Mark used to really enjoy the feeling and experience he got from cocaine, but now it no longer brings him pleasure. Yet he keeps using because he finds he has to just to help him feel normal and keep him from getting withdrawal symptoms. Mark has reached a state of .

Wearing a condom or wear protection

You can write out the letter, but it should specify: the patient hasn't been controlling their diabetes bc glucose and ketones spilling into the urine. also, the positive nitrite could indicate a u.t.i. infections can cause hyperglycemia in a diabetic. also the reverse, uncontrolled blood sugar can lead to glycosuria, which is a good nidus for bacteria to grow from sugar in urine, leading to a uti.