Glycosuria – Meaning, Types, Symptoms, Ayurveda Understanding

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Glycosuria is a condition when you pass blood sugar into urine. Glycos = blood sugar, Uria = urine

Generally, urine contains no glucose. This is because in normal conditions your kidneys reabsorb all the filtered glucose from the tubular fluid back into the bloodstream. When you have glycosuria, kidneys fail to take back enough blood sugar from urine. This leads to passage of more sugar out of the body through urine and hence the name. It is a common symptom of type 1 as well as type 2 diabetes.

Introduction

Mostly glycosuria is caused by elevated levels of blood glucose. It may also occur due to untreated or poorly managed diabetes mellitus. In rare conditions it occurs due to intrinsic problem related with reabsorption of glucose within your kidneys. This produces a condition called as renal glycosuria. As an effect of glycosuria dehydration is caused due to excessive loss of water into the urine. This is a process called as osmotic diuresis.

Glycosuria occurs mainly due to two reasons –

• Hyperglycemia – abnormally high quantities of glucose in your blood
• Renal Glycosuria – sugars are eliminated in the urine in spite of blood sugar levels being normal or low
  Read – Diabetes: Ayurvedic Treatment, Remedies, Prevention Tips

Causes, Risk factors

Any underlying conditions that affect blood sugar levels can cause glycosuria. Glycosuria is typically caused by conditions that affect blood sugar levels. Type 1 and Type 2 Diabetes Mellitus are the most common underlying causes for glycosuria.

Causes – Glycosuria grossly occurs due to the below mentioned causes –

1. Level of blood glucose is very high and renal tubules are unable to reabsorb all glucose available to it.
2. The tubules fail to reabsorb all glucose at levels of glucose where it should ideally be possible under normal circumstances. This is called renal glycosuria.
   Read – Prameha: Ayurvedic Approach To Urinary Disorders

Glycosuria due to Diabetes Mellitus

Diabetes is often the main cause of glycosuria unless proved otherwise. Type 2 diabetes mellitus is the most common cause.

When you have diabetes –

1. Your insulin fails to transport blood sugar into cells. This might lead to passage of blood sugar out in urine.
2. On the other hand, there are conditions wherein your body doesn’t make enough insulin which can balance blood sugar levels. Again, there is excessive sugar in the blood. This excessive sugar passes out through urine.

Type 2 DM – Here pancreas doesn’t manufacture enough insulin or the insulin becomes ineffective. Due to this, the body fails to properly control the glucose levels. When blood sugar increases beyond limits, it can cause blood glucose to enter the urine. This causes glycosuria.

Type 1 DM – This develops due to progressive destruction of specific cells in pancreas. This results in decreased insulin production. Low insulin in the body will not be able to control sugar levels. These people need daily treatment with insulin to keep things under control.

Other conditions which may cause hyperglycemia can also cause glycosuria. They are –

• Thyrotoxicosis
• Acromegaly
• Cushing’s syndrome
• Severe states of anxiety
• Very rapid gastric emptying – as in dumping syndrome after surgery for peptic ulcers, this causes raise in blood glucose above threshold levels
• Stress hormones elevate blood glucose
• Fanconi’s Syndrome – In this, there is inadequate resorption of glucose in proximal renal tubes. This may be associated with history of growth failure, dehydration / polydipsia, polyuria and rickets.
  Read – Stress Causes, Types, Tips On How To Handle Stress

Glycosuria due to Gestational Diabetes

Gestational diabetes is another cause of glycosuria. Here glucose will be found in the urine. During pregnancy the kidneys expel more glucose from the body. In this case the placental hormones prevent the insulin in the woman’s body from properly controlling blood sugar levels. Due to this blood sugar becomes abnormally high. This condition is preventable.

Renal Glycosuria (due to kidney disease)

It is a rare form of Glycosuria. Renal glycosuria is a genetic or acquired condition. This occurs due to kidney damage. In this condition, the tubules in kidney do not filter blood sugar or other substances out of urine properly. This is often caused by specific gene mutation.

It is a rare inherited disorder. In this, despite of normal blood glucose concentrations, there is glucose excretion in the urine. It is usually due to mutations in SLC5A2 gene coding for glucose transporter SGLT2 in the proximal tubule.

