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Health

Sugar in the urine

, medical expert
Last reviewed: 23.04.2024
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Glucose is one of the main sources of energy, so necessary for the human body in its normal work, providing the necessary vital activity of a person. Entering the cage, it splits, releasing energy substances. This product enters the body with sweet foods. Often, glucose and sugar are equated, but this is wrong, because glucose, along with fructose, are constituents of sugar. As studies show, sugar in the blood in the acceptable range is the norm, while sugar in the urine is an indicator of pathological changes affecting the human body.

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Urine analysis for sugar

Such a study does not require special and lengthy preparation. Urina is going to one patient during the day in a sick, sterile jar (three-liter will suit). The morning first portion of the liquid merges without taking part in the analysis, whereas the subsequent ones are collected completely. The analysis of urine for sugar is the most complete indicator, allowing to determine the level of glucose present in urine.

Collection of urine for sugar

To conduct the study was complete and most reliable, you should listen to the recommendations and properly collect urine for sugar.

It should immediately be distinguished that there are two types of study of the presence of the enzyme in question in a urological fluid - morning analysis and daily. The second option is considered the most informative and correct. If there is no suspicion of a deviation in these indicators or as a primary analysis, a morning analysis can be assigned. If he identified an elevated level of the indicator of interest, then to determine the result the doctor can assign a daily urine analysis.

The recommended collection rules are simple, do not require additional training, but the correct approach to research will allow obtaining the most objective results.

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The rules for collecting urine for sugar

Anyone should know that in the process of taking the analysis, the fact that the physical and emotional stresses he experienced the day before, which was part of his diet, is of great importance. All these factors can affect the reliability of the result.

The rules for collecting urine for sugar are simple, but their observance allows the attending physician to get the most complete and correct picture of the patient's health status. Let's consider these recommendations in more detail.

  • A day before the expected delivery of tests from his diet, the patient must exclude a number of products: beets, tomatoes, citrus fruits and others that are capable of staining the liquid released by a person. It is also worth while during these 24 hours to refrain from taking sweet, as it can provoke a short burst of sugar level, which will invariably affect the summing result, and the result will lose its reliability.
  • Before collecting material for research, it is worth to abandon sports training and other types of increased physical activity.
  • It is necessary to have a good rest and sleep.
  • It is necessary to try to avoid conflict situations, stresses, emotional instability.
  • Do not drink a lot of fluids.
  • To exclude on the eve of the analysis the use of medications. If their introduction is not to be interrupted, then the doctor in charge should know about this.

The process of collection also requires some refinement.

  • To carry out the collection of material should be stocked with three or five-liter jar. Sterilize it.
  • Since morning the first portion in the analysis does not go, it is drained.
  • All subsequent portions throughout the day must arrive in the jar, which, in order not to spoil the analysis, should be in a cool place (refrigerator).
  • When the collection is completed, the contents of the jar are shaken well (mixed) and only after that a small part is selected for analysis in a specialized container.

To fully and normally prepare for this analysis, the patient will need only a day. But thanks to this preparation, the result of the research will give the most accurate results.

Determination of sugar in the urine

Morning analysis is carried out by taking about 150 ml of liquid placed in glassware, which must be pre-prepared: washed and dried. After this, the patient passes the samples to the laboratory independently or through a medical worker. The vessel must be well sealed with a lid.

To make the result more realistic, it is worthwhile to fulfill a number of medical recommendations: before carrying out the "event" it is worthwhile to thoroughly wash, thoroughly washing the perineum. In doing so, apply warm water with soap of neutral alkalinity. This is due to the fact that in urine there may be microorganisms capable of quickly splitting glucose. Therefore, urine should be without additional impurities and quickly delivered to the laboratory. The time from collection to laboratory testing should not exceed six hours.

To date, the definition of sugar in the urine is done with the use of test strips. This method allows to carry out this research, both in the walls of laboratories, and at home. The accuracy of this technique is quite high - 99%.

The analysis itself is carried out in stages:

  • Collection of the studied material.
  • Take a strip - a test (it is made of plastic), on the surface of which are painted small stripes of different colors, each of them is processed by a certain reagent.
  • This test strip is lowered into the test liquid, removed and excess is removed using filter paper.
  • It lasts for about a minute and the resulting shade is compared with the table on the package.
  • It should be cautioned that you should not rush and conduct testing in less than a minute, likewise, it is not worthwhile to overexert the test sample for more than two minutes. This deviation from the recommendations is fraught with overestimation of the indicators.

