94 



METABOLISM IN SEVERE DIABETES. 



experiment and the loss of weight which such patients usually undergo at once 

 is thus in part explained. Conversely, a gain in weight almost universally 

 accompanies the oatmeal cure. 



That other conditions also play an important role in the storage of water 

 in the body has been shown in our extensive experience with diabetics. It has 

 been frequently found that when diabetics are on a strict diet and are given 

 relatively large amounts of sodium bicarbonate to counteract the ever-present 

 tendency to acidosis, there may be a considerable retention of water and con- 

 sequent increase in body-weight inside of a few days. An abstract of the 

 results with one of the cases (Case A) is given in table 113. The records of 

 the body-weights were made in the early morning before food was taken. 

 Beginning November 6, 20 grams of sodium bicarbonate were given daily, and 

 the results show that while the body-weight, on the morning of November 6, 

 was 49.3 kilos., on the morning of November 11 it had increased to 53.3 kilos., 

 or a gain of 4 kilos. Since at this time the subject was living on a very 

 restricted diet, with barely enough energy in the diet for daily maintenance, it 

 can be seen that this increase must have been due not to the retention of organ- 

 ized body-material, either protein or fat, but simply to water. If the dietetic 

 conditions had been reversed, an equally rapid loss in weight would have been 

 expected, corresponding to the amount of water lost. 



Table 113. Gain in weight of a diabetic with administration of sodium bicarbonate* 



*The proportions of protein, carbohydrate, and fat, as well as total calories, were nearly constant throughout. 



While a knowledge of the fluctuations in body-weight due to the retention 

 or loss of water plays an important role in gaining a correct understanding of 

 the significance of changes in body-weight, we need pay particular attention 

 only to drafts upon organized body-material. Of the four remaining constit- 

 uents of the body the protein, fat, carbohydrate, and the mineral matter 

 the largest addition or depletion can be made in the case of fat. Additions 

 to the protein content of the body are not so easily made as are additions to 

 the fat. Experiments in the laboratory of Professor von Noorden 1 have shown, 

 however, that considerable quantities of nitrogenous material can be stored in 

 the body, but how this is stored and in what form is by no means certain. It is, 

 however, reasonably certain that the protein is not stored in the form of active 

 protoplasmic tissue which necessitates an active metabolism. After the body 

 has been subjected to a fast it seems to have an especial ability to restore the 

 loss of nitrogenous material and even take on a greater amount. While under 



l See Miiller, Zentralblatt f. die ges. Path. u. Pharm. des Stoffwechsels, 1911, 6, p. 617. 



