Betascan Reagent Strips, Kyodex and Chemstrip uG. Either hold the strip briefly in the urine stream and read after the correct time or you can save urine samples during the day to test at home. As with the blood glucose monitoring strips, it is important that you follow the manufacturer’s instructions carefully.

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