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Daily urine for sugar

Sometimes the doctor - the urologist appoints the analysis of daily urine. This analysis is therefore called daily, that the collection of urine for the study is carried out for one day.

  • The liquid for the study is collected, as in the previous case, in a dry and clean glass container with a lid. The volume of the collecting vessel is 3 to 5 liters. The choice depends on the individual characteristics of the patient's body, and more specifically - the amount of daily diuresis.
  • Urine is being collected for analysis from six to nine in the morning of one day and six to nine in the morning of the next day.
  • After the night, the first portion of urine does not go to analysis, it is sent to the toilet. Subsequent urination is considered the first, and the last is just a portion taken immediately after sleep the next morning.
  • While collecting the analysis, the collected material should be stored in a cool place at a temperature of 4 - 8 ° C (for example, in a refrigerator). The can should be tightly closed with a lid.
  • The amount of urine allocated per day is also fixed by the attending physician-urologist. The same indicators are also reflected on the sheet - the direction.
  • After the collection is completed, the contents of the jar are shaken well, after which part of it is selected for study.
  • For the analysis, a test liquid of 150 ml is taken into a 200 ml container.
  • Not later than the next six hours, the container must enter the laboratory, otherwise the result of the investigation will not be so true.

Daily urine for sugar is given in a situation where there is a suspicion of diabetes. He gives an answer to the question, how much glucose per day is cumulated in urine.

This analysis allows the urologist to get a more realistic picture of pathological changes than in the morning analysis for sugar. A more complete picture can be obtained only by conducting additional studies.

Modern medicine can offer more innovative methods for determining sugar in the urine: the use of special test strips and solutions, which are classified as highly accurate methods of determination.

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The norm of sugar in the urine

How is the selection of fluid for analysis, and what methods modern medicine can offer to their patients, has already been said above. Now we need to understand what is the norm of sugar in the urine, which is allowed and speaks about human health, and which of the indicators indicate a serious degree of damage to the body.

In a healthy body, the daily amount of glucose in urine is allowed by a figure not exceeding 2.8 mmol.

There is a so-called renal threshold, which is controlled as the average number of sugar in the blood, but is of an individual character. On average, for adults this figure is determined by the figure of 10 mmol / l, while for women who are in the period of pregnancy and small children this figure is somewhat lower and is determined by an average threshold of 7 mmol / l.

Therefore, the norm of sugar in the urine is its absence, or single traces that are present in it and do not exceed the permissible threshold of 0.06-0.033 mmol / l, in some cases this number rises to a value of 0.2 mmol / l.

What does sugar in urine mean?

In normal operation of the body, glucose in the kidneys overcomes the glomerular filters and is completely adsorbed by the renal tubules, entering the human circulatory system. Therefore, it does not fall into the urine and, therefore, can not be detected in the urine.

Hence, concluding, can answer the question, what does sugar in urine mean? This indicates the presence of some kind of malfunction in the body.

Primarily, the level of this component in the blood is assessed, the normal threshold of which is in the range from 8.8 to 9.9 mmol / l. If this indicator starts to increase, renal filters cease to cope with such a volume of adsorption, so part of the glucose remains in urine. Such a clinical picture in medicine is called glucosuria.

Sugar falls into the body along with food, especially on them are rich in carbohydrates. After passing through the digestive tract, this component of food is absorbed in the intestine and thus enters the blood, which is carried throughout the body and through insulin, penetrates into all cellular structures. The part in the form of glycogen is cumulated in the liver. And the other, blood is carried to the kidneys, where the filtration passes, which is carried out by specific glomerular filters, getting into the primary urine.

After this, together with urine, the enzyme in question enters the proximal renal tubules. It is here that in the presence of a special protein, the sugar is absorbed back into the blood. Until the moment when his blood level in the blood does not exceed the norm, he is absorbed completely. That is, a healthy person should not have sugar in urine. But as soon as the threshold is exceeded, part of the glucose ceases to be adsorbed, remaining in the urine.

Gradually, with age, this level of the norm begins to decline, which invariably entails its increase in urine. And it is in connection with the reduction of the renal threshold and the increase in its level in the blood that the appearance of the problem in question can be associated.

