98 



METABOLISM IN SEVERE DIABETES. 



us or at death. From these the loss in body- weight has been computed, as 

 well as the percentage loss. It is seen that in these cases the loss in body- 

 weight varied from 5.4 to 48.3 per cent of the initial highest body-weight, with 

 an average loss of 22.7 per cent. It is thus clear that a large percentage loss 

 in body-weight is almost regularly observed in severe diabetes. 



On some 200 cases taken from several hundred in the practice of one of us 

 (E. P. J.) we have likewise computed the percentage loss in body-weight, 

 using the highest and minimum body-weights observed. These are given in 

 table 116. It so happens that the maximum percentage loss observed in these 

 200 cases (that of Case No. 3, an excessively fat individual) was but slightly 

 greater than that observed in our Case R, who had an initial body-weight 

 essentially one-half that of Case No. 3. We have also computed the loss in 

 weight experienced by these patients before being seen by E. P. J. as an index 

 of the degree of emaciation which patients usually reach before coming under 

 special treatment for diabetes. It should be borne in mind that these losses in 



Table 115. Comparison of body-weights of subjects in health and disease. 



Subject. 



Greatest 

 body- 

 weight 



in health. 



Minimum 

 weight 



Loss in 

 body 



observed, weight. 



kilos. 



Average . 



49. 



38. 



51. 



34 



57. 



50. 



35.8 



58.3 



51.7 



62.3 



kilos. 

 11.6 

 11.5 



2.9 

 32.2 

 13.6 

 20.6 

 17.3 



5.2 

 11.8 

 28.4 



Per cent 

 loss of 

 original 



best 

 weight. 



p. ct. 

 19.1 

 23.0 



5.4 

 48.3 

 19.1 

 28.9 

 32.6 



8.2 

 18.6 

 31.3 



22.7 



weight of diabetic patients are not necessarily the result of a sudden change in 

 1 or 2 weeks, but usually extend over a period of several months; the only 

 inference that can be drawn is that patients undergoing such losses in body- 

 weight are prone to delay dietetic treatment too long. 



The gains in weight of diabetics noted on the administration of sodium 

 bicarbonate or following a change in the diet with the ingestion of large amounts 

 of carbohydrate in the form of oatmeal may be and probably are due wholly to 

 the variations in composition of the water-content of the body; hence such 

 gains are not to be considered as additions to organized body-tissue. The 

 tendency of optimistic patients to consider the gain in weight of a pound or 

 more as an advantageous sign must, in certain instances at least, be dispelled 

 by the attending physician, who should explain that the change in body- weight 

 is probably due to a change in the water-content of the body, and in some cases 

 can demonstrate this by calling attention to the appearance of edema. With 

 the diabetic cases, therefore, we have practically two fundamentally different 

 alterations in body-weight to be considered : first, an initial rapid loss in weight 



