FACTORS ALTERING CONCENTRATION OF BLOOD LIPIDS 449 



reducing both cholesterol and lipid P in hypercholesteremic diabetics. 



Another suggestion as to the cause of the hyperlipemia in diabetes is to 

 the effect that a greater than normal lipemic reaction may occur on the 

 ingestion of fatty meals. Abnormal responses were reported by Bing and 

 Heckscher, 610 and by Hatakeyama et a 7 ., 611 but they were not obtained by 

 Blix 255 or by Man. 533 Hatakeyama and collaborators 611 also assume that 

 hyperlipemia in diabetes may be traced to diets high in fat and low in car- 

 bohydrate. Freyberg et al. 602 deny that, in modern methods of treatment, 

 the diets used cause a consistent and a constant hyperlipemia. 



Although hyperlipemia is a constant concomitant of acidosis, many 

 causes of hyperlipemia have been reported in which no acidosis could be 

 demonstrated. In the cases of diabetic patients not suffering from acidosis, 

 reported by Man and Peters, 607 24% of the 79 patients presented hyperli- 

 pemia, evidenced by hypercholesterolemia. After an examination of the 

 patients, these authors suggest that lesions of the l^pothalamus may ac- 

 count for the instability of the autonomic system, and for the hyperlipemia. 



(c') Diabetic Acidosis and Hyperlipemia. — When carbohydrate cannot 

 be metabolized, as occurs in diabetes, or when the supply of carbohydrate 

 is exhausted, as a result of fasting, the body must fall back on fat and 

 protein as sources of its energy. In the absence of carbohydrate oxidation, 

 the fatty acids derived from the neutral fat and from certain amino acids 

 fail to be utilized completely, leaving intermediate acids in the blood 

 stream. These acids result in the production of the so-called diabetic 

 acidosis. 



The condition of diabetic acidosis is brought about when the rate of pro- 

 duction of these intermediate acids is sufficient to result in a reduction of 

 the alkali reserve of the blood. The ketone body acids are acetoacetic 

 (or diacetic) acid, CH 3 COCH 2 COOH, and /3-hydroxybutyric acid, 

 CH 3 CHOHCH 2 COOH. Acetone, CH 3 COCH 3 , is formed in this series 

 of reactions. For this reason, these three components (the two acids and 

 acetone) are referred to collectively as the ''acetone bodies" or "ketone 

 bodies." The appearance of these products in the blood is described as 

 a "ketosis," while their appearance in larger than normal amounts in the 

 blood is known as a "ketonemia." When the ketone bodies are excreted 

 in the urine, the condition is called a "ketonuria" or an "acetonuria." 



The state of acidosis develops because the diacetic and /3-hydroxybutyric 

 acids remove the fixed bases (sodium and potassium) from the blood. The 



610 H. I. Bing and H. Heckscher, Biochem. Z., 149, 83-99 (1924). 



611 T. Hatakeyama, K. Takahashi, Y. Tutumi, and K. Yamazaki, Biochem. Z., 300, 

 392-402, 403-413 (1938-1939). 