It may occur in both sexes. Presence of glucose in urine in association with normal or low blood glucose levels in lab tests confirms the diagnosis and is usually asymptomatic. In most cases treatment may not be needed. Some individuals with this condition may develop diabetes mellitus in later stages.

Other causes of renal glycosuria (secondary causes) –

• Wilson’s disease
• Interstitial nephritis
• Cystinosis
• Lowe’s syndrome
• SGLT2 drugs can lead to dose-dependent glycosuria
• Heavy metal poisoning – lead, mercury etc
• Intestinal glucose-galactose malabsorption

Other names of Renal Glycosuria –

• Benign glycosuria
• Non-diabetic glycosuria
• Primary renal glycosuria
• Familial renal glycosuria
• Renal glucosuria
  Read – Charaka Prameha Chikitsa – 6th chapter

Alimentary Glycosuria

Alimentary glycosuria is another variant. It is a temporary condition related to high carbohydrate intake. It is also caused when high carbohydrates are rapidly absorbed in the stomach in some cases wherein a part of stomach is removed surgically. This excessive glucose appears in urine producing glycosuria.

Pathophysiology

Almost all glucose that is filtered through glomeruli is reabsorbed through the proximal renal tubules of your kidneys. The amount of glucose which remains unabsorbed through the kidneys is usually less than 0.1%.

Kidneys comprise of functional units called nephrons. They filter the blood entering the kidneys. Glomerulus is a tuft of leaky capillaries within the kidney. Blood flows from the arteriole into the glomerulus in each nephron. The Bowman’s capsule surrounding each glomerulus collects the filtrate formed by the glomerulus. The filtrate contains urea, electrolytes including sodium, potassium and chloride, amino acids and glucose. This filtrate then passes into the renal tubules.

In the proximal convoluted tubule, the first part of renal tubule, glucose is reabsorbed from the filtrate, across the tubular epithelium and into bloodstream. This tubule can reabsorb only a limited amount of glucose from the blood. This is known as transport maximum. The is broken and the tubule starts to excrete glucose in the urine once the blood glucose level exceeds 160-180 mg/dL. This point is called as ‘Renal Threshold for Glucose’ (RTG).

If the RTG is low and even normal blood glucose levels also produce this condition, it will be termed as renal glycosuria.
Read – Diabetes Insipidus – Causes, Pathogenesis, Symptoms, Prevention, Cure, Ayurveda Understanding

Correlation between approximate plasma concentration of glucose and urine dipstick designation

Symptoms of Glycosuria

Immediate obvious symptoms are rare in glycosuria. The condition may exist for many years and yet not show any obvious symptoms.

Untreated glycosuria might cause the below mentioned symptoms –

• Extreme hunger
• Extreme thirst associated with dehydration
• Excessive urination, more than usual
• Accidental urination
• Frequent urination
• Urination during nighttime

Additional symptoms with those having diabetes

• Fatigue
• Unexplained weight loss
• Trouble seeing
• Cuts and abrasions that take long time to heal
• Darkening of skin near armpits, neck or other areas having skin folds

In glycosuria associated with type 2 diabetes, you may experience –

• Fatigue
• Unexplained weight loss
• Difficulty in seeing
• Darkening of skin in your neck folds, armpits and other areas
• Cuts or injuries which heal slowly, sores

Fanconi Syndrome – is an acquired or genetic condition that involves excretion of excess substances including sugar through urine. Here too there is glycosuria.

It may not show up symptoms for extended periods of time. Urine test can reveal the problem. Glycosuria is a red flag for previously undiagnosed diabetes.

Gestational diabetes – This will have similar complaints as in Type 2 Diabetes Mellitus. It is often asymptomatic. It is detected through routine screening done during pregnancy.
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Diagnosis

Urinalysis is the most important tool to diagnose glycosuria. This is done to check if urine glucose levels suggest presence of glycosuria. If the urine glucose is more than 180 mg/dL in a single day suggests presence of glycosuria. Presence of glucose in urine is identified by Benedict’s qualitative test.
Blood tests to check blood sugar levels.
Hb A1C – to analyze blood sugar levels for the past few months.

Preventive measures

It isn’t always possible to prevent glycosuria. The underlying conditions including diabetes or kidney problems shall be addressed effectively. It is also not possible to prevent type 1 diabetes. Type 2 Diabetes Mellitus can be prevented by measures such as limiting sugar intake, eating balanced diet, maintaining healthy weight and regular exercising if done regularly.