Therefore, sugar in the urine is a rather dangerous factor, which a person can not ignore, in order to avoid the development of more serious complications and pathologies.

Causes of sugar in the urine

Before embarking on an analysis of one or another clinical picture of the disease, a specialist should really have an idea and possible reasons capable of provoking such a reaction of the patient's body, which led to such a picture.

Having considered the mechanism of appearance of this enzyme in the excreted fluid, it can be concluded that the causes of the appearance of sugar in the urine are identical to those that cause the growth of glucose level and in the blood.

  • The first disease, which has the highest percentage of diagnoses, is diabetes mellitus.
  • Disease Itenko-Cushing is a pathology that progresses against the background of excessive production of adrenocorticotropic hormone by the pituitary gland. It works as a regulator of adrenal function.
  • Pheochromocytoma is a benign active tumor, the primary source of which are chromaffin cells of the sympathoadrenal system.
  • Hemorrhagic stroke.
  • Pathological changes affecting organs such as the liver, kidneys, pancreas. In the event of a malfunction in the function of kidney function, there is a violation in the process of re-uptake of glucose and its adsorption into the blood - in such a situation, sugar in the urine can appear even without an increase in its level in the blood.
  • The acute form of the course of encephalitis, the presence in the anamnesis of a patient of epileptic seizures, which, acting on the central nervous system, provoke a malfunction in the work of the organism.
  • Thyrotoxicosis is a condition of the human body that appears with an excess of thyroid hormones. Also this condition is called hyperthyroidism.
  • Glomerulonephritis is a severe form of immune-inflammatory kidney damage.
  • Other diseases of the endocrine system.
  • Pyelonephritis is a kidney inflammatory disease.
  • Craniocerebral injury.
  • Girke's disease is a hereditary pathology characterized by a defect in the liver enzyme system that modifies glucose-6-phosphate into glucose.
  • Aggravated course of infectious body damage.
  • Acute pancreatitis.
  • Tumor formation affecting the brain.
  • Brain hemorrhage.
  • Meningitis or encephalitis.

To provoke a jump in the parameter under consideration can:

  • Active physical activity.
  • Stresses, irritation of the central nervous system.
  • Emotional instability of the patient.
  • Food. For example, if you eat a jar of honey and go to the test, then the sugar level, both in serum and in urine, will simply go off scale. Although such indicators and hold on not for long.
  • Passage of the course of treatment using some drugs, for example, anti-inflammatory drugs.
  • Acute intoxication, which appeared after poisoning with chloroform, morphine, phosphorus and / or carbon monoxide.

Based on a significant list of causes that can provoke this pathology, it can be concluded that the appearance of sugar in the urine is an indicator of pathological changes that affected the human body and an incentive factor that should force the patient to seek medical help from a doctor.

trusted-source[9], [10]

Symptoms of sugar in the urine

When the amount of glucose in the urine increases, a person develops symptoms of sugar in the urine, which are sufficiently consonant with the symptomatology at an elevated level of this parameter in the blood plasma.

  • There is dryness in the mouth and the patient begins to feel thirsty.
  • It becomes noticeable and dryness of the skin in the genital area, which provokes the appearance of cracks, severe itching, rash.
  • Weakness.
  • Pain in the head area.
  • There is an increase in blood pressure.
  • Increased work of the sweat glands.
  • The patient "wakes up" the appetite or he, on the contrary refuses food.
  • Dizziness is possible.
  • The person begins to receive more signals to urinate.

Sugar in urine in men

All of us periodically take various tests, and when changing glucose values, the doctor raises the question of the need for further examination of the body, since sugar in the urine of men is a factor not at all rare, but saying that the male organism undergoes significant negative changes, the source which the doctor must determine. An exception is only a single surge of the indicator in question, which may be associated, for example, with the intake of a specific food or medicine.

Moreover, with the addition of years, the likelihood of pancreatitis, and other diseases affecting the structural structure, and the rate of functioning of the kidneys in the stronger sex is rapidly increasing.

Of course, in the urine of an adult human glucose should not be present. But experts still admit traces of her presence, since this indicator is not a constant. It can change a little even during the day. Such instability is determined by age, lifestyle, dietary preferences and a man's anamnesis.

