sugar is present is not as accurate as blood testing,
however it can give a fast and simple reading.
Ketones in the urine can be detected using similar
types of dipstick tests (Acetest or Ketostix). Ketoaci-
dosis can be a life-threatening situation in Type I
diabetics, so having a quick and simple test to detect
ketones can assist in establishing a diagnosis sooner.
Another dipstick test can determine the presence of
protein or albumin in the urine. Protein in the urine can
indicate problems with kidney function and can be used
to track the development of renal failure. A more sen-
sitive test for urine protein uses radioactively tagged
chemicals to detect microalbuminuria, small amounts
of protein in the urine, that may not show up on dip-
stick tests.
Blood tests
FASTING GLUCOSE TEST.Blood is drawn from a
vein in the patient’s arm after a period at least eight
hours when the patient has not eaten, usually in the
morning before breakfast. The red blood cells are sep-
arated from the sample and the amount of glucose is
measured in the remaining plasma. A plasma level of
7.8 mmol/L (200 mg/L) or greater can indicate diabetes.
The fasting glucose test is usually repeated on another
day to confirm the results.
POSTPRANDIAL GLUCOSE TEST.Blood is taken
right after the patient has eaten a meal.
ORAL GLUCOSE TOLERANCE TEST.Blood samples
are taken from a vein before and after a patient drinks
a thick, sweet syrup of glucose and other sugars. In a
non-diabetic, the level of glucose in the blood goes up
immediately after the drink and then decreases grad-
ually as insulin is used by the body to metabolize, or
absorb, the sugar. In a diabetic, the glucose in the
blood goes up and stays high after drinking the sweet-
ened liquid. A plasma glucose level of 11.1 mmol/L
(200 mg/dL) or higher at two hours after drinking the
syrup and at one other point during the two-hour test
period confirms the diagnosis of diabetes.
A diagnosis of diabetes is confirmed if there are
symptoms of diabetes and a plasma glucose level of
at least 11.1 mmol/L, a fasting plasma glucose level
of at least 7 mmol/L; or a two-hour plasma glucose
level of at least 11.1 mmol/L during an oral glucose
tolerance test.
Home blood glucose monitoring kits are available
so patients with diabetes can monitor their own levels.
A small needle or lancet is used to prick the finger and
a drop of blood is collected and analyzed by a mon-
itoring device. Some patients may test their blood
glucose levels several times during a day and use this
information to adjust their doses of insulin.TreatmentThere is currently no cure for diabetes. The con-
dition, however, can be managed so that patients can
live a relatively normal life. Treatment of diabetes
focuses on two goals: keeping blood glucose within
normal range and preventing the development of long-
term complications. Careful monitoring of diet, exer-
cise, and blood glucose levels are as important as the
use of insulin or oral medications in preventing com-
plications of diabetes. In 2003, the American Diabetes
Association updated its Standards of Care for the
management of diabetes. These standards help man-
age health care providers in the most recent recom-
mendations for diagnosis and treatment of the disease.Dietary changes
Diet and moderate exercise are the first treatments
implemented in diabetes. For many Type II diabetics,
weight loss may be an important goal in helping them
to control their diabetes. A well-balanced, nutritious
diet provides approximately 50–60% of calories from
carbohydrates, approximately 10–20% of calories
from protein, and less than 30% of calories from fat.
The number of calories required by an individual
depends on age, weight, and activity level. The calorie
intake also needs to be distributed over the course of
the entire day so surges of glucose entering the blood
system are kept to a minimum.
Keeping track of the number of calories provided
by different foods can become complicated, so patients
usually are advised to consult a nutritionist or dietitian.
An individualized, easy to manage diet plan can be set
up for each patient. Both the American Diabetes Asso-
ciation and the American Dietetic Association recom-
mend diets based on the use of food exchange lists.
Each food exchange contains a known amount of calo-
ries in the form of protein, fat, or carbohydrate. A
patient’s diet plan will consist of a certain number of
exchanges from each food category (meat or protein,
fruits, breads and starches, vegetables, and fats) to be
eaten at meal times and as snacks. Patients have flexi-
bility in choosing which foods they eat as long as they
stick with the number of exchanges prescribed.
For many Type II diabetics, weight loss is an
important factor in controlling their condition. The
food exchange system, along with a plan of moderate
exercise, can help them lose excess weight and improve
their overall health.Diabetes mellitus