6 METABOLISM IN SEVERE DIABETES. 



seemed important to verify this observation, if possible, by further evidence; 

 hence a number of experiments are here included in which beefsteak was 

 ingested. 



Our earlier experiments also suggested that during severe acidosis, when 

 the patients were clinically in the worst condition, there was a higher meta- 

 bolism. The relationship between the acidosis and metabolism was by no 

 means clearly established or, indeed, recognized in our earlier report, but as 

 these investigations progressed, it became desirable to make a particular study 

 of the relationship between the degree of acidosis and the total metabolism. 

 This has been given a special and prominent part in the later research, and 

 the relationship between the degree of acidosis and the total metabolism has 

 proved to be one of the most interesting points in this study. 



It was possible so to adjust the diet of the diabetics as to secure with the 

 same subject degrees of acidosis varying from very severe to very light; hence 

 we have here an opportunity of comparing the metabolism of a diabetic with 

 a severe acidosis with his metabolism when without an acidosis. This has 

 proved to be a great advantage, since the results obtained are more strictly 

 comparable than those obtained when comparing the metabolism of a diabetic 

 with a severe acidosis with that of a normal subject without acidosis. 



The general plan of the research as outlined in the preceding pages was 

 that upon which the year's work was based, but it became clear as time went 

 on that the program must be so restricted as to settle absolutely one or two 

 fundamentally important points rather than to attempt to secure conclusive 

 evidence on so many different phases of the question as are here outlined. 

 While it was thoroughly practicable to secure evidence with regard to the 

 increased metabolism during different degrees of severity of diabetes, and while 

 the relationship between the severity of diabetes and the metabolism began to 

 be strikingly apparent, nevertheless, for experiments on the ingestion of oat- 

 meal, carbohydrates, and beefsteak, both a certain type of case and a certain 

 type of experimental plan were necessary. For this reason it was more diffi- 

 cult to secure patients for this series of experiments than for a study of the gen- 

 eral and broader questions ; hence, while a considerable amount of data has 

 been accumulated on the points here raised, we do not presume in this report 

 to discuss in any way the questions with regard to the influence of the inges- 

 tion of food, the dextrose-nitrogen ratio, the influence of the ingestion of car- 

 bohydrates and sugars upon the positive carbohydrate balance, and similar 

 questions, except in a very general way incidental only to their effect upon the 

 question of the relation between the severity of the diabetes and the general 

 metabolism. On the other hand, it seems desirable to present in this report 

 all of the statistical data for the experiments thus far made, so as to make them 

 available for clinicians and for scientists interested in metabolism during dia- 

 betes. A complete discussion of the data, together with additional material, 

 will be given in a subsequent publication. 



Consequently the final plan of work considered in this report will be first, 

 the evidence with regard to the increased metabolism during diabetes; second, 



