DISCUSSION OF RESULTS AND GENERAL CONCLUSIONS. 123 



light cases, nevertheless there is a serious objection to this form of comparison 

 owing to the fact that we have so few light cases. If, however, we examine the 

 figures in table 120, we see that if Case M be omitted the carbon-dioxide pro- 

 duction is still lower with the two remaining cases than the average value for 

 the severe cases. Similarly, if the low oxygen consumption of Case M be omitted 

 in table 123, the average oxygen consumption with severe cases is greater than 

 with any of the moderately severe cases; hence it seems perfectly justifiable 

 to state that the more severe the case, the greater the intensity of the meta- 

 bolism. Thus the experimental evidence seems to justify fully our earlier con- 

 tention to this effect. 



A Comparison of the Metabolism of Fasting Diabetics under 

 Varying Conditions as to the Intensity of the Acidosis. 



As was pointed out in the earlier report, there was a period in the history of 

 Case A when he was apparently in a much more serious condition than at any 

 other time. During this period the evidence was clear that both his meta- 

 bolism and pulse-rate were considerably higher than at other times. This 

 suggested a relationship between metabolism and the degree of severity of the 

 diabetes, a suggestion that was emphasized and accentuated by the fact that 

 the whole group of subjects with severe diabetes indicated a higher metabo- 

 lism than did those with light diabetes, although admittedly the number of 

 the latter was too few for us to draw any definite deductions. 



In the new cases here reported at least two gave indications of a markedly 

 different severity of the disease within a very short period of time, and these 

 fluctuations in severity occurred during the experimental period at the labora- 

 tory. Both cases were boys. With Case N it was noted that on days fol- 

 lowing green days the metabolism was high, there was a higher excretion of 

 0-oxybutyric acid, the pulse-rate was high and the alveolar carbon-dioxide 

 tension was low. On days following oatmeal days, on the other hand, the 

 metabolism was distinctly lower, the pulse-rate lower, and the alveolar carbon- 

 dioxide tension was higher. The results with this case were, however, com- 

 plicated by an uncertainty as to whether there was not a surreptitious inges- 

 tion of food ; since the ingestion of food per se would stimulate metabolism, it is 

 uncertain whether the high metabolism experienced on certain dates was due to 

 the severity of the disease or to the previous ingestion of food. Nevertheless 

 the other evidence, particularly the carbohydrate balance, is of material assist- 

 ance in determining whether or no food was ingested prior to coming to the 

 laboratory, and we believe that for the two days here cited there is reasonable 

 ground for belief that the actual conditions of metabolism were not compli- 

 cated by the previous ingestion of food. The results are given in table 133. 



On November 30 to December 1 the acidosis was severe; the /3-oxy butyric 

 acid, which was fortunately determined on that day, amounted to 35 grams, 

 with a minus carbohydrate balance of 25 grams; the oxygen consumption was 

 179 c.c. with a pulse-rate of 75 and a carbon-dioxide tension of 17 mm. On 

 December 1 the subject had an oatmeal day, and on December 2 to 3, the dia- 