You can’t always control renal glycosuria especially those with genetic backdrop. You may prevent this condition and conditions like diabetes causing it through proper and guided lifestyle choices including diet and exercise.

In pregnancy –

Regular exercising can help in reducing the risk of diabetes. Gestational diabetes affects approximately 16% pregnant women according to the International Diabetes Federation. Glycosuria occurring in pregnancy should not be neglected or dismissed. This may be the first sign of gestational diabetes.

Once the pregnancy ends, gestational diabetes and glycosuria will go away. A woman who would have had gestational diabetes is more likely to develop type 2 diabetes mellitus in later part of her life. Therefore these women should take all necessary steps to reduce the risk of developing type 2 diabetes mellitus.
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Treatment

If there are no underlying conditions causing glycosuria, no treatment will be needed. Treatment will be needed when glycosuria is caused by some underlying conditions like diabetes.

The key treatment and management options include –

Regular physical activities and exercises – at least 30 minutes per day

Balanced diet plan – diet which provides you enough nutrients and decreasing intake of foods rich in sugar and fat and including foods having more of fruits, vegetables, whole grains and lean proteins in your food

Medications – to enable effective use of insulin by your body like metformin or those which help your body to make more insulin like sulfonylureas. Taking oral or injectable medications for type 2 DM patients is a must. Insulin shots for those with type 1 DM and for some patients of type 2 DM wherein insulin is needed.

Tracking blood sugar levels – helps you to understand how your body reacts with certain foods, activities or therapies in a better way.
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Outcome of glycosuria

If glycosuria is not associated with any medical condition, the prognosis will be good.

Renal glycosuria may result in diabetes mellitus if it is not managed properly.

If properly treated and managed, glycosuria caused by diabetes mellitus will have good outlook and good improvement may be seen. You may avoid complications by eating well, exercising daily and promptly taking medicines.

Glycosuria – Ayurveda understanding

Ikshumeha – Ikshu means sugarcane. Meha means excessive voiding of urine. Since glycosuria is marked by elimination of blood sugar into urine it can be closely correlated to a condition called ikshumeha explained in Ayurveda. Ikshumeha is one of the subtypes of kaphaja prameha. Ikshumeha also translates to closer meaning of glycosuria. Ikshumeha means a condition wherein there is voiding of excessive urine which has the appearance and taste of sugarcane juice.

Kaphaja Meha – Since Ikshu Meha is a type of kapha type of prameha, glycosuria grossly falls under this type of prameha. Glycosuria can also be treated on the lines of treating kapha type of prameha in general and ikshumeha line of treatment specifically.
Read – Lifestyle, Food And Factors That Cause Increase Of Kapha Dosha

Madhumeha – Glycosuria is closely related to diabetes mellitus and hyperglycemia. Diabetes mellitus is compared to madhumeha, a type of vataja prameha. In madhumeha the urine appears and tastes like honey. Improperly managed glycosuria may result in diabetes mellitus. Similarly any type of prameha not treated properly will lead to madhumeha, including ikshumeha. On the other hand glycosuria results from diabetes mellitus. Even from Ayurveda perspective we can consider the association of madhumeha with ikshumeha though madhumeha causing ikshumeha has not been explained in Ayurveda. If in madhumeha the urine still tastes and appearing like sugarcane juice the prognosis might be better. But when the taste and appearance of sugarcane juice in ikshumeha transforms into taste and appearance of honey, the prognosis is bad since at this stage there is more destruction of tissues and aggravation of vata. Treatment principles of madhumeha too shall be adopted in treating glycosuria especially in secondary and complicated glycosuria.

Jata Pramehi – It is a name given to hereditary / inherited prameha mentioned by master Charaka. This condition is considered to be incurable. This condition can be compared to renal glycosuria explained in modern texts.
Read – Appetite And Digestion In Diabetic Patients – An Ayurveda Perspective

Symptoms of Ikshumeha

The person suffering from ikshumeha voids urine which appears and excessively tastes like the juice of sugarcane.

