DR. PAVY AND DIABETES 43 



is observed in its severest form in man. The view is being 

 forcibly expressed that the production of sugar in the body 

 is an independent variable, determined, it may be, by the 

 activity of specialised organs. 



Temporary Glycosuria. The Latest Theories of Diabetes 



No one who has any acquaintance with metabolism can 

 doubt that the normal utilisation of sugar is a process of a 

 nicely balanced nature which an extraordinary number and 

 variety of events can upset. Even the normal man has his limit 

 of tolerance for sugar and the degree of tolerance can be easily 

 modified. Temporary glycosuria may appear during many 

 departures from health which have nothing to do with diabetes. 

 It is induced by psychic strain or shock, by critical physiological 

 events, such as pregnancy, even by sudden exposure to cold. 

 It often follows as a secondary effect from the action ol certain 

 drugs on the body. But a condition of glycosuria which has 

 received special attention of late is that associated, not with the 

 absence or depression of an organic function but rather with 

 the hyper-functioning of certain organs ; in particular, of the 

 thyroid, adrenal and pituitary bodies. I must not stop here to 

 consider the evidence for this association. I can only point out 

 that the facts have led to the conception that the normal 

 equilibrium of carbohydrate metabolism involves a balance 

 between factors, such as the activity of the glands just mentioned, 

 which are concerned with the " mobilisation " of sugar and 

 factors, such as the pancreatic function, which are concerned in 

 its utilisation. The balance may be upset from either of two 

 sides. The mobilisation of the sugar may be too rapid for 

 normal utilisation processes to deal with it or the power to 

 utilise it may diminish and so fail to cope with the normal 

 supply. In either case, glycosuria results and may be intensified 

 in certain cases, when there is at once over-production and 

 under-utilisation. 



This conception, for which the school of Von Noorden is 

 chiefly responsible, is at once the latest addition to our views 

 upon normal carbohydrate metabolism and the basis ol the 

 most recent theory of diabetes. 



It is one of great interest but it cannot be said to be upon a 

 firm foundation yet. Although it is beyond question that the 

 internal secretions of the ductless glands just mentioned affect 



