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One of the most common diseases associated with glucose and ketones in the urine is Diabetes mellitus.

Normally glucose in the blood is filtered and fully reabsorbed by the kidney so that no glucose appears in the urine. In diabetes mellitus, blood glucose is so high that an excessive amount of glucose is filtered -- so much so that the kidney cannot fully reabsorb it. Consequently, the excess glucose winds up in the urine, a condition called glucosuria.

In normal individuals, blood glucose is kept at a stable level by the actions of insulin. When insulin is present and the body's cells are sensitive to it, glucose from the blood is taken up by the cells, decreasing blood glucose. In diabetes mellitus, however, either insulin is not present, or the body's cells are insensitive to it. Consequently, the cells do not take up glucose. As glucose is one of the cell's major substrates for energy, the cell must use alternative measures to generate energy. One of the major mechanisms is through the metabolism of fats. One of the produces of fat metabolism is a molecule called acetyl CoA, which can be further metabolized to form energy. But in fat metabolism, so much excess acetyl CoA is produced that it overwhelms the enzymes that convert it into energy. As a consequence, the excess acetyl CoA is shunted to alternative pathways that take care of it. One of the pathways is the production of ketone bodies. As a result, ketone levels rise and ultimately can end up in the urine just as glucose did, as described above.

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