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July 27, 2005

Hyperglycemia and DKA, Other

Question from San Angelo, Texas, USA:

I went for an employment urine drug screening and got the results yesterday. I was told that I came up positive for alcohol. I do not drink alcohol because it raises my blood sugar. For three days prior to my drug screening, I was out of insulin due to finances. Two days prior to my drug test, my blood sugar got above 500 mg/dl [27.8 mmol/L]. I then tested myself for glucose and ketones. My glucose in my urine registered at 2000 or more and, luckily, my ketones were negative. I got my insulin the next day when my husband got paid as I'm on a pre-existing waiting period and my insurance does not cover any medications. I resumed my insulin regimen immediately. When I got my result yesterday, I was shocked because I do not drink alcohol and am trying to figure out how I came up positive for it. The lady informed me that I had no glucose in my urine at the time. I'm upset because this was a good job and now I may not have the opportunity of getting it for something I did not even do. There aren't many jobs in the area I live. Can you help me figure this out?

Answer:

The ketones and the blood sugar are usually high in a person with poorly controlled sugars, as you would have had without your usual insulin therapy. I would suggest you contact the human services department about this test result. There is always the possibility the specimen was messed up. I would also ask if there are any false positive results with any of the medications you might be taking.

JTL
Additional comments from Galen Mark Eversole, MD, FCAP, MBA:

As a follow up, the questioner had an abnomal urine drug screen for alcohol while the blood sugar was quite high. Increased urinary glucose excretion with bacterial contamination can result in fermentation in the collection container with resultant elevated ethanol results on drug screen.

Galen Mark Eversole, MD, FCAP, MBA
Medical Director, Quest Diagnostics, Rocky Mountain Business Unit
695 S. Broadway, Denver, CO 80209