CONCLUSIONS AS TO ORIGIN FROM FAT 245 



satisfied by some other material. Other things being equal 

 it is, always easy to force the other three foods into metab- 

 olism by increasing their assimilation, ; but this is impossible 

 in the case of fat. Increased combustion of fat occurs in the 

 diabetic animal, which is kept on protein and fat alone, only 

 when protein is withdrawn. As a given degree of lowering of 

 protein exchange is followed by a decrease in sugar, so some 

 degree of increase of sugar elimination would be entirely 

 covered after increased fat combustion." In this connec- 

 tion it may be stated that (as in a case of very severe diabetes 

 in v. Noorden's clinic 64 ) after administration of large 

 amounts of fat an enormous sugar elimination has been ob- 

 served, the sugar-nitrogen ratio (D|N) reaching the extra- 

 ordinary height of 10. Falta, in his valuable efforts to es- 

 tablish the rules of sugar elimination in diabetes mellitus, 

 came to the conclusion that many facts of the pathology of 

 metabolism are entirely inexplicable without the assumption 

 that sugar may be formed from fat, and that the evidence in 

 favor of this has been distinctly enlarged by his own and his 

 associates ' investigations. 65 



The question of sugar formation from fat today is in 

 about the following status : that it has not been absolutely 

 proved, but has on the other hand not been disproved or 

 even become improbable. Magnus-Levy 66 very properly 

 suggests that the body, as shown by all experiments in spon- 

 taneous and experimental diabetes, has a relentless need for 

 carbohydrates which it tries to satisfy under all circum- 

 stances. For this end the carbohydrate supply in the body 

 first comes in question; thereafter the formation of sugar 

 from protein ; and only in the third place the formation of 

 sugar from fat. If, however, the position be taken (and 



64 S. Bernstein, C. Bolaffio, v. Westenrijk (v. Noorden's Clinic, Vienna), 

 Zeitschr. f. klin. Med., 66, Heft. 5/6, 1908; cf. also W. Falta and A. Gigon, 

 Zeitschr. f. klin. Med., 65, 326, 1908. 



66 W. Falta (v. Noorden's Clinic), Zeitschr. f. klin. Med., 66; separate, p. 

 7, 1908. 



66 A. Magnus-Levy, Noorden's Handb., 2d ed., 1, 179, 1906. 



