Management of Juvenile Diabetes Mellitus: Usefulness of 24-Hour Fractional Quantitative Urine Glucose

Abstract

The use of quantitative urine glucose determinations permits accurate assessment of glucose homeostasis in diabetic children. Four specimens from a representative 24-hour period are collected, generally from 8 AM to noon, noon to 4 PM, 4 PM to 8 PM, and 8 PM to 8 AM and measured for total glucose excreted. When performed on an ambulatory basis, this test best reflects actual conditions the child faces each day and takes into account time, dose and type of insulin adminstered as well as diet, activity and stress. The test is inexpensive, easily performed and allows the physician to make rational changes in therapy. Children are usually cooperative and can understand what the actual amount of glucose spilled represents in terms of calories lost and total control. In those children in whom increases in NPH would be made to achieve better nighttime coverage, afternoon hypoglycemia can be prevented by changing to a combination of semilente and ultralente insulins without fear of long-acting insulin effect.