Because your heart is a muscle the more you exercise it it gets

STRONGER would be your answer

Dialect is probably part of the answer

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.