Irvine McQuarrie 421 



enced a severe insulin reaction and his rccjuircment lor insulin steadily de- 

 clined thereafter from 115 to 55 units per day while the extra salt was being 

 given. Wilder's experience led him to believe that smaller doses of NaCl were 

 effective in some cases of diabetes. He concluded that the special usefulness of 

 the procedure would be found principally in the management of patients with 

 relative insensitivity to insulin. Insulin requirements were reduced signifi- 

 cantly in a number of his cases so treated. Sanstead^^ reported lowering of the 

 fasting blood sugar in all of eight adult male diabetics to whom he gave from 

 10 to 90 gm. of NaCl daily. Ingestion of the added salt made it possible to 

 either reduce the insulin dosage or increase the diet of these patients. 



In a more recent therapeutic trial of the procedure, Strouse and co-workers'^^ 

 reported very variable results when they gave twelve adult diabetics 20 to 30 

 gm. of NaCl daily supplementary to their ordinary diabetic diets (presumably 

 with high K content). They reported that in any one patient administration 

 of NaCl was followed at one time by decreased glucose excretion and at an- 

 other by increased excretion. One juvenile diabetic given a special diet with 

 fairly low K content for 5 days showed no significant decrease irj glycosuria. 

 Because their patients complained of nausea, however, these authors gave 

 much smaller amounts of NaCl than those given by most of the previous work- 

 ers. Similar variability in results followed administration of KCl. One de- 

 pancreatized dog showed a decrease in glucose excretion from 26.2 gm. (average 

 for 5 control days) to 12.4 gm. per day (average for 7 experimental days), when 

 the Na intake was increased by 3.96 gm. daily. In a second depancreatized 

 dog, showing spontaneous decreases in glucose excretion dtning the course 

 of the experiment, extra NaCl appeared to decrease glycosuria in one experi- 

 ment and to increase it in another. Experiments on a depancreatized goat fed a 

 diet of sucrose and alfalfa, containing 7.8 to 10 gm. of K daily, showed no effect 

 when 2.5 to 3 gm. of Na was given daily. Glycosuria remained fairly marked 

 and the blood sugar was high. This negative effect of NaCl in the presence of 

 so much K in the diet would be expected in view of data presented above. From 

 their variable results these observers concluded that "changes in carbohydrate 

 metabolism which follow ingestion of Na or K chloride cannot be explained 

 as a result of the mere addition of these salts to the dietary intake." 



Further light has been thrown on the role of NaCl in carbohydrate metab- 

 olism by experimental studies concerned with the effects of deficiency of this 

 salt on carbohydrate tolerance. Michelson^" reported that high blood-sugar 

 values accompanied the NaCl deficiency produced by diuretin. McCance"" later 

 found that five normal human subjects, maintained on NaCl-deficient diets 

 and exposed to profuse sweating, exhibited impaired glucose tolerance. The 

 fasting blood samples, as well as those taken at 30, 60, 90, and 120 minutes 

 after ingestion of 50 gm. of glucose, showed consistently higher glucose values 

 than did normal control subjects. Aldersberg and Wachstein"' observed a pro- 

 found sweeping out of NaCl in experimental animals after complete pan- 

 createctomy and concluded that the pancreas normally controls CI metabolism. 



