Diabetes Urine Smell: Why Does It Happen?

Urine has a typical odor, but when it starts to smell different, it can make you take notice. Sweet-smelling urine can be caused by a few conditions, including diabetes, hyperglycemia, or diabetic ketoacidosis.

In this article, we’ll explore reasons why urine might smell sweet and how to know if you need medical attention.

Can Diabetes Cause Urine to Smell?

Diabetes is a condition that leads to higher levels of glucose circulating in the blood. When blood sugar levels get really high, the body tries to find balance in any way that it can, including through the urine. Urine that contains glucose smells sweet because it literally contains sugar. But since that is not a normal route for glucose to leave the body, it’s a sign that diabetes needs medical attention to avoid further health complications.

In addition to sweet-smelling urine, other signs of uncontrolled or undiagnosed diabetes include:

• Unexplained weight loss
• Extreme thirst
• Fatigue
• Appetite changes

Causes of Sweet-Smelling Urine

There are several conditions that can lead to sweet-smelling urine or changes to a normal urine odor. Some people also describe sweet-smelling urine as fruity or syrupy. If you notice changes, consult a medical provider. A simple urinalysis or other lab tests can determine the cause and lead to effective treatment.

Diabetes

Any type of diabetes can result in hyperglycemia, or blood sugar levels that are too high. If you have been diagnosed with type 1 diabetes, type 2 diabetes, or gestational diabetes and you notice sweet-smelling urine, let a medical provider know. If you do not have diabetes, but you notice urine that smells sweet or fruity, you should check in with a healthcare provider. In some cases, people find out that they have type 1 diabetes, an autoimmune disorder, because of changes to their urine smell or frequency.

Diabetes can be diagnosed with simple blood testing or urine testing. The type of treatment that is effective for managing diabetes depends on the type of diabetes you have, your other medical conditions, and how high your blood sugar levels are.

Diabetic ketoacidosis

A serious complication of diabetes, diabetic ketoacidosis can be life-threatening. In some cases, complications from diabetic ketoacidosis, or DKA, are what leads to a person finding out that they have diabetes. Diabetic ketoacidosis occurs when the body runs out of insulin.

Without insulin, cells cannot take glucose into them for energy. As a result of cells being unable to get glucose, the liver starts making more glucose, and eventually starts converting fat into an alternative energy source known as ketones. 

The body has this backup emergency energy system in case glucose or sugar is not available, but ketones increase acidity in the blood. If this acidity level gets to a critical level, it can lead to coma and even death if it is not treated with emergency medical care.

While diabetic ketoacidosis can happen in any type of diabetes, it is most common in type 1 diabetes, when the body becomes unable to make its own insulin. Type 1 diabetes cannot be cured and requires close management of glucose intake and insulin.

Maple syrup urine disease

Maple syrup urine disease is medically known as branched chain ketoaciduria. It is a rare genetic disorder and only occurs when a person receives a mutated gene from both parents. Maple syrup urine disease (MSUD) prevents the body from breaking down amino acids from proteins.

Normal cellular and DNA processes, as well as hormone production and nearly every other physiological process in the body relies on utilizing amino acids. Without amino acids, the body can suffer serious problems, including brain damage and coma.

MSUD is diagnosed in infants via newborn screening methods as well as genetic testing and urinalysis. Signs of maple syrup urine disease in infants include:

• Sweet-smelling urine
• Poor feeding
• Failure to thrive
• Delayed development
• Seizures

MSUD can be treated with intravenous (IV) supplementation of amino acids as well as a specialized dietary plan that is supervised by dietitians and medical nutrition experts.

Medications and supplements

There are many medications and supplements that can cause urine to look or smell different. Some foods can also alter the smell of urine, like asparagus, although that produces a distinct odor that is not sweet. Vitamin B6 supplements may contribute to a sweeter smelling urine, while vitamin B2 (riboflavin) can cause urine to appear neon yellow.

If you have recently started taking any new supplements or medications and notice changes to your urine, check with your healthcare provider. However, if you notice urine changes and have not had recent alterations to dietary intake, medications, or dietary supplements, you should also consult a medical provider.

Dehydration

When the body is properly hydrated, urine can appear anywhere from a pale yellow to a light amber color and should not have a strong odor. If you do not drink enough fluids, it can make urine appear darker and have a more noticeable smell because it is more concentrated.

Urine that appears to be dark amber or even brown can be a sign of dehydration or other problems. If it smells sweet, fruity, or like it has chemicals or ammonia in it, you should check with a healthcare provider. They may suggest drinking more fluids and seeing if it improves over a few hours, or they may recommend some blood tests to check for dehydration or a urinalysis to determine if there is any infection or other problem that is causing the changes.

Yeast infection

Yeast infections are caused by Candida albicans, a fungus that lives in the body. If it starts to overproduce or is not kept controlled by the immune system, it can lead to a vaginal yeast infection. However, yeast can also lead to infections elsewhere in the body.

While yeast infections do not change the smell of urine, they can cause vaginal discharge or cervical mucus to have a sweeter smell, which can make it seem like urine smells sweet. A yeast infection scent often smells sweet like bread, beer, or honey. Along with a sweet smell, yeast infections may also cause symptoms like vaginal itching, burning, redness, irritation, and discharge that may look white, thick, or have a cottage cheese appearance. It is also possible to have a yeast infection without noticeable discharge.

Vaginal yeast infections can typically be treated with over-the-counter antifungal creams or medicines. However, even if you suspect that you have a yeast infection, check with a medical provider. Symptoms of yeast infections can overlap with other conditions. People who have chronic disorders or are immune compromised may also have trouble clearing yeast or other fungal infections, and may require prescription strength treatment.

When to Seek Medical Attention for Urine Odor

Changes to urine odor do not always last or indicate a problem. However, in many cases, slight changes to urine scent can be a sign of a health problem. By letting your medical provider know, you can get testing and have possible causes ruled out.

Let a healthcare provider know if you have changes to urine smell or appearance that last for more than a few days, or sooner if you have any other symptoms, such as:

• General feelings of unwellness
• Fatigue
• Urinary urgency or frequency
• Burning or pain when urinating
• Blood in the urine
• Lower abdominal pain
• Mid or lower back pain
• Unexplained weight changes
• Mental confusion

People who have HIV, AIDS, cancer, or other serious immune problems should get emergency medical care as soon as they notice sweet-smelling urine.

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