FATTY DIABETES 269 



spare the proteins of the body and in this way lessen the 

 sugar elimination at times in diabetics 67 is easily appreci- 

 able; as, too, the fact that an influence tending to cause 

 tissue break-down, as exposure to Bontgen rays, is likely 

 to occasion an increase in the glycosuria in diabetes. 68 



There seem to be times when aminoacids pass into the 

 urine in diabetes in increased amount; but little certain 

 knowledge is had of this phenomenon. 69 



While to a certain extent toxic protein decomposition 

 in human diabetes is, from what has been said, a matter of 

 minor importance, the fat breakdown often dominates the 

 general situation. This is really, as far as we can readily 

 appreciate, what is actually meant when we are forced to 

 say that the body must finally draw on some source to cover 

 the necessary requirements for energy-production; if the 

 sugar is eliminated unconsumed, if the tissue protein is 

 preserved from destruction, and if the food protein is insuf- 

 ficient, there is nothing else left the body to draw upon 

 except its stores of fat. Many writers are inclined to 

 accept a possibility of sugar being formed from fat in 

 severe diabetes. 70 Later, in connection with acidosis in 

 relation to fat decomposition, this subject will be more fully 

 reverted to. 



Brief reference should be made at this point to the rela- 

 tionship of obesity to diabetes. Very frequently in litera- 

 ture a "lipogenic diabetes " (diabete gras of the French) 

 is spoken of. C. v. Noorden 71 has suggested a very 

 plausible idea in this connection, that there exists a form of 

 masked diabetes in which the sugar does not pass into the 

 urine even though the capacity for sugar combustion is 



67 H. Benedict and B. Torok, Zeitschr. f . klin. Med., 60, 329, 1906. 



68 P. Menetrier and A. Touraine, Arch. Maladies de Coeur, 5, 641, 1910. 



68 P. Bergell and F. Blumenthal, Zeitschr. f. exper. Pathol., 2, 413, 1906; 

 L. Mohr, ibid., 2, 665, 1906. 



70 Cf. E. Grafe and Ch. G. L. Wolf (Med. Clinic, Heidelberg), Deutsch. 

 Arch. f. klin. Med., 107, 201, 1912. 



71 C. v. Noorden, Handb. d. Pathol. d. Stoffwechs., 2d ed., 2, 25-26, 1907. 



