November 26, 2002
Diagnosis and Symptoms
Question from New York, USA:
My husband recently had a routine physical during which he had a high bilirubin (2.56 mg/dl), and his urine was cloudy with a trace of ketones. I know that the presence of ketones is suggestive of not having enough insulin since my father-in-law has diabetes, but I didn’t know if the bilirubin was another indicator of possible diabetes, since it has more to do with the liver. Do these factors indicate that my husband is most likely developing diabetes?
The cloudy urine appearance does not mean anything, as long as he doesn’t have cells or sediment in his urine. This would have come out in the rest of the report if that were the case. We can probably relax about that issue. The ketones in the urine can occur in anyone who fasts for a long time. This, by itself, does not mean diabetes. Finally, the mild elevation in the bilirubin does not mean he is likely to have diabetes. A very large proportion of the population has an abnormality in an enzyme that metabolizes bilirubin. It is called Gilbert’s syndrome and has no major medical consequence. I would not worry about this. Nothing you have mentioned puts your husband at increased risk for diabetes.