This may be an indicator of progressive diabetes mellitus, and the inflammation of the prostate gland, the prostate, can also provoke a high content, a disease that "extends" to young men, but is aggravated in the process of their growing up.

Therefore, doctors recommend that you pass a preventive examination with the delivery of tests at least once a year, but it is better to do it once in six months. This approach to the problem allows us to recognize and determine the disease early in its development.

Sugar in the urine during pregnancy

If the woman's body is healthy, then this indicator should not be determined. But if the analysis of sugar in the urine during pregnancy is determined once, or was received more than once, but this burst was significantly spaced in time, then you should not worry - this is an indicator of the norm. After all, at the time of taking the analysis, a woman waiting for a child could be for some reason in a stressful situation or regretted something that triggered a jump in the level of glucose.

If the increased amount of sugar in the urine of a pregnant woman keeps for a long period of time, then the doctor can presume the presence of diabetes in the pregnant woman or another pathology. To confirm or disprove it, additional tests are prescribed.

In order not to miss an unpleasant moment, a woman who is preparing to become a mother, with every consultative reference to an obstetrician - gynecologist, who leads a pregnancy, must pass a general urine test.

Sugar in the urine of a child

If you raise the issue of physiological norms within which sugar in the urine of a child can be present without causing weighty concerns among pediatricians, then it can be unequivocally answered that this standard fully complies with the norms of permissible glucose in the urine of an adult.

To provoke its high level can as a pathological change in the work of the body (one of the many diseases that can cause this clinical picture), and love "to sweet" or the result of taking certain medications.

If the study has given a positive result, the pediatrician can assume his falsity and prescribe an additional analysis, but now, the glucose content in the blood plasma. If the norm is shown there, then the doctor can assume that a small patient in the recent past was eaten a certain amount of sweets. This result is called false positive.

But there is a reverse option, in the case of taking a sufficient amount of ascorbic acid (vitamins C), the analysis can give a false-negative result.

Sugar in urine with diabetes

To make a study of the presence of glucose in the secreted fluid is much easier and cheaper than determining this parameter in the blood. Therefore, the doctor appoints, primarily, the patient's surrender of this particular type of analysis and if the result of the study shows a deviation from the norm, then an additional examination, including a laboratory one, is already appointed.

But if the patient has already diagnosed diabetes, then controlling sugar in the urine with diabetes is almost useless. Modern medicine offers all persons suffering from this disease to control the necessary parameter, the glucometer is a special medical device that allows you to test blood sugar level yourself at home. For such patients, it is especially important to monitor this parameter several times throughout the day.

Sugar and protein in the urine

When appointing a clinical or general analysis of the secreted fluid, including sugar, the laboratory worker identifies indicators of many characteristics: color, acidity and density of the fluid, the presence of impurities in it, the level of sugar and protein in the urine, ketone bodies, bilirubin, red and white blood cells, urobilinogen, hemoglobin and cylinders.

For each of these elements, their norms were obtained over long years. There are such indicators for the protein, the norm of its numerical component is not more than 0.033 ‰ (ppm). Therefore, the change in the quantitative component of the protein in the urine of the patient toward its growth indicates a proteinuria developing in the organism of the subject under study.

In this case, the specialist makes a discount on the fact that an insignificant surge of this indicator (up to 0.3 g / l) can cause banal hypothermia or simply intense physical exertion received on the eve of the analysis.

Also, protein growth during the analysis can be observed against a background of late toxicosis in pregnant women. As to provoke the raised figures of the given parameter such pathological diseases as:

  • Glomerulonephritis is an immunoinflammatory disorder characterized by the defeat of the glomerulus (glomerulus of the kidneys).
  • Pre-eclampsia is a late toxicosis already mentioned above.
  • Cystitis is an inflammation of the mucous membrane of the bladder.
  • Arterial hypertension.
  • Pyelonephritis is an infectious pathology that affects the tissues of the kidneys.
  • Urethritis is an inflammatory process that affects the tissues of the urethra (urethra).
  • Amyloidosis is a pathology of a systemic nature, which is a deposition in the amyloid tissue layers (a complex protein-polysaccharide complex).
  • Other infectious diseases.
  • Other pathologies.

In any case, if this parameter is rejected from the norm, a second study should be carried out, and a general examination of the organism will not be superfluous.

High glucose values, suggest the patient has glucosuria. And as already mentioned, such a picture can develop in some diseases, or be provoked by a number of physiological factors.

