4 METABOLISM IN SEVERE DIABETES. 



The fundamentally vital conclusion of our first report, i. e., that the 

 metabolism of diabetics was increased above normal somewhat over 15 per 

 cent, was not readily accepted, as was, perhaps, natural, and criticisms of the 

 methods, particularly of the method of comparison of diabetics with normals, 

 were freely made. While we believe that the earlier results showed definitely 

 that our conclusion was well founded, the fact that the criticisms raised were 

 made by a number of excellent workers in the field of metabolism justified our 

 continuing the accumulation of experimental evidence. As a result of this 

 later work, we find ample confirmation of the conclusion drawn from our ear- 

 lier investigations, namely, that the metabolism of diabetics was increased 

 (about 15 per cent) above normal. The criticisms raised by a number of 

 writers with regard to this general thesis are discussed in Part III. 



In our first report the principal subjects considered were the energy trans- 

 formations and gaseous exchange of diabetics. Incidentally evidence was 

 presented regarding the dextrose-nitrogen ratio and the ingestion of food. In 

 discussing the influence of the ingestion of beefsteak upon the metabolism of 

 one of the subjects we were entirely at fault in our statements regarding the 

 dextrose-nitrogen ratio an error that has been clearly pointed out by Lusk. 1 



On the other hand, we see no reason to alter our opinion there expressed 

 that with diabetics the dextrose-nitrogen ratio is at best a very uncertain factor, 

 and unless a rigidly strict carbohydrate-free diet be adhered to for several 

 days, the dextrose-nitrogen ratios have little, if any, significance. Neither do 

 we see any reason for changing our belief that the adherence to a strictly 

 carbohydrate-free diet in severe diabetes during a period of several days is a 

 procedure very much to be questioned. This being the case, the significance 

 of the dextrose-nitrogen ratio for diagnostic purposes has not, we believe, the 

 importance that has been ascribed to it by other writers. 



Plan of Research. 



The original plan of research involved the study of a number of different 

 problems. Of these, the first was the accumulation of further evidence with 

 regard to the increase in metabolism noted with practically all of the diabetics 

 previously studied. The difficulty incidental to a satisfactory comparison of 

 diabetics with normal subjects was pointed out in great detail in the first report, 

 and while we firmly believe that the evidence there set forth showed that on 

 the average there was an increase in metabolism of 15 per cent in diabetes over 

 health, nevertheless plausible arguments could be brought forward indicating 

 that the comparison of diabetics with normal subjects might not be scientif- 

 ically sound or correct. The disproportion between the body-weight and the 

 body-surface of the two classes of subjects, the differences in the kinds of food 

 eaten, the possibility of a larger protein katabolism with diabetics, and the 

 error of drawing deductions from one individual as normal and another indi- 

 vidual as a diabetic are by no means convincing arguments against our thesis; 



'Lusk, Science, Si, p. 433. 



