92 LECTURE V. 



shows that many forms of glucosuria belong in this category. It is not 

 impossible, but on the contrary extremely probable that many of these 

 light forms of diabetes result from conditions similar to those resulting 

 from the diabetic puncture, etc. The only difference here is probably 

 that in the case of the operation we have but a single shock to the system, 

 whereas here there is evidently a permanent irritation of the sugar center. 

 This coincides with the fact that many persons afflicted with the disease 

 are very nervous. 



Between these light forms of diabetes and the more severe types, there 

 are, as we have said, all stages of intermediate types, and not infrequently 

 the former change into the latter. In the first case the disease is not of 

 a very bad character, and appears chiefly in elderly people, producing 

 symptoms which are easily understood, but in the more serious types we 

 are astonished at the severity of the disease. How great the disturb- 

 ance in the carbohydrate metabolism is, may be illustrated by the fact 

 that the elimination of sugar continues even after carbohydrates are 

 entirely withheld from the diet, and the patient eats, for example, only 

 meat and fat. 



Let us now turn our attention to the main symptom of diabetes, the 

 glucohemia. Why does this exist? There are a priori two possibil- 

 ities. On the one hand, the amount of sugar formed may be abnormally 

 large; or, on the other hand, the sugar produced normally may not be 

 consumed as it should be, and thus lies unutilized in the tissues only to be 

 removed finally from the organism as a waste-product. The last expla- 

 nation is really the more plausible; for although we can easily conceive 

 that there mi ht be temporarily an increased formation of sugar, possibly 

 from fat or perhaps from albumin, it is not easy for us to understand 

 how thi cou'.d taLe place continuously. Furthermore, the whole behavior 

 of the patient does not correspond to any such assumption. Fats and 

 albumin agree with him. With their help and the removal of carbo- 

 hydrates from the diet, it is possible greatly to diminish the elimination of 

 sugar. On the other hand, the glucosuria immediately becomes more 

 severe if carbohydrates are fed to the sick. In these severe cases we cannot 

 account for the facts by assuming that the liver has lost its power of storing 

 up sugar in the form of glycogen. The disease continues during a period 

 of fasting, long after all carbohydrates have left the alimentary canal. 



The fact that the liver actually retains its ability of storing up sugar in 

 the form of glycogen is proved by the fact that glycogen has been re- 

 peatedly found in the livers of those who have suffered from severe 

 diabetes. 1 This, however, is not always the case. Sometimes the liver 



1 Cf. Kiihne: Virchow's Arch. 32, 536 (1865). Jafte: ibid. 36, 20 (1866). Kiilz: 

 Pfliiger's Arch. 13, 267 (1876). J. v. Mering: ibid. 14, 274 (1877). Abeles: Zentr. 

 med. Wissensch. 23, 449 (1885). F. Th. Frerichs: Ueber den Diabetes, Berlin, 1884. 