Therefore, the presence of protein and sugar in the urine, which appeared once can be a deviation of the norm, but unnecessary examination does not hurt, because they can be provoked by pathological lesions of the body.

Consequences of sugar in the urine

If a person ate a sweetie or got high physical activity in the gym, then worry about his health should not be enough, in a short period of time, the level of glucose in the blood and urine will come to normal.

But if the increased number of the considered indicator is a consequence of some disease, the consequences of sugar in the urine can be catastrophic. Against the backdrop of consistently high rates, diabetes begins to develop. There is a systemic damage to the entire body of a sick person, normal work of water and carbohydrate metabolism is disrupted, the problem with blood vessels is aggravated, which can not but affect the functioning of the pancreas.

The defeat affects the peripheral receptors of the nervous system, a pathological change in the vessels of the ocular retina occurs. Gradually develops the so-called diabetic foot, leading to a loss of sensitivity in the foot, there are violations in the skin, joints and so on. In the future, if appropriate medical measures are not taken, such a patient can get gangrene of the lower extremities, and then their amputation.

Therefore, it should be very responsible to approach such a fact as the deviation in the norm of the sugar content in the urine. Ignoring such deviations can lead to fatal results.

trusted-source[11], [12], [13]

Treatment of sugar in the urine

To lead to a normal glucose content, it is first necessary to establish the cause that triggers the development of glucosuria. But in any case, the first thing that needs to be done is to adjust your nutrition.

Diet with high sugar involves the exclusion of its diet of sweet dishes, alcoholic beverages, preserves, high-carb products and dishes.

Treatment of sugar in the urine also involves keeping the patient's weight within normal limits and getting rid of excess kilograms, since overweight can provoke the emergence of additional complications.

If the cause of the pathology in question is one of the diseases that can provoke it, the attending physician will draw up a protocol of treatment. Only having coped the root cause, one can get rid of the problem, and the diet will allow it to be done much more quickly, without allowing a diabetic crisis that can develop against a background of a sharp surge of glucose concentration to large digits.

How to reduce sugar in urine?

At the next delivery of the analysis, the attending doctor informs the patient about the presence in his investigated urine of high glucose content. If a person first encounter this problem, the first question that comes to his mind is how to reduce sugar in the urine?

And the first thing that an expert advises him is to correct his food. For some time it will be necessary to abandon the sweet and confectionery products, replacing sugar with fructose, from alcohol and other bad habits, conservation and food products with a lot of "yeshos" containing dyes, stabilizers, preservatives and so on.

You should also adjust your meal schedule. It should consist of at least five to six receptions, while the consumed portions should be small. Exclude snacks. If the professional activity of the patient involves difficult physical work, it is worthwhile to raise the issue before the leadership about the temporary transfer to easier work. It is necessary to reduce the intensity of sports.

And also, if this is not enough, and the doctor believes that medical treatment is necessary, it should not be ignored.

The recipes of our grandmothers also show high efficiency.

Alternative remedies for sugar in the urine

In order not to bring your body to more serious complications that can arise during the long-term detection of the parameter in question, you can turn to the knowledge of our ancestors for help. Using alternative means from sugar in urine, it is possible to receive appreciable positive results, having resulted a pathology in a stage of remission.

