Ketone and urine glucose readings

Coping & Support
1

Hi all,

I have a question re: the value of regular urine ketone and glucose readings (if any):

  1. How useful would it be to have an automatic ketone reading (presence and level) every time you use the toilet?

  2. I realise that urine glucose in itself is not a substitute for blood glucose readings, because it indicates blood glucose over the past few hours. However, would urine glucose readings be helpful as a complement to blood glucose readings by providing additional data on how you are managing your levels, to give a fuller picture? Please assume again that the data is collected automatically - just use the toilet as normal

Thank you very much!

Dan

2

Dan,

That is a question best answered by your doctor and YOUR history of showing ketones.

I personally don’t show ketone in my urine even when I was hospitalized for 9 days treating UTI and blood infections - ugggggg. Testing for glucose could be useful to see if you have "spillage’ in an over night collection or a 24 hour collection. but this is best left to medical professionals for analysis.

I agree with you that routine [at every void] testing for glucose in urine isn’t a substitute for the simple blood test which tells how you presently are managed rather that the “historic” urine test.

Dennis

3

Well Dan, I noticed on your profile (I try to check before I reply since people are coming from different places here)that you know someone with T1D. So I’m assuming you’re thinking of developing something for the T1 community. So my thoughts on you’re ideas are: while automatically checking ketones would be great how would you overcome the issue of women being on their menstrual cycles and the sample being tested? As well as contamination from other “waste” (might seem crass, but just being realistic here). And which ketones would you be testing for? As far as I know there’s 3 ketone bodies that are spilled, 2 acids as well as acetone, I know the strips test for one of the acids. As for the glucose readings in the urine, doesn’t really excite me, but I also obsessively check my bg readings, I know others who don’t so maybe it would be good for people who don’t, I’m just not very sure about it for myself. I think it would come down to cost vs the urine strips and here in the U.S. whether health insurance would cover it and if it were an attachment vs a separate toilet that would need to be installed. Also, we would still have to test outside of the house so the strips would still be needed. Something like this would be best utilized for younger children perhaps, but being an adult, there’s a lot of situations where I’m outside of the house and need to check for ketones. If you could make something portable that was reusable and easy to test on and didn’t need disposable, separate parts then that would be great!!! (Ok, maybe I ask for a lot)

4

Dennis, Laurel, thank you both for your kind replies! To answer in turn:

Dennis:

“I agree with you that routine [at every void] testing for glucose in urine isn’t a substitute for the simple blood test which tells how you presently are managed rather that the “historic” urine test.”

I guess my question is whether having those glucose readings as well would provide any incremental benefit such as additional context about how you are managing your levels in light of food intake, exercise etc. Would that help you in terms of adjusting your routine? Sorry to ask a hypothetical question - maybe hard to answer as haven`t done before.

Laurel:

“<em>Well Dan, I noticed on your profile (I try to check before I reply since people are coming from different places here)that you know someone with T1D. So I’m assuming you’re thinking of developing something for the T1 community.</em>”

That`s right! :slight_smile:

“So my thoughts on you’re ideas are: while automatically checking ketones would be great how would you overcome the issue of women being on their menstrual cycles and the sample being tested? As well as contamination from other “waste” (might seem crass, but just being realistic here)”

We`ve got some clever ways worked out to do this, so please assume this is not an issue.

“And which ketones would you be testing for? As far as I know there’s 3 ketone bodies that are spilled, 2 acids as well as acetone, I know the strips test for one of the acids”

Acetoacetic acid, as tested for by most ketone strips. Beta-hydroxybutryic acid and acetones are derived from acetoacetic acid so we can assume they exist if AAA is found, hence only test for one :slight_smile:

“<em>As for the glucose readings in the urine, doesn’t really excite me, but I also obsessively check my bg readings, I know others who don’t so maybe it would be good for people who don’t, I’m just not very sure about it for myself.</em>”

Maybe it would be more helpful for Type 2 diabetics who want more information on their levels without having to prick themselves as often as Type 1s?

“<em>I think it would come down to cost vs the urine strips and here in the U.S. whether health insurance would cover it and if it were an attachment vs a separate toilet that would need to be installed.</em>”

It`s an attachment (have clear design and patents around this), so no need to purchase a new toilet. Good point re: insurance, are looking into this. Cost wise, we would aim for no more than $20 a month including glucose and ketone readings plus a software management tool for your phone/tablet. Does that feel pricey?