Treatment

Glycosuria can be treated on the lines of –

• Prameha chikitsa – general line of treatment of prameha
• Kaphaja prameha chikitsa – lines of treating kapha type of prameha
• Ikshumeha chikitsa – lines of treating ikshumeha
• Madhumeha chikitsa – lines of treating madhumeha

Ikshumeha and Madhumeha are two different conditions and types of prameha in which there is excretion of sugar in urine – which can be compared with glycosuria. In Ikshumeha the urine is said to be as sweet as sugarcane juice whereas in Madhumeha the urine tastes like honey. But the common thing about both these conditions is the urine carrying sweetness with it. This reflects elimination of excessive sugars from the body.
Read – Prameha: Ayurvedic Approach To Urinary Disorders

Glycosuria vs ikshumeha

Glycosuria can be managed with perfect planning of food and diet, and treatment of primary conditions like diabetes. It can even be prevented. Conditions like gestational glycosuria will revert back after delivery in most cases. Therefore, it is ideal correlate it with ikshumeha. Ikshumeha falls under kapha category of prameha. All 10 kapha prameha are curable as per Ayurveda prognosis. Therefore, with good efforts, ikshumeha may be cured effectively.

Renal glycosuria and secondary glycosuria with complications can be included under madhumeha or jata prameha.

In ikshumeha sugar is present in the urine but most of its variants cannot still be strictly correlated with diabetes mellitus. For glycosuria to be called as madhumeha sugar should be present in abnormal quantities in the blood. We do not have any straight parameter in Ayurveda to access presence of sugar in blood.
Read – Appetite And Digestion In Diabetic Patients – An Ayurveda Perspective

But here we can consider the reference of master Vagbhata –

In madhumeha or all conditions of prameha resulting in madhumeha, sweetness is present in the entire body. According to this reference sugar is also present in blood in madhumeha.

Master Vagbhata’s explanation can be equated with Hyperglycemia with glycosuria. This also marks the differentiation between madhumeha and ikshumeha. In Madhumeha – diabetes mellitus the entire body including blood will carry sweetness which points towards increased blood sugar levels. The blood sugar levels will be more than the renal threshold. In ikshumeha sugar levels are not raised in blood.

Master Sushruta further states –

‘All types of prameha eventually get transformed into Madhumeha when they are not promptly treated. Once this happens the condition becomes incurable’. According to this principle Madhumeha is a condition wherein glycosuria progresses and graduates to form diabetes mellitus. If glycosuria doesn’t progress to form diabetes mellitus or not associated with it, it can simply be correlated with ikshumeha.

Ikshumeha and Alimentary Glycosuria – Glycosuria may be caused due to excessive and regular consumption of foods rich in sugars and carbohydrates. This is called as Alimentary Glycosuria. Excessive consumption of these foods added with sedentary lifestyle practices will increase kapha to abnormal proportions in the body and lead to kapha type of pramehas, mainly ikshumeha. Therefore, ikshumeha can be closely correlated to alimentary glycosuria. If treated promptly it might just be a temporary condition.
Read – Diabetes: Ayurvedic Treatment, Remedies, Prevention Tips

Sanskrit Verses

Types of sugar rich prameha

1. Kapha predominant – occurs due to excessive nutrition (oversaturation) – often due to excessive intake of carbohydrates and sugars in food, is unstable and most often short lived. This condition can be compared to alimentary glycosuria.

But when this condition runs for longer duration, is not treated or diagnosed promptly and when vata gets aggravated being enveloped (avarana) by other doshas – mainly kapha, madhumeha i.e. diabetes mellitus sets in and show features of vata. Even in this condition there will be excretion of sugars through urine. This can be considered as glycosuria developing on the backdrop of or associated with diabetes mellitus.
Read – Lifestyle, Food And Factors That Cause Increase Of Kapha Dosha

2. Vata predominant – occurs due to aggravation of vata which occurs due to excessive destruction of tissues. This condition can be considered due to malnutrition or under-nutrition eventually resulting in tissue damage and loss (dhatu kshaya) subsequently leading to vata aggravation. This will cause voiding of excessive urine having taste and appearance of honey (sweet in nature). This in actual terms is madhumeha or diabetes mellitus. Glycosuria associated with madhumeha can be considered to be a sign of diabetes mellitus or secondary to diabetes mellitus.

Diabetes mellitus caused by mental trauma and stress, loss of strength and immunity shall be considered to be caused by vata and is often associated with under-nutrition.

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