  • With this problem, a decoction from a herbal mixture proved to be very useful: it is necessary to collect the harvest by taking in the same proportions the leaves of the nettle, the leaves of the blueberry and the crushed dandelion root. All ingredients should be mixed thoroughly. Take a tablespoon of the resulting composition and pour it with 200 ml of boiling water. This drink should be drunk, taking three times throughout the day just before meals. Such an event should be held once in eight days.
  • Well reduces the sugar in the urine of the moth, or as it is called in the people bitter melon, pumpkin or cucumber. By stimulating the production of insulin, it reduces the level of glucose in the blood and urine. Primarily it is necessary to save this miracle of nature from seeds, and from the remaining parts get juice (you can use a juicer). The resulting amount of medical fluid diluted with a small amount of water and a drink. The schedule of treatment provides for the morning daily intake of this medication for at least a couple of weeks. This product can be used for cooking various dishes.
  • The drink is also effective from the leaves of blueberry itself. To obtain the greatest effect, it is desirable to boil them for five minutes in two glasses of boiled water. This remedy should be taken every day, half a glass half an hour before meals.
  • High efficiency in the elimination of this problem shows and decoction of the seeds of oats. Take one volume of grain and five volumes of boiling water. This mixture is put on a small fire, brought to a boil and in this form is maintained for about an hour. Then he strains and drinks a glass before each meal.
  • A patient with elevated glucose in urine can rid himself of the problem, taking half a teaspoon of ground cinnamon. It can be added as a meal, and in drinks and taken every day. But she should not get carried away.
  • Here you can include a delicious and healthy drink: cinnamon with kefir.
  • Well proven, when it is necessary to reduce sugar in the urine, and beans. Six - seven medium sized grains put on all night in the water. Swollen grains take in the raw form for the next day.
  • In light of the relief of this problem, a medicinal drug such as fenugreek has proved itself very well. This plant has the necessary hypoglycemic activity to stimulate the growth of glucose resistance, and to reduce the amount of sugar. It contains a large amount of fiber, which allows to slow down the adsorption of sugars and high-carbohydrate food. Seeds of this plant must be soaked for the night in a sufficient amount of water, drinking every day infusion on an empty stomach. The duration of the treatment course, for obtaining therapeutic effectiveness, is at least two months. This will consolidate the state of remission.
  • It is necessary to take two portions of the bean pod. This bean must be collected in green form, when the grain did not start forming. Dry them, and grind before use. For the preparation of "medicine" it is necessary to take two portions of blueberry leaf and in a similar volume of oat straw, which should be crushed as thoroughly as possible, and one flaxseed should be introduced here. All ingredients should be mixed thoroughly. Three tablespoons of the collection should be placed in a liter of freshly boiled water. Place the vessel on a stove, bring it to a boil, lower the fire to the minimum level and so sustain it for twenty minutes. After this, set aside on the side and let cool, then drain. The resulting amount of fluid, not particularly adhering to the dosage, should be drunk for two days.
  • You can get the expected effectiveness and in the event that every day chew two tablespoons of pre-seeded fenugreek seeds. It is advisable to drink this "medicine" with enough milk.
  • Many people perceive Jerusalem artichoke as garbage, which clogs our kitchen gardens. They do not even guess how useful this product is. To once and for all get rid of the problem, one medium-sized root must be thoroughly rinsed and cleaned. Then it must be crushed in any convenient way. The resulting gruel fill with one liter of barely boiling water. The vessel with the contents should be properly wrapped and held for at least one hour. The resulting amount of liquid, not particularly withstanding the dosage, drink throughout the day.
  • You can drink a very useful tea, brewing 200 grams of boiling water three to four leaves of such a medicinal plant as honey stevia.
  • Buy or cook yourself a buckwheat flour. Take it about half a glass and stir with 250 grams of curdled milk (preferably if it is a natural home product). This porridge should be left to swell throughout the night. Do not subject to any heat treatment, eat the cereal for breakfast. 14.
  • You can recommend a patient with this pathology every day on an empty stomach (before breakfast) to eat a baked onions in advance. It is enough to take a bulb of medium size.
  • You can make yourself such a tea: for its preparation use about 60 grams of blueberry leaves, which are filled with one liter only - that the boiling water. The vessel with this composition should be properly wrapped and left to cool completely. Such gulls in a warm form can be consumed throughout the day without restriction.
  • Take young leaves of the Volhovian walnut (most of them know under the name of the Greek). Green the grind and take 10 grams, fill them with 200 ml of freshly boiled water. Let it be insisted until the liquid becomes warm, then drain. Take in warm form without restrictions. Throughout the day.

Human life is multifaceted and it needs a lot of energy for its full realization, and this energy is provided by glucose entering the human body in conjunction with food. But what if this product is in excess? The answer suggests itself - the body receives more energy for life. But this is not so. If, during the analysis, the result produced sugar in the urine, then a re-examination and additional examination are necessary, because such a result can be false positive when the patient just got carried away by sweet food or pumped into the fitness room the day before. But if the subsequent result showed the same parameters, then it's up to the expert. He, having carried out the necessary examinations and laboratory tests, should diagnose and schedule the treatment. But, not waiting for this, a person, faced with this problem, can independently help his body by changing his diet, and better, and the whole way of life.

trusted-source[14], [15], [16]

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