122 



METABOLISM IN SEVERE DIABETES. 



est to note that the relatively few light cases of diabetes show essentially the 

 same carbon-dioxide production as the normal subjects, with a slightly greater 

 oxygen consumption. This difference in oxygen consumption may easily be 

 explained by the fact that the number of cases studied was altogether too few 

 from which to draw deductions. If we compare the values for the severe cases 

 of diabetes with those for the mild cases, we find that both the carbon-dioxide 

 excretion and the oxygen consumption were materially less with the moderately 

 severe and the light cases of diabetes than those with the severe cases. As 

 pointed out earlier, however, they are in large part affected by the very low 

 values found with Case M. 



Comparison of the Metabolism of Diabetics with Varying 



Degrees of Severity. 



The observations made in our earlier publication indicated that there was 

 a tendency for the metabolism to increase pari passu with the severity of the 

 diabetes, but this inference was based upon slight experimental data, the num- 

 ber of cases of light diabetes being very few. Similarly, in connection with the 

 new experiments, we find a difficulty in drawing a careful deduction on this 

 point, owing to the fact that we still have so few observations upon cases of 

 light diabetes. A comparison of the carbon-dioxide production and oxygen 

 consumption per kilogram of body- weight per minute, as well as the respiratory 

 quotient, with both severe and light cases, is, however, of interest. These com- 

 parisons are given in table 132. 



Table 132. Comparison of the metabolism of diabetics with varying degrees of severity. 



It is obvious that with the severe cases there was a greater intensity of 

 metabolism as indicated by an increased carbon-dioxide production and an 

 increased oxygen consumption. On the other hand, there was a lower respira- 

 tory quotient, indicating a consumption of fat with a minimum consumption of 

 carbohydrates; with the moderately severe and light cases there is a slightly 

 increased respiratory quotient, corresponding to the slightly greater carbo- 

 hydrate tolerance. A critical examination of these figures and the tables from 

 which they are drawn, namely, tables 119 to 127, shows that the values for the 

 moderately severe and light cases are enormously affected by the very low 

 values for both carbon dioxide and oxygen found with subject M, who was dis- 

 tinctly fat. While, therefore, the original contention may be made that in severe 

 diabetes a somewhat higher metabolism is shown than in moderately severe or 