“Also, we would still have to test outside of the house so the strips would still be needed. Something like this would be best utilized for younger children perhaps, but being an adult, there’s a lot of situations where I’m outside of the house and need to check for ketones. If you could make something portable that was reusable and easy to test on and didn’t need disposable, separate parts then that would be great!!! (Ok, maybe I ask for a lot)”

Very true and good suggestion - as it happens we`re already doing something to enable this. How many ketone strips would you say you use a month on average? Or rather, how much money you spend on them? It seems a 50 pack is c.$7 (Walmart).

5

many years ago there was only urine glucose testing for diabetes management at home, no matter what improvements are made, it will always suffer from the basic issue of the unpredictable blood sugar level at which your kidneys will pass sugar. it is so unreliable, I might say that a glucose reading in urine is just about useless today as a tool to treat diabetes. T1’s “spill sugar” (gee I loved that saying as a kid) when your blood sugar is above 140-180 but for some people (especially T2’s), above 240 mg/dl blood sugar. I would like to ask, with such a moveable datum, what exactly would be your output from a urine glucose reading? as a long-time T1, I would not pay any amount of money (0.0) on a device that reads urine glucose. Home blood sugar tests are +/-20% accurate compared with whole blood sugar above 75 mg/dl and within 10% below. that’s a tough (I am being kind… literally impossible) hurdle for a urine test, IMO.

keytones are present in urine and don’t always mean trouble. If I am working out or losing weight on purpose, or both, I expect and want to detect keytones in my urine. It’s only really a warning to detect high keytones when there is insufficient/or no insulin, AND high blood sugar to be used as a prediction of possible ketoacidosis. Since I could care less for over 99% of my testing, I would only use strips and expect to pay little to almost nothing.

so I guess I am confused why, and equally confused at the direction this kind of product/research would go. anyway, if you are an entrepreneur, good luck!

6

Joe,

Thank you for your detailed thoughts! I think first point to clarify is aim is

    not
to replace blood glucose readings. The question is whether having that additional info (which is collected without effort/pain) would be helpful in better understanding how successfully you are controlling your levels, particularly post-meal levels.

However, thinking about it now - urination generally takes place 1 hour after fluid consumption but that may or may not be after a meal, plus if there is glucose in the urine that glucose could be from the most recently consumed meal or one before or both - so basically you cant easily relate the presence of glucose precisely to what you ate in a meaningful way. You just know that your blood sugar was over 180mg/dL at some point since the last time you peed. I suppose the one thing it would tell you is whether your blood sugar went over 180mg/dL despite taking insulin - i.e. that you werent able to time the blood sugar and insulin spikes together. But that doesn`t seem like a big enough point to buy a device for. Does that make sense?

<em>T1’s “spill sugar” (gee I loved that saying as a kid) when your blood sugar is above 140-180 but for some people (especially T2’s), above 240 mg/dl blood sugar.</em>

Very interesting. I`ve read that the average spill range is c. 160-180mg/dL and increases with age. 240mg/dL is much higher tho…do you know how common this is/how much variation there is?

Many thanks,

Dan

7

hi Dan, I am an engineer and not a doctor, I know the barrier changes with age as you describe, but I am pretty sure the barrier value is vastly different for T1’s versus T2’s. T2’s generally being able to hold back much higher concentrations in other words their blood sugar is “much higher” IE much more variable, when the kidneys fail to re-absorb it and it is detectable in urine.

as far as “fuller picture” what I am suggesting is that since the additional data is lower resolution and has far more contributing factors, my opinion is that knowing this data will not help. My analogy is that if you already measured an unknown distance with a tape measure, what new information would you get by going back and measuring by “pacing off” the distance to estimate it? Also, I would use the information of my blood sugar at +1 hour after a meal, compared to +2, +3, +4, etc. much differently, while urinalysis kind of mixes it all together obscuring the most relevant information.

don’t let me discourage you - urinalyses is cheaper than a metabolic blood panel, and likely cheaper than a clinical accuracy blood glucose meter, so maybe the objective would be to use your device in a clinical setting, rather than in everyday use, given it could be economic and adopted by doctors offices for example.

8

Joe > Thats great feedback, thank you! I agree with your position. Re: clinical settings - doctors already have urinalysis test strips, so Im not sure it would be any additional use in this area.