452 V. BLOOD LIPIDS 



fast day amounted to 20.65, 19.15, 13.88, 9.96, and 6.68 g., respectively. 408 

 In one case the CCVcombining power of the blood was decreased to 26.9 

 volume per cent on the fourth fast day. 408 



There is no entirely satisfactory explanation to account for the precipi- 

 tation of an acidosis. Peters and Van Slyke 202 do not attribute the appear- 

 ance of ketosis to overindulgence in carbohydrate. Some factor which 

 reduces the ability of the individual to burn sugar is the most important 

 underlying cause. The recent report of Mirsky et aZ. 618 demonstrates 

 that both carbohydrate and insulin are necessary to counteract the inci- 

 dence of ketosis. When smaller doses of insulin were given to patients 

 than were required to control their glycosuria, together with large doses of 

 carbohydrate, ketosis disappeared, although an increased glycosuria ob- 

 tained. On the other hand, when the insulin was given without the carbo- 

 hydrate, ketosis increased. Finally, when insulin was omitted and carbo- 

 hydrate was given, the ketosis could not be controlled, except in a few cases 

 in which the carbohydrate intake was very high. These results prove that 

 sugar is required to alleviate the ketosis, together with insulin. Either 

 by itself is ineffective. Presumably the ingested sugar functions in the 

 presence of insulin, not only to provide carbohydrate for combustion, but 

 also to serve as a precursor for replenishing the stores of glycogen in the 

 liver. 



(e') Lipidoses in Diabetes Mellitus. — Several types of abnormal lipid 

 deposition are frequently associated with diabetes. The two commonest 

 types of lipidoses are called xanthomatosis and lipemia retinalis. They 

 usually occur when a marked hyperlipemia is present. 



a". Xanthomatosis: In this condition, fatty nodules appear on the skin, 

 chiefly on the eyelids. The condition is frequently known as cutaneous 

 xanthomatosis. In the cases of this disease studied by Yamakawa and 

 Kashiwabara, 619 the cholesterol and neutral fat in the serum were three 

 times the normal value, and the phospholipid was slightly elevated. 

 Rosen and Krasnow 620 likewise reported a hypercholesterolemia, as well 

 as a hyperphospholipidemia, in this condition. In xanthomatosis, large 

 amounts of free and esterified cholesterol were present in the tumors, but 

 practically no phospholipids. 619 



Xanthomas occur in diabetes associated with hyperlipemia. How- 

 ever, the hyperlipemia per se is not the sole cause of the condition, since 



618 I. A. Mirsky, A. N. Franzblau, N. Nelson, and W. E. Nelson, J. Clin. Endocrinol, 

 1, 307-313(1941). 



619 S. Yamakawa and M. Kashiwabara, Tdhoku J. Exptl. Med., 3, 317-332 (1922). 

 620 1. Rosen and F. Krasnow, Arch. Dermatol. Syphilol, 26, 48-55 (1932